Opioid overdose and mortality have increased at an alarming rate prompting new public health initiatives to reduce
drug poisoning. One initiative is to expand access to the
opioid antidote naloxone.
Naloxone has a long history of safe and effective use by organized healthcare systems and providers in the treatment of
opioid overdose by paramedics/emergency medicine technicians, emergency medicine physicians and anesthesiologists. The safety of
naloxone in a prehospital setting administered by nonhealthcare professionals has not been formally established but will likely parallel medically supervised experiences.
Naloxone dose and route of administration can produce variable intensity of potential adverse reactions and
opioid withdrawal symptoms:
intravenous administration and higher doses produce more adverse events and more severe
withdrawal symptoms in those individuals who are
opioid dependent. More serious adverse reactions after
naloxone administration occur rarely and may be confounded by the effects of other co-intoxicants and the effects of prolonged
hypoxia. One component of the new
opioid harm reduction initiative is to expand
naloxone access to high-risk individuals (addicts, abusers, or patients taking high-dose or extended-release
opioids for
pain) and their close family or household contacts. Patients or their close contacts receive a
naloxone prescription to have the medication on their person or in the home for use during an emergency. Contacts are trained on overdose recognition, rescue breathing and administration of
naloxone by
intramuscular injection or nasal spraying of the injection prior to the arrival of emergency medical personnel. The safety profile of
naloxone in traditional medical use must be considered in this new context of outpatient prescribing, dispensing and treatment of overdose prior to paramedic arrival. New
naloxone delivery products are being developed for this prehospital application of
naloxone in treatment of
opioid overdose and prevention of
opioid-induced mortality.