Intranasal Naloxone as Initial Treatment For Opioid Overdose In the Pre-Hospital Setting
34 EMS Professional  September 2009 Intranasal Naloxone As Initial Treatment For Opioid Overdose In The Pre-Hospital Setting Special Feature Tipu V. Khan, M.D.; Safa S-S Khan, PhC; Andre Akhondi, M.D. This study received no outside agency or company support or loan equipment. Abstract Context In the prehospital setting, it has been a standard to administer intravenous nalox-one for opioid overdose. Alternatively, naloxone can be administered intranasally, thereby eliminating the need for intra-venous access and the risk of needle sticks to the paramedic. Evidence Acquisition PubMed and Embase were searched for studies published from 1998 to May 2006 that reported the use of intravenous, in-tranasal and intramuscular naloxone. Only articles that reported original data were in-cluded. Three articles were identified. Evidence Synthesis 74-91% of patients responded to in-tranasal naloxone alone or when preced-ing intravenous administration. Of these patients, 64-83% did not require a rescue intravenous dose. Average response time was shorter with intravenous and intra-muscular administration. Intranasal nalox-one is a promising alternative to intravenous delivery since it can be rapidly administered, and reduces the risk of blood-borne exposure. The limitations of its use are the longer response time, and the reduced bioavailability compared to intravenous and intramuscular adminis-tration. Conclusions We suggest that intranasal naloxone be considered as an initial therapy for opioid abusers, with intravenous and intramus-cular naloxone kept as rescue therapy. Key Words Naloxone, opioid, overdose, intranasal EMS_0909_p34-37:Layout 1 9/4/09 2:29 PM Page 34