Intranasal naloxone delivery is an alternative to intravenous naloxone for opioid overdoses☆
Received 17 August 2008; received in revised form 25 October 2008; accepted 4 December 2008. published online 26 October 2009.
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.
aDepartment of Emergency Medicine and Pediatrics, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
bRobert Wood Johnson University Hospital, New Brunswick, NJ, USA
cUniversity of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School Piscataway, NJ, USA
dDepartment of Emergency Medicine, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
eDepartment of Biostatistics, School of Public Health, University of Medicine and Dentistry of New Jersey, Piscataway, NJ, USA
fDepartment of Pharmacy Practice, Rutgers University, School of Pharmacy, Piscataway, NJ, USA
Corresponding author. Department of Emergency Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, NJ 08901, USA. Tel.:+1 732 235 8717.
☆ This study received no grants or financial support. It has not been presented at any meeting.
ABSTRACT