Adverse events after naloxone treatment of episodes of suspected acute opioid overdose

Buajordet, Ingebjørg; Næss, Anne-Cathrine; Jacobsen, Dag; Brørs, Odd

doi:10.1097/00063110-200402000-00004

Cited by 146 publications

(90 citation statements)

References 21 publications

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“…Buajordet and colleagues [Buajordet et al 2004] conducted a prospective study to assess adverse events after naloxone treatment for episodes of suspected acute opioid overdose. This study included 1192 episodes treated with naloxone.…”

Section: Naloxone Safety Profile After Parenteral Usementioning

confidence: 99%

Review of naloxone safety for opioid overdose: practical considerations for new technology and expanded public access

Wermeling

2015

Therapeutic Advances in Drug Safety

134

101

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Opioid overdose and mortality have increased at an alarming rate prompting new public health initiatives to reduce drug poisoning. One initiative is to expand access to the opioid antidote naloxone. Naloxone has a long history of safe and effective use by organized healthcare systems and providers in the treatment of opioid overdose by paramedics/ emergency medicine technicians, emergency medicine physicians and anesthesiologists. The safety of naloxone in a prehospital setting administered by nonhealthcare professionals has not been formally established but will likely parallel medically supervised experiences. Naloxone dose and route of administration can produce variable intensity of potential adverse reactions and opioid withdrawal symptoms: intravenous administration and higher doses produce more adverse events and more severe withdrawal symptoms in those individuals who are opioid dependent. More serious adverse reactions after naloxone administration occur rarely and may be confounded by the effects of other co-intoxicants and the effects of prolonged hypoxia. One component of the new opioid harm reduction initiative is to expand naloxone access to high-risk individuals (addicts, abusers, or patients taking high-dose or extended-release opioids for pain) and their close family or household contacts. Patients or their close contacts receive a naloxone prescription to have the medication on their person or in the home for use during an emergency. Contacts are trained on overdose recognition, rescue breathing and administration of naloxone by intramuscular injection or nasal spraying of the injection prior to the arrival of emergency medical personnel. The safety profile of naloxone in traditional medical use must be considered in this new context of outpatient prescribing, dispensing and treatment of overdose prior to paramedic arrival. New naloxone delivery products are being developed for this prehospital application of naloxone in treatment of opioid overdose and prevention of opioid-induced mortality.

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Section: Naloxone Safety Profile After Parenteral Usementioning

confidence: 99%

Review of naloxone safety for opioid overdose: practical considerations for new technology and expanded public access

Wermeling

2015

Therapeutic Advances in Drug Safety

134

101

View full text Add to dashboard Cite

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“…Serious adverse effects of naloxone are rare, and are likely related to the overdose rather than the medication, when administered in either clinical or street settings. [16][17][18][19][20][21][22][23] In March 2010, the Governor of the State of Washington signed overdose intervention legislation that permits the prescription and possession of naloxone, and administration to others suffering from opioid overdoses. 24 This legislation became effective in June 2010 and also includes another relatively uncommon overdose prevention measure in the US-limited immunity from prosecution for drug possession charges for individuals who overdose or seek medical assistance in drug overdoses.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Nonfatal Overdose at Seattle-Area Syringe Exchanges

et al. 2011

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Opioid-involved overdose deaths are on the rise, both nationwide and in the state of Washington. In a survey of 443 participants at syringe exchanges in Seattle, Washington, 16% had overdosed in the last year. Several factors were significantly associated in bivariate analysis: lack of permanent housing; incarceration of five or more days in the past year; gender of sex partners; sharing of syringes and other injection paraphernalia; use of speedballs (cocaine and heroin together), goofballs (methamphetamine and heroin together), buprenorphine; injection use of crack cocaine and sedatives; and use of opioids with sedatives. Adjusting for other variables in multivariate logistic regression analyses, only recent incarceration and sharing of injection materials were still significantly associated with overdose. Correctional facilities, syringe exchange programs, and other agencies serving opioid injectors should include overdose prevention components in release planning and services.

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“…Adverse events related to naloxone treatment are quite common, occurring in up to 45 % of administrations [9]. Additionally, arousal from opioid poisoning frequently results in patients refusing medical care and facing the complications that can occur owing to a shorter duration of action for naloxone than most opioid agonists (e.g., methadone) [8].…”

Section: Introductionmentioning

confidence: 99%

Validation of Criteria to Guide Prehospital Naloxone Administration for Drug-Related Altered Mental Status

Friedman

Manini

2016

J. Med. Toxicol.

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Introduction We aimed to validate previously derived clinical criteria to predict successful prehospital response to naloxone in patients with altered mental status treated by EMS. We hypothesized that prehospital naloxone criteria would have high sensitivity for effective antidote response, but would be underutilized, in patients with drug-related altered mental status (DRAMS). Methods This study was a secondary data analysis of a prospective cohort of acute DRAMS at an urban ED. Naloxone criteria (respiratory rate (RR) <12, miotic pupils, or drug paraphernalia) and mental status, graded by either AVPU (Alert, Verbal, Painful, Unresponsive) or Glasgow Coma Scales, were abstracted from prehospital care reports. Interventions were compared for effective antidote response (EAR), defined as immediate improvement in RR, AVPU, or GCS. Results EMS transported 249 DRAMS over 17 months (48 % males, mean age 41.5, ALS 33.7 %). Forty-three (17 %) patients met naloxone criteria, of whom 44.2 % received the antidote. Naloxone criteria significantly predicted EAR (OR 7.0, p < 0.05) with 83 % sensitivity (95 % CI, 55-95 %). Miotic pupils (OR 20.0, p < 0.01) outperformed RR (OR 2.3, p = NS) as the best single criterion with 91 % sensitivity (95 % CI, 62-98 %). Conclusions This study validates prehospital criteria to guide naloxone administration. In addition, prehospital naloxone was underutilized for DRAMS. Further studies should address potential barriers to prehospital naloxone administration.

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Adverse events after naloxone treatment of episodes of suspected acute opioid overdose

Abstract: Although adverse events were common among patients treated for opioid overdose in an out-of-hospital setting, serious complications were rare. Out-of-hospital naloxone treatment by paramedics seems to save several lives a year without a high risk of serious complications.

Cited by 146 publications

References 21 publications

Review of naloxone safety for opioid overdose: practical considerations for new technology and expanded public access

Review of naloxone safety for opioid overdose: practical considerations for new technology and expanded public access

Risk Factors for Nonfatal Overdose at Seattle-Area Syringe Exchanges

Validation of Criteria to Guide Prehospital Naloxone Administration for Drug-Related Altered Mental Status

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