Academic physicians' and medical students' perceived barriers toward bystander administered naloxone as an overdose prevention strategy

Gatewood, Amanda; Wert, Michael J. Van; Andrada, Andrew; Surkan, Pamela J.

doi:10.1016/j.addbeh.2016.05.013

Cited by 30 publications

(43 citation statements)

References 21 publications

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“…V E remained above 100% of control levels for at least 60 minutes after MCAM administration, whereas V E returned to below control values within 45 minutes after administration of the largest dose of naloxone. This observation is consistent with a major limitation of naloxone when it is used clinically to reverse the effects of an opioid that lasts longer than naloxone (e.g., Dahan et al, 2010;Gatewood et al, 2016;Tomassoni et al, 2017). Moreover, 1 day after a reversal test, when the effects of the acute dose of heroin were no longer evident, the heroin dose-effect curve was shifted to the right in monkeys that received MCAM the preceding day (i.e., during the reversal test) but not in monkeys that received 0.032 mg/kg naloxone or saline the preceding day.…”

Section: Discussionsupporting

confidence: 72%

“…Naloxone, the only antagonist used to treat opioid overdose, and naltrexone, the only antagonist used to treat opioid abuse, are both competitive, reversible antagonists at m-opioid receptors; however, their therapeutic utility (for overdose and abuse, respectively) is limited by their pharmacological properties. For example, because of a short duration of action, the antagonist effects of naloxone can wane before the respiratory-depressant effects of some opioid receptor agonists, potentially resulting in a re-emergence of respiratory depression after rescue (e.g., Dahan et al, 2010;Gatewood et al, 2016;Tomassoni et al, 2017). In addition, the effects of these antagonists are surmountable, so that fatal respiratory depression can occur, even in the presence of an antagonist, if patients continue to take opioids.…”

Section: Discussionmentioning

confidence: 99%

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Reversal and Prevention of the Respiratory-Depressant Effects of Heroin by the Novel μ-Opioid Receptor Antagonist Methocinnamox in Rhesus Monkeys

Gerak¹,

Maguire²,

Woods³

et al. 2018

J Pharmacol Exp Ther

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One consequence of the ongoing opioid epidemic is a large number of overdose deaths. Naloxone reverses opioid-induced respiratory depression; however, its short duration of action limits the protection it can provide. Methocinnamox (MCAM) is a novel opioid receptor antagonist with a long duration of action. This study examined the ability of MCAM to prevent and reverse the respiratory-depressant effects (minute volume [V E ]) of heroin in five monkeys. MCAM (0.32 mg/kg) was given before heroin to determine whether it prevents respiratory depression; heroin dose-effect curves were generated 1, 2, 4, and 8 days later, and these effects were compared with those of naltrexone (0.032 mg/kg). Heroin dose dependently decreased V E . MCAM and naltrexone prevented respiratory depression, shifting the heroin dose-effect curve rightward at least 10-fold. MCAM, but not naltrexone, attenuated these effects of heroin for 4 days. MCAM (0.1-0.32 mg/kg) was given 30 minutes after heroin to determine whether it reverses respiratory depression; heroin dose-effect curves were generated 1, 2, 4, 8, and 16 days later, and these effects were compared with those of naloxone (0.0032-0.1 mg/kg). MCAM and naloxone reversed respiratory depression within 30 minutes, although only MCAM antagonized heroin on subsequent days. Thus, MCAM prevents and reverses respiratory depression, the potentially lethal effect of heroin, longer than opioid receptor antagonists currently in use. Because of its sustained effects, MCAM might provide more effective rescue from and protection against the fatal respiratorydepressant effects of opioids, thereby improving treatment of opioid overdose.

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

Reversal and Prevention of the Respiratory-Depressant Effects of Heroin by the Novel μ-Opioid Receptor Antagonist Methocinnamox in Rhesus Monkeys

Gerak¹,

Maguire²,

Woods³

et al. 2018

J Pharmacol Exp Ther

View full text Add to dashboard Cite

show abstract

“…Concerns referenced by seven of the nine studies 16,19,21,22,24,25,31 include: lack of knowledge around prescribing naloxone, lack of knowledge around educating patients, and inability to identify patients eligible for naloxone. In one paper, a provider explained the concern around lack of knowledge: “I probably just don’t have quite as much knowledge about the outpatient safety of it to feel comfortable prescribing it right now.” 19 Additional concerns included fear of risk compensation, fear of offending patients, and that prescribing may take too long.…”

Section: Resultsmentioning

confidence: 99%

Acceptability and feasibility of naloxone prescribing in primary care settings: A systematic review

Behar

Bagnulo

Coffin

2018

Preventive Medicine

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“…However, although the New York University School of Medicine integrated naloxone rescue into BLS training for medical students in 2014, this innovation has not been broadly adopted elsewhere. A qualitative study examining barriers to medical student attitudes toward naloxone rescue identified lack of knowledge and stigma of naloxone as barriers to naloxone prescription . Incorporating naloxone into BLS training may help address some of these concerns and fits within broader national calls for improved substance use disorder (SUD) education .…”

mentioning

confidence: 99%

Making Naloxone Rescue Part of Basic Life Support Training for Medical Students

Jack

Warren

Sundaram

et al. 2018

AEM Education and Training

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As opioid overdose deaths in the United States continue to climb, medical students must be prepared to prevent and treat opioid use disorder and opioid overdose. The administration of naloxone is an evidence-based way to reverse overdoses and save lives. At our medical school, a coalition of medical students, emergency medicine educators, and administrators worked together to permanently integrate naloxone rescue training into the Basic Life Support (BLS) curriculum required of all first-year medical students. This article outlines an argument for the integration of naloxone rescue into BLS training and an introduction to emergency medical care for medical students. The authors then describe the steps that students took to transform this program from an original pilot to a formally integrated curriculum offered to all first-year medical students. The article highlights the role of medical student advocacy in curriculum design and its potential to align medical training with community health needs, such as the ongoing opioid epidemic.

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Academic physicians' and medical students' perceived barriers toward bystander administered naloxone as an overdose prevention strategy

Cited by 30 publications

References 21 publications

Reversal and Prevention of the Respiratory-Depressant Effects of Heroin by the Novel μ-Opioid Receptor Antagonist Methocinnamox in Rhesus Monkeys

Reversal and Prevention of the Respiratory-Depressant Effects of Heroin by the Novel μ-Opioid Receptor Antagonist Methocinnamox in Rhesus Monkeys

Acceptability and feasibility of naloxone prescribing in primary care settings: A systematic review

Making Naloxone Rescue Part of Basic Life Support Training for Medical Students

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