Heroin overdose: the case for take-home naloxone

Strang, John; Darke, Shane; Hall, Wayne; Farrell, Michael; Ali, Robert

doi:10.1136/bmj.312.7044.1435

Cited by 148 publications

(113 citation statements)

References 12 publications

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“…8,14 On standing orders of a physician, first responders routinely administer naloxone through injection when summoned to the scene of drug overdose. 2,12,[15][16][17] Side effects associated with naloxone treatment for opiate overdose are generally rare. 12,18,19 Too often, timely medical attention is not provided to victims of opiate overdose.…”

Section: Introductionmentioning

confidence: 99%

Physicians’ Knowledge of and Willingness to Prescribe Naloxone to Reverse Accidental Opiate Overdose: Challenges and Opportunities

et al. 2006

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Naloxone, the standard treatment for heroin overdose, is a safe and effective prescription drug commonly administered by emergency room physicians or first responders acting under standing orders of physicians. High rates of overdose deaths and widely accepted evidence that witnesses of heroin overdose are often unwilling or unable to call 9-1-1 has led to interventions in several US cities and abroad in which drug users are instructed in overdose rescue techniques and provided a Btake-homed ose of naloxone. Under current Food and Drug Administration (FDA) regulations, such interventions require physician involvement. As part of a larger study to evaluate the knowledge and attitudes of doctors towards providing drug treatment and harm reduction services to injection drug users (IDUs), we investigated physician knowledge and willingness to prescribe naloxone. Less than one in four of the respondents in our sample reported having heard of naloxone prescription as an intervention to prevent opiate overdose, and the majority reported that they would never consider prescribing the agent and explaining its application to a patient. Factors predicting a favorable attitude towards prescribing naloxone included fewer negative perceptions of IDUs, assigning less importance to peer and community pressure not to treat IDUs, and increased confidence in ability to provide meaningful treatment to IDUs. Our data suggest that steps to promote naloxone distribution programs should include physician education about evidence-based harm minimization schemes, broader support for such initiatives by professional organizations, and policy reform to alleviate medicolegal concerns associated with naloxone prescription. FDA re-classification of naloxone for over-the-counter sales and promotion of nasal-delivery mechanism for this agent should be explored.

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Section: Introductionmentioning

confidence: 99%

Physicians’ Knowledge of and Willingness to Prescribe Naloxone to Reverse Accidental Opiate Overdose: Challenges and Opportunities

et al. 2006

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“…It has been demonstrated that interventions can improve the responses of heroin users when emergency medical systems and police have agreed on emergency protocols that bar/prevent/limit police from routinely attending overdose emergencies. 75 Provision of Naloxone Given the reluctance of heroin users to seek medical intervention, we and others [76][77][78] have proposed that the provision of naloxone hydrochloride to heroin users be tested and evaluated. Naloxone hydrochloride is a narcotic antagonist that reverses the effects of acute narcosis, including respiratory depression, sedation, and hypotension.…”

Section: Improving Responses At Overdosesmentioning

confidence: 99%

Heroin Overdose: Research and Evidence-Based Intervention

Darke

2003

Journal of Urban Health: Bulletin of the New York Academy of Me

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287

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“…Strang and colleagues (Strang et al, 1996;Strang et al, 1999) have argued that an inadequate response to overdoses is a major cause of fatalities among heroin users. They contended that home-based supplies of naloxone would save lives because they might enable family or friends to effect emergency resuscitation in the critical period between the sudden onset of heroin overdose and eventual naloxone administration by a health care professional.…”

Section: Discussionmentioning

confidence: 99%