Prehospital treatment of opioid overdose in Copenhagen—Is it safe to discharge on-scene?

Rudolph, Søren Steemann; Jehu, G.; Nielsen, Søren; Nielsen, Karina; Siersma, Volkert; Rasmussen, Lars S.

doi:10.1016/j.resuscitation.2011.06.027

Cited by 47 publications

(35 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A large US retrospective cohort study (n=4,926) concluded that THN provision did not lead to increased heroin use (Doe-Simkins et al, 2014). Previously, a Danish study had found that death from (presumed) 'rebound' overdose toxicity occurred only in 3 out of 3,245 cases of naloxone administration (Rudolph et al, 2011).…”

Section: -2016 Circa: Emergence Of Stronger Data Alternative Impmentioning

confidence: 99%

Twenty years of take-home naloxone for the prevention of overdose deaths from heroin and other opioids—Conception and maturation

McDonald

Campbell

Strang

2017

Drug and Alcohol Dependence

113

View full text Add to dashboard Cite

Highlights Deaths from opioid overdose can be prevented by prompt administration of naloxone  It has been 20 years since take-home naloxone provision was first proposed  Take-home naloxone programs have recently overcome legal barriers in many countries  Take-home naloxone provision remains low compared to evident growing clinical need  The 'opt-out' model of required pre-provision may achieve wider naloxone coverage Abstract Background: Opioid overdose is a major cause of mortality, but injury and fatal outcomes can be prevented by timely administration of the opioid antagonist naloxone. Pre-provision of naloxone to opioid users and family members (take-home naloxone, THN) was first proposed in 1996, and WHO Guidelines were issued in 2014. While widespread in some countries, THN is minimally available or absent elsewhere. This review traces the development of THN over twenty years, from speculative harm reduction proposal to public health strategy.Method: Medline and PsycINFO were searched for peer-reviewed literature using Boolean queries: 1) "naloxone OR Narcan"; 2) "(opioid OR opiate) AND overdose AND prevention". Grey literature and specialist websites were also searched. Data were extracted and synthesized as narrative review, with key events presented as chronological timeline. Results Conclusions:Framed as a public health tool for harm reduction, THN has overcome social, clinical, and legal barriers in many jurisdictions. Nonetheless, the rising death toll of opioid overdose illustrates that current THN coverage is insufficient, and greater public investment in overdose prevention will be required if THN is to achieve its full potential impact.

show abstract

Section: -2016 Circa: Emergence Of Stronger Data Alternative Impmentioning

confidence: 99%

Twenty years of take-home naloxone for the prevention of overdose deaths from heroin and other opioids—Conception and maturation

McDonald

Campbell

Strang

2017

Drug and Alcohol Dependence

113

View full text Add to dashboard Cite

show abstract

“…Six studies (n=84 to 2241) reported on outcomes in patients who received naloxone for opioid overdose who were not transported to a health care facility (Table 4 and Appendix D, Table D-3). One study was conducted in Finland, 69 one in The Netherlands 70 and the others in the United States. None of the studies reported industry funding, though four of five studies did not report funding source.…”

Section: Detailed Synthesismentioning

confidence: 99%

“…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%

See 1 more Smart Citation

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

Chou¹,

Korthuis²,

McCarty³

et al. 2017

View full text Add to dashboard Cite

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...

show abstract

“…Bad outcomes due to Rebound sedation after reversal agent use, even after a massive overdose in the setting of poisoning, accidental or otherwise, are extremely rare [16,17] . Because titrated doses of short-acting sedatives are used in the GI lab, clinical practice experiences and reported studies in the medical literature have shown this practice to be very safe.…”

Section: Administration Of Supplemental Oxygen To Increase Patient Samentioning

confidence: 99%

Myths, fallacies and practical pearls in GI lab

Kumar¹

2014

WJGE

View full text Add to dashboard Cite

Many prevalent practices and guidelines related to Gastrointestinal endoscopy and procedural sedation are at odds with the widely available scientific-physiological and clinical outcome data. In many institutions, strict policy of pre-procedural extended fasting is still rigorously enforced, despite no evidence of increased incidence of aspiration after recent oral intake prior to sedation. Supplemental oxygen administration in the setting of GI procedural sedation has been increasingly adopted as reported in the medical journals, despite clear evidence that supplemental oxygen blunts the usefulness of pulse oximetry in timely detection of sedation induced hypoventilation, leading to increased number of adverse cardiopulmonary outcomes. Use of Propofol by Gastroenterologist-Nurse team is erroneously considered dangerous and often prohibited in various institutions, at the same time worldwide reports of remarkable safety and patient satisfaction continue to be published, dating back more than a decade. Of patient monitoring practices that have been advocated to be standard, many merely add cost, not value. Advances in the technology often are not incorporated in a timely manner in guidelines or clinical practices, e.g. , Capsule endoscopy or electrocautery during GI procedures do not interfere with proper functioning of the current pacemakers or defibrillators. Orthopedic surgeons have continued to recommend prophylactic antibiotics for joint replacement patients prior to GI procedures, without any evidence of need. These myths are explored for a succint review to prompt a change in clinical practices and institutional policies. Core tip: Many prevalent endoscopic procedural practices and policies are not only unsupported by clinical and scientific evidence, but are counterproductive. Rather than enhancing patient safety and comfort, these increase risk and expense, introduce unnecessary delays. Evidence to reach proper decisions about these topics has been available for a while, but is not appropriately acknowledged and implemented. Avoiding these pitfalls can have a significant positive impact because these policies cover routine events, actions and decisions, including: required prolonged pre-procedural fasting, routine supplemental oxygen during sedation, prohibition of Propofol use by nonanesthesia personnel, multiple monitoring practices and prophylactic recommendations.Kumar P. Myths, fallacies and practical pearls in GI lab. World J Gastrointest Endosc 2014; 6(12): 584-591 Available from: URL:

show abstract

Prehospital treatment of opioid overdose in Copenhagen—Is it safe to discharge on-scene?

Cited by 47 publications

References 13 publications

Twenty years of take-home naloxone for the prevention of overdose deaths from heroin and other opioids—Conception and maturation

Twenty years of take-home naloxone for the prevention of overdose deaths from heroin and other opioids—Conception and maturation

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

Myths, fallacies and practical pearls in GI lab

Contact Info

Product

Resources

About