Objective: To determine whether naloxone administered IV to out-of-hospital patients with suspected opioid overdose would have a more rapid therapeutic onset than naloxone given subcutaneously (SQ). Methods: A prospective, sequential, observational cohort study of 196 consecutive patients with suspected opioid overdose was conducted in an urban out-of-hospital setting, comparing time intervals from arrival at the patient's side to development of a respiratory rate 2 1 0 breathdmin, and durations of bag-valve-mask ventilation. Subjects received either naloxone 0.4 mg IV (n = 74) or naloxone 0.8 mg SQ (n = 122). for respiratory depression of < l o breathdmin. Results: Mean interval from crew arrival to respiratory rate 2 1 0 breathdmin was 9.3 2 4.2 min for the IV group vs 9.6 & 4.58 min for the SQ group (95% CI of the difference -1.55. 1.00). Mean duration of bagvalve-mask ventilation was 8.1 & 6.0 min for the IV group vs 9.1 _+ 4.8 min for the SQ group. Cost of materials for administering naloxone 0.4 mg IV was $12.30/patient, compared with $10.7O/patient for naloxone 0.8 mg SQ. Conclusion: There was no clinical difference in the time interval to respiratory rate 2 10 breathdmin between naloxone 0.8 mg SQ and naloxone 0.4 mg IV for the out-of-hospital management of patients with suspected opioid overdose. The slower rate of absorption via the SQ route was offset by the delay in establishing an IV.
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