Prepacked naloxone administration for suspected opioid overdose in the era of illicitly manufactured fentanyl: a retrospective study of regional poison center data

Mahonski, Sarah; Leonard, James; Gatz, J. David; Seung, Hyunuk; Haas, Erin; Kim, Hong

doi:10.1080/15563650.2019.1615622

Cited by 15 publications

(16 citation statements)

References 21 publications

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“…Most studies used observational or quasi-experimental designs, including 11 uncontrolled before-and-after studies, 35 – 37 , 46 , 50 , 53 , 55 , 60 – 62 , 64 five controlled before-and-after studies, 42 , 44 , 57 , 58 , 65 one prospective cohort study, 63 four retrospective cohort studies, 45 , 51 , 52 , 54 four case series, 32 – 34 , 41 three non-randomized cluster trials, 48 , 56 , 59 one interrupted time-series analysis 49 and one cross-sectional study. 47 Experimental studies included two randomized controlled trials 38 , 39 and two cluster randomized controlled trials.…”

Section: Resultsmentioning

confidence: 99%

Emergency care with lay responders in underserved populations: a systematic review

Orkin¹,

Venugopal²,

Curran³

et al. 2021

Bull World Health Org

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Section: Resultsmentioning

confidence: 99%

Emergency care with lay responders in underserved populations: a systematic review

Orkin¹,

Venugopal²,

Curran³

et al. 2021

Bull World Health Org

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“…The amount of naloxone used for reversal has not increased either [32,33]. However, the introduction of Narcan in 2016 [34] resulted in a dramatic rise of dose levels approaching those associated with serious pulmonary complications [35]. Ultimately, the major challenge with THN in preventing overdose deaths may not be the dose of naloxone, but whether there are bystanders present that carry naloxone [27].…”

Section: Role Of 14 Mg/01 ML In Thn Programsmentioning

confidence: 99%

Comparison of intranasal and intramuscular naloxone in opioid overdoses managed by ambulance staff: a double‐dummy, randomised, controlled trial

et al. 2022

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Aims To measure and evaluate clinical response to nasal naloxone in opioid overdoses in the pre‐hospital environment. Design Randomised, controlled, double‐dummy, blinded, non‐inferiority trial, and conducted at two centres. Setting Participants were included by ambulance staff in Oslo and Trondheim, Norway, and treated at the place where the overdose occurred. Participants Men and women age above 18 years with miosis, rate of respiration ≤8/min, and Glasgow Coma Score <12/15 were included. Informed consent was obtained through a deferred‐consent procedure. Intervention and comparator A commercially available 1.4 mg/0.1 mL intranasal naloxone was compared with 0.8 mg/2 mL naloxone administered intramuscularly. Measurements The primary end‐point was restoration of spontaneous respiration of ≥10 breaths/min within 10 minutes. Secondary outcomes included time to restoration of spontaneous respiration, recurrence of overdose within 12 hours and adverse events. Findings In total, 201 participants were analysed in the per‐protocol population. Heroin was suspected in 196 cases. With 82% of the participants being men, 105 (97.2%) in the intramuscular group and 74 (79.6%) in the intranasal group returned to adequate spontaneous respiration within 10 minutes after one dose. The estimated risk difference was 17.5% (95% CI, 8.9%–26.1%) in favour of the intramuscular group. The risk of receiving additional naloxone was 19.4% (95% CI, 9.0%–29.7%) higher in the intranasal group. Adverse reactions were evenly distributed, except for drug withdrawal reactions, where the estimated risk difference was 6.8% (95% CI, 0.2%–13%) in favour of the intranasal group in a post hoc analysis. Conclusion Intranasal naloxone (1.4 mg/0.1 mL) was less efficient than 0.8 mg intramuscular naloxone for return to spontaneous breathing within 10 minutes in overdose patients in the pre‐hospital environment when compared head‐to‐head. Intranasal naloxone at 1.4 mg/0.1 mL restored breathing in 80% of participants after one dose and had few mild adverse reactions.

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“…Doses of fentanyl and serum fentanyl prior to naloxone are unknown. Time from onset of symptoms to naloxone treatment is unknown Mahonski et al ( 2020 ) 1139 records of suspected opioid overdose from Poison Control Center in Maryland, 2015–2017 Various suspected: heroin (774 cases), oxycodone (48 cases), methadone (16 cases), fentanyl, morphine, hydrocodone, and buprenorphine (16 cases total) Average 3.12 mg naloxone The majority of patients received 2 mg naloxone (62.2%) and another 33.2% received 4 mg naloxone. The total dose of naloxone increased between 2015 and 2017, while the reversal rate decreased Less than 16 cases were suspected of fentanyl overdose.…”

Section: Naloxonementioning

confidence: 99%

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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Prepacked naloxone administration for suspected opioid overdose in the era of illicitly manufactured fentanyl: a retrospective study of regional poison center data

Cited by 15 publications

References 21 publications

Emergency care with lay responders in underserved populations: a systematic review

Emergency care with lay responders in underserved populations: a systematic review

Comparison of intranasal and intramuscular naloxone in opioid overdoses managed by ambulance staff: a double‐dummy, randomised, controlled trial

Treatment of opioid overdose: current approaches and recent advances

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