UMEM Educational Pearls

Title: Intranasal administration of naloxone for suspected opioid overdose

Keywords: intranasal naloxone, opioid overdose, reversal (PubMed Search)

Posted: 6/19/2019 by Hong Kim, MD, MPH
Click here to contact Hong Kim, MD, MPH

Naloxone distribution programs have been expanding to promote the naloxone adminstration by laypersons, usually intranasal (IN) device, to victims of opioid overdose. A recent study analyzed the reports of prehospital naloxone administration reported to a regional poison center.

1139 cases of prehospital naloxone administrations were identified between 2015 and 2017.
98.2% had ventilatory depression
97% were unresponsive
Law enforcement officers administered 91% of the naloxone, 97.9% via IN route

Opioid toxicity revesal:

Opioid-induced ventilatory or CNS depression was reversed in 79.2% after administering a mean naloxone dose of 3.12 mg.
EMS administered additional naloxone (mean dose: 2.2 mg) to 291 due to lack of or partial reversal of opioid toxicity.
254 out of 291 (92.4%) regained normal/improved mental and ventilatory status.
95.9% of the overdose victims survived.

However, between 2015 and 2017, the reversal rate decreased (82.1% to 76.4%) while mean administered naloxone dose increased (2.12 mg to 3.63 mg). The cause of this trend is unknown but the dose of commercially available IN naloxone kit increased from 2 mg to 4 mg in 2016.

Bottom line:

IN naloxone administration is an effective intervention to reverse opioid toxicity.
However, larger naloxone doses were administered between 2015 and 2017 while the reversal rate decreased.
It is essential for bystander/witness of overdose to notify EMS as overdose victims may require additional naloxone administration/medical attention.

References

Mahonski SG et al. Prepacked naloxone administration for suspected opioid overdose in the era of illicitly manufactured fentanyl: a retrospective study of regional poison center data. Clin Toxicol 2019.

https://doi.org/10.1080/15563650.2019.1615622