Intranasal naloxone and related strategies for opioid overdose intervention by nonmedical personnel: a review

Abstract

Deaths due to prescription and illicit opioid overdose have been rising at an alarming rate, particularly in the USA. Although naloxone injection is a safe and effective treatment for opioid overdose, it is frequently unavailable in a timely manner due to legal and practical restrictions on its use by laypeople. As a result, an effort spanning decades has resulted in the development of strategies to make naloxone available for layperson or “take-home” use. This has included the development of naloxone formulations that are easier to administer for nonmedical users, such as intranasal and autoinjector intramuscular delivery systems, efforts to distribute naloxone to potentially high-impact categories of nonmedical users, as well as efforts to reduce regulatory barriers to more widespread distribution and use. Here we review the historical and current literature on the efficacy and safety of naloxone for use by nonmedical persons, provide an evidence-based discussion of the controversies regarding the safety and efficacy of different formulations of take-home naloxone, and assess the status of current efforts to increase its public distribution. Take-home naloxone is safe and effective for the treatment of opioid overdose when administered by laypeople in a community setting, shortening the time to reversal of opioid toxicity and reducing opioid-related deaths. Complementary strategies have together shown promise for increased dissemination of take-home naloxone, including 1) provision of education and training; 2) distribution to critical populations such as persons with opioid addiction, family members, and first responders; 3) reduction of prescribing barriers to access; and 4) reduction of legal recrimination fears as barriers to use. Although there has been considerable progress in decreasing the regulatory and legal barriers to effective implementation of community naloxone programs, significant barriers still exist, and much work remains to be done to integrate these programs into efforts to provide effective treatment of opioid use disorders.

Lay responder naloxone access and Good Samaritan law compliance: postcard survey results from 20 Indiana counties

“…Furthermore, those protections offered to the lay responder are limited in that they only cover criminal liability for possession of drugs or paraphernalia, making it less likely someone would call if they were at risk for other offenses (e.g., violating parole, having a current warrant for arrest issued, or public intoxication). The limitations of Good Samaritan laws are a noted problem across the USA [ 4 , 6 , 21 , 41 ], and strengthening protections offered to lay responders and extending them to the overdose survivors and all witnesses at the scene have potential for improving compliance.…”

“…Illicit opioids, including natural opioids mixed with synthetic analogs and pure synthetic analogs, are extremely potent and can require multiple doses of naloxone to counteract. Therefore, it is recommended that administration of naloxone be coupled with appropriate emergency medical care in case follow-up supportive care and additional doses of naloxone are needed [ 6 , 7 ]. However, many lay responders do not call 911 [ 8 – 10 ] because they fear legal repercussions (e.g., arrest, loss of public housing, or benefits) [ 8 , 9 , 11 – 20 ].…”

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study

“…Naloxone is a medication designed to rapidly reverse opioid overdose. 144,145 It is an opioid antagonist that binds to opioid receptors and can reverse and block the effects of other opioids. It can quickly restore normal respiration to a person whose breathing has slowed or stopped as a result of overdosing with illicit fentanyl, heroin, or prescription opioid pain medications.…”

Keynote Address 2018 Southern Maine Harm Reduction Conference

“…n Naloxone is provided to people at high risk of experiencing or witnessing overdose. 10 n Outreach workers, harm reduction staff, and trusted clinicians are properly educated and comfortable distributing naloxone to those using illicit opioids or receiving a high-risk opioid prescription. 11 n People who use drugs and first responders are well informed as to the potential effects and actions of naloxone.…”