Intranasal naloxone delivery is an alternative to intravenous naloxone for opioid overdoses

• Published in: The American journal of emergency medicine 2010-03, Vol.28 (3), p.296-303
• Main Authors: Merlin, Mark A., DO, EMT-P, Saybolt, Matthew, BS, Kapitanyan, Raffi, MD, Alter, Scott M., BS, EMT-P, Jeges, Janos, MD, Liu, Junfeng, PhD, Calabrese, Susan, MICP, Rynn, Kevin O., PharmD, Perritt, Rachael, PharmD, Pryor, Peter W., MD, MPH
• Format: Article
• Language: English
• Subjects: Administration, Intranasal; Adult; Aged; Chi-Square Distribution; Drug delivery systems; Drug dosages; Drug overdose; Drug Overdose - drug therapy; Emergency; Emergency medical care; Emergency medical services; Female; Humans; Hypotheses; Information management; Injections, Intravenous; Male; Middle Aged; Naloxone - administration & dosage; Narcotic Antagonists - administration & dosage; Opioid-Related Disorders - drug therapy; Overdose; Paramedics; Retrospective Studies; Statistics, Nonparametric; Studies; Treatment Outcome
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2008.12.009

Abstract Introduction This study proposes that intranasal (IN) naloxone administration is preferable to intravenous (IV) naloxone by emergency medical services for opioid overdoses. Our study attempts to establish that IN naloxone is as effective as IV naloxone but without the risk of needle exposure. We also attempt to validate the use of the Glasgow Coma Scale (GCS) in opioid intoxication. Methods A retrospective chart review of prehospital advanced life support patients was performed on confirmed opioid overdose patients. Initial and final unassisted respiratory rates (RR) and GCS, recorded by paramedics, were used as indicators of naloxone effectiveness. The median changes in RR and GCS were determined. Results Three hundred forty-four patients who received naloxone by paramedics from January 1, 2005, until December 31, 2007, were evaluated. Of confirmed opioid overdoses, change in RR was 6 for the IV group and 4 for the IN group ( P = .08). Change in GCS was 4 for the IV group and 3 for the IN group ( P = .19). Correlations between RR and GCS for initial, final, and change were significant at the 0.01 level ( ρ = 0.577, 0.462, 0.568, respectively). Conclusion Intranasal naloxone is statistically as effective as IV naloxone at reversing the effects of opioid overdose. The IV and IN groups had similar average increases in RR and GCS. Based on our results, IN naloxone is a viable alternative to IV naloxone while posing less risk of needle stick injury. Additionally, we demonstrated that GCS is correlated with RR in opioid intoxication.