Saved by the Nose: Bystander-Administered Intranasal Naloxone Hydrochloride for Opioid Overdose

Abstract

Administering naloxone hydrochloride (naloxone) during an opioid overdose reverses the overdose and can prevent death. Although typically delivered via intramuscular or intravenous injection, naloxone may be delivered via intranasal spray device. In August 2006, the Boston Public Health Commission passed a public health regulation that authorized an opioid overdose prevention program that included intranasal naloxone education and distribution of the spray to potential bystanders. Participants were taught by trained nonmedical needle exchange staff. After 15 months, the program provided training and intranasal naloxone to 385 participants who reported 74 successful overdose reversals. Problems with intranasal naloxone were uncommon. Overdose prevention education with distribution of intranasal naloxone is a feasible public health intervention to address opioid overdose.

Overdose Education and Naloxone for Patients Prescribed Opioids in Primary Care: A Qualitative Study of Primary Care Staff

“…6 Program evaluations suggest that community-based overdose education and naloxone distribution is an effective strategy to prevent overdose fatalities. [7][8][9][10][11][12] Community-based programs have traditionally served people who use heroin and nonmedical opioids, but a significant proportion of overdose deaths are related to opioids prescribed for pain. [13][14][15][16][17] In the Veteran's Administration and large managed care organizations, the overdose risk is particularly high in people prescribed more than 100 milligrams morphine equivalent daily doses.…”

Police Officers’ and Paramedics’ Experiences with Overdose and Their Knowledge and Opinions of Washington State’s Drug Overdose–Naloxone–Good Samaritan Law

“…[5][6][7] A fairly robust research literature that addresses training those at risk for witnessing an overdose in how to recognize and intervene during an emergency exists. 3,[8][9][10][11] However, much less is known about law enforcement officers' experience and perspectives on overdose. Engaging police in opioid overdose response is critical because they are often the first to arrive at the scene and can provide or enhance effective emergency response, especially in rural and poorly resourced areas.…”

Expanding Access to Naloxone in the United States

“…Administration of naloxone by bystanders is reported in over a dozen feasibility studies with reversal rates ranging from 75 to 100 % of cases [15,16,[19][20][21][22][23][24][25][26][27][28][29][30]. Two studies measured the impact of a naloxone program on mortality rates.…”

“…Lastly, while all bystanders are instructed to call 911, it is activated in only 10-60 % of cases [22,25,43]. Bystanders reported concerns of police involvement as the major reason for not calling.…”

“…Bystanders reported concerns of police involvement as the major reason for not calling. Fear of outstanding warrants, confiscation of naloxone mistaken as drug paraphernalia by police, drug seizures, fear of eviction, and threat of arrest or incarceration were cited as reasons for not calling 911 [25,29]. These fears constitute a substantial barrier to care in states where immunity laws for drug-related emergencies are limited or absent [44,45].…”