Assessment for Deaths in Out-of-hospital Heroin Overdose Patients Treated with Naloxone Who Refuse Transport

Vilke, Gary M.; Sloane, Christian; Smith, Alan; Chan, Theodore C.

doi:10.1111/j.1553-2712.2003.tb00636.x

Cited by 67 publications

(40 citation statements)

References 12 publications

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“…Two publications report on the medical examiner records of overdose deaths [Vilke et al 1999[Vilke et al , 2003] over a 1-year and 5-year period, respectively. These studies each compare databases of patients who received naloxone for opioid overdose and then left AMA to the databases of the medical examiner for deaths within 12 hours of the naloxone treatment.…”

Section: Post-treatment Recurrence Of Respiratory Depressionmentioning

confidence: 99%

Review of naloxone safety for opioid overdose: practical considerations for new technology and expanded public access

Wermeling

2015

Therapeutic Advances in Drug Safety

132

101

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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.

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Section: Post-treatment Recurrence Of Respiratory Depressionmentioning

confidence: 99%

Review of naloxone safety for opioid overdose: practical considerations for new technology and expanded public access

Wermeling

2015

Therapeutic Advances in Drug Safety

132

101

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“…Within 0 to 2 days of naloxone administration, the proportion of patients was 0 percent in three studies [71][72][73] (n=317, 552, and 998), one study 74 reporting one death (0.49% [1/205]), and one study 70 reporting 14 deaths (0.6% [14/2241]): three attributed to likely rebound overdose (0.13%), ten to new overdose, and one to a natural death. The final study reported one case of a life-threatening adverse event (1.2% [1/84]).…”

Section: Detailed Synthesismentioning

confidence: 99%

“…Although six studies reported low rates (0 to 1.2%) of death or serious adverse events among patients who received naloxone for opioid overdose and were not transported to a health care facility, [69][70][71][72][73][74] there was no comparison group of patients who were transported, and the studies provided limited details regarding the characteristics of the nontransported patients. This makes interpretation of findings difficult, as patients who refuse transport or are assessed as not requiring transport are likely to be at lower risk of opioid overdose-related complications than patients who are transported.…”

Section: Key Findings and Strength Of Evidencementioning

confidence: 99%

Management of Suspected Opioid Overdose With Naloxone by Emergency Medical Services Personnel

Chou¹,

Korthuis²,

McCarty³

et al. 2017

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Key Messages Purpose of ReviewTo determine optimal doses, routes of administration, and dosing strategies of naloxone for suspected opioid overdose in out-of-hospital settings, and whether transport to a hospital following successful opioid overdose reversal with naloxone is necessary. Key Messages• Higher concentration intranasal naloxone may be similarly effective and safe compared with intramuscular naloxone, but the available studies did not evaluate formulations approved by the Food and Drug Administration.• While field administration of naloxone is generally effective in reversing opioid overdose, there is not strong evidence concerning differences in effectiveness between doses or routes of administration.• More research is needed to determine optimal doses of naloxone, appropriate timing of repeat dosing, and whether it is necessary to dose patients to full consciousness.• More research is needed to determine whether transporting patients to a hospital after successful reversal of overdose is necessary.ii This report is based on research conducted by the Pacific Northwest Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2015-00009-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services.None of the investigators have any affiliations or financial involvement that conflicts with the material presented in this report.The information in this report is intended to help health care decisionmakers-patients and clinicians, health system leaders, and policymakers, among others-make well-informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients.This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders.AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies, may not be stated or implied.This report may periodically be assessed for the currency...

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“…To the Editor:-We read with interest the article by Vilke et al 1 There are several points that we feel require clarification before we would consider allowing narcotic-reversed patients to sign out against medical advice (AMA).…”

Section: Leaving Against Medical Advice After Out-of-hospital Naloxonmentioning

confidence: 99%

Leaving Against Medical Advice after Out-of-hospital Naloxone: A Closer Look is Needed

Perez¹

2004

Academic Emergency Medicine

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Assessment for Deaths in Out-of-hospital Heroin Overdose Patients Treated with Naloxone Who Refuse Transport

Abstract: Giving naloxone to patients with heroin overdoses in the field and then allowing them to sign out AMA resulted in no identifiable deaths within this study population.

Cited by 67 publications

References 12 publications

Review of naloxone safety for opioid overdose: practical considerations for new technology and expanded public access

Review of naloxone safety for opioid overdose: practical considerations for new technology and expanded public access

Management of Suspected Opioid Overdose With Naloxone by Emergency Medical Services Personnel

Leaving Against Medical Advice after Out-of-hospital Naloxone: A Closer Look is Needed

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