Citation

Jauncey M, Bartlett M, Roxburgh A. Addiction 2022; ePub(ePub): ePub.

Copyright

(Copyright © 2022, John Wiley and Sons)

DOI

10.1111/add.15887

PMID

35388569

Abstract

The expansion of naloxone availability has been critically important in responding to increasing opioid overdose deaths in several countries over the past decade. [1-3]. Naloxone is a life-saving medicine that blocks the effects of opioids. It works rapidly, but temporarily, to reverse overdose. [4] There has been growing interest in intranasal (IN) naloxone products designed to increase ease of administration and therefore likelihood of use, along with the benefit of reduced risk of needlestick injury [5, 6]. Research shows a clear preference among communities accessing take-home naloxone (THN) for IN compared to intramuscular (IM) naloxone [7, 8]. Skulberg et al. [9] provides important information on the efficacy of IN versus IM naloxone formulations. Using real world data from ambulance callouts to opioid overdose, their study confirms previous findings; response times to IN naloxone are longer than for IM naloxone [10].

Three concepts are key in naloxone administration; (i) time to sufficient response, (ii) duration of sufficient response, and (iii) precipitation of significant withdrawal. All three concepts are dose-dependent. The context of administration is also critical.

Within ambulance settings (as in the current study), naloxone administration occurs in the presence of experienced clinical staff, where appropriate airway management, supplemental oxygen and assisted ventilation are available if needed. The same is true of supervised injecting facilities (SIFs) (such as the Sydney Medically Supervised Injecting Centre [MSIC]). Accordingly, time to sufficient naloxone response is less important because there is less risk of hypoxia. This is not the case in unsupervised community settings where THN is administered. In these settings, timing and oxygenation of the brain is everything. If time to sufficient response is 10 minutes, there is a high chance of hypoxic brain damage and even death for someone...

Language: en

Keywords

Harm reduction; intramuscular naloxone; intranasal naloxone; narcotic antagonists; opioid overdose; take home naloxone