Effective Use of Naloxone by Law Enforcement in Response to Multiple Opioid Overdoses

Kitch, Bryan B.; Portela, Roberto C.

doi:10.3109/10903127.2015.1076097

Cited by 19 publications

(28 citation statements)

References 4 publications

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Section: Results Of Literature Searchesmentioning

confidence: 99%

“…Similarly, no study evaluated the recently FDAapproved formulations of highly-concentrated IN naloxone. One trial evaluated IN naloxone at a concentration lower (2 mg/5 mL) than used off-label in the United States (2 mg/2 mL) 37 and another trial evaluated IN naloxone at a concentration (2 mg/1 mL) that appears to have been formulated specifically for that study, and is not available in any product otherwise. 38 Studies indicate very high usability rates (>90%) with the auto-injector and FDA-approved IN naloxone, even without prior training, compared with older/off-label devices.…”

Section: Applicabilitymentioning

confidence: 99%

“…38 Although another trial found the same dose of IN naloxone using a lower concentration formulation (2 mg/5 mL) to be less effective than IM naloxone, 37 these findings are of limited applicability to ES-9 the United States, where off-label IN naloxone is typically given at a concentration of 2 mg/2 mL and FDA-approved concentrations are 4 or 2 mg/0.1 mL. Evidence regarding other route of administration comparisons is even more limited, with one trial of IN compared with IV naloxone conducted in an Iranian ED setting (SOE: insufficient).…”

mentioning

confidence: 99%

“…[37][38][39] Among the three trials, two compared IN versus IM naloxone 37,38 and one trial evaluated IN versus IV naloxone. 39 No trial evaluated the recently FDA-approved naloxone auto-injector for IM administration or highly concentrated (4 mg/0.1 mL or 2 mg/0.1 mL) IN formulations of naloxone.…”

mentioning

confidence: 99%

“…After dual review of abstracts and titles, 202 articles were selected for full-text dual review, and 13 studies were determined to meet inclusion criteria and were included in this review. We identified three RCTs (n=100 to 182) [37][38][39] and four cohort studies (n=93 to 609) 40-43 that compared different routes of naloxone administration.• o One trial conducted in an Iranian ED setting found that IN naloxone (0.4 mg, administered as a 0.4 mg/2 mL formulation) was associated with a greater likelihood than IV naloxone (0.4 mg) of an adequate response (defined as level of consciousness following naloxone of lethargic or conscious, 100% vs. 60%, RR 1.7, 95% CI 1.3 to 2.1) and lower likelihood of agitation than IV naloxone (0% vs. 24%, RR 0.04, 95% CI 0.002 to 0.66). The SOE was insufficient, due to moderate study limitations, inability to assess consistency, and indirectness (poor applicability to U.S. field settings due to high proportion of overdoses related to use of opium and ED setting).…”

mentioning

confidence: 99%

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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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Section: Results Of Literature Searchesmentioning

confidence: 99%

Section: Applicabilitymentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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

Chou¹,

Korthuis²,

McCarty³

et al. 2017

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Medication-Assisted Treatment for Opioid Use Disorders 2: Detoxification

Tidder

Baldacchino

Teck³

2022

Opioids

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Treatment of opioid overdose: current approaches and recent advances

Britch

Walsh

2022

Psychopharmacology

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Background The USA has recently entered the third decade of the opioid epidemic. Opioid overdose deaths reached a new record of over 74,000 in a 12-month period ending April 2021. Naloxone is the primary opioid overdose reversal agent, but concern has been raised that naloxone is not efficacious against the pervasive illicit high potency opioids (i.e., fentanyl and fentanyl analogs). Methods This narrative review provides a brief overview of naloxone, including its history and pharmacology, and the evidence regarding naloxone efficacy against fentanyl and fentanyl analogs. We also highlight current advances in overdose treatments and technologies that have been tested in humans. Results and conclusions The argument that naloxone is not efficacious against fentanyl and fentanyl analogs rests on case studies, retrospective analyses of community outbreaks, pharmacokinetics, and pharmacodynamics. No well-controlled studies have been conducted to test this argument, and the current literature provides limited evidence to suggest that naloxone is ineffective against fentanyl or fentanyl analog overdose. Rather a central concern for treating fentanyl/fentanyl analog overdose is the rapidity of overdose onset and the narrow window for treatment. It is also difficult to determine if other non-opioid substances are contributing to a drug overdose, for which naloxone is not an effective treatment. Alternative pharmacological approaches that are currently being studied in humans include other opioid receptor antagonists (e.g., nalmefene), respiratory stimulants, and buprenorphine. None of these approaches target polysubstance overdose and only one novel approach (a wearable naloxone delivery device) would address the narrow treatment window.

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Effective Use of Naloxone by Law Enforcement in Response to Multiple Opioid Overdoses

Abstract: This article presents case descriptions demonstrating the feasibility and safety of law enforcement naloxone programs.

Cited by 19 publications

References 4 publications

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

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

Medication-Assisted Treatment for Opioid Use Disorders 2: Detoxification

Treatment of opioid overdose: current approaches and recent advances

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