Naloxone for Opioid Overdose

A recent article in the New York Times lamented the limited availability of the opioid antagonist naloxone (Narcan, and generics) to treat opioid overdose, especially since heroin seems to be making a comeback and OxyContin continues to be widely abused. Naloxone can reverse CNS depression and respiratory depression. Its main drawback is that it may precipitate acute opioid withdrawal with severe agitation and vomiting. Acute opioid withdrawal is associated with anxiety, piloerection, yawning, sneezing, rhinorrhea, nausea, vomiting, diarrhea and abdominal or muscle cramps, which may be uncomfortable but are rarely life-threatening.

Available only by prescription in injectable formulations, naloxone is not usually included among the supplies given to emergency medical technicians (EMTs), who are often the first responders to reports of opioid overdose. Some authors have argued that it should be available not only to all the medical personnel that may be involved in caring for these patients, but also to the opioid users themselves and their significant others. An article this year in the Annals of Internal Medicine from the National Institute of Allergy and Infectious Diseases (January 1, page 1) estimated that distributing naloxone kits to appropriate laymen would very likely reduce overdose deaths and would be cost-effective, even under the most conservative assumptions.

Others have lamented the absence of naloxone formulations that could be administered more easily by laymen (SB Leavitt, Practical Pain Management, October, 2010). Administration of naloxone intranasally would be an off-label use of the drug, but it has been tried in some areas in the US, notably in one demonstration project in North Carolina called Project Lazarus. The cost of the kit used in Project Lazarus, which included 2 prefilled syringes (2 mL each) and an atomizer tip, was estimated to be $25. That certainly seems to deserve more attention than it has received to date.

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Comments

  1. Hello sir,
    Thank you for your nice posting.Available only by prescription in injectable formulations, naloxone is not usually included among the supplies given to emergency medical technicians (EMTs).
    Thanks……

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