Management of Opioid Analgesic Overdose

Department of Emergency Medicine, Division of Medical Toxicology, University of Massachusetts Medical Center, Worcester, MA 01655, USA.
New England Journal of Medicine (Impact Factor: 55.87). 07/2012; 367(2):146-55. DOI: 10.1056/NEJMra1202561
Source: PubMed


Opioid analgesic overdose is a life-threatening condition, and the antidote naloxone may have limited effectiveness in patients with poisoning from long-acting agents. The unpredictable clinical course of intoxication demands empirical management of this potentially lethal condition.

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    • "The kits contain naloxone, a short-acting opioid antagonist which can be administered via intravenous (IV), intramuscular (IM) or subcutaneous injection or intranasally (IN) using an adapter. Naloxone is approved by the Food and Drug Administration for the reversal of OOD with well-established safety and efficacy (Boyer, 2012; Buajordet et al., 2004; Clarke, Dargan, & Jones, 2005; Dahan, Aarts, & Smith, 2010). Naloxone administered via IM injection has historically been the most common route of administration, but IN administration is becoming increasingly common in the USA. "
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    ABSTRACT: Aims: The Veterans Health Administration (VHA) is implementing opioid overdose (OOD) education and naloxone distribution to reduce rising rates of OOD deaths. This study assessed knowledge and interest in OOD prevention with naloxone at a VHA hospital where naloxone kits were not yet available. Methods: Veterans receiving opioids for ≥3 months, including 52 from the Opioid Substitution Clinic (OSC) and 38 from the Pain Management Clinic (PMC), were interviewed about their attitudes and experience with OOD and naloxone. Findings: 52% of OSC and 21% of PMC veterans reported having ever experienced an OOD. Less than half had heard of naloxone and none owned a naloxone kit. After a brief explanation, 73% of OSC and 55% of PMC veterans reported wanting a kit. Veterans who reported wanting a kit were more likely to have witnessed (p < 0.001) and/or experienced (p < 0.001) an OOD and were more likely to have used intravenous drugs in their lifetimes (p < 0.05). Conclusions: Participants were not well informed about naloxone but many OSC veterans had a history of OOD and were interested in having a naloxone kit. There was also a subgroup of veterans prescribed opioids for chronic pain who had a history of OOD and were interested in naloxone.
    Full-text · Article · Dec 2015 · Drugs: Education Prevention and Policy
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    • "To avoid severe opiate withdrawals and complications, a more conservative and cautious use of naloxone is advised. Intravenous route by well-trained personnel to better titrate the naloxone dose is recommended, as at low dose naloxone can reverse the respiratory depression from opiate overdose without causing overt withdrawal from opiates [3]. With subcutaneous and intramuscular administration of naloxone, the time to peak effect and peak effect are less predictable than intravascular administration. "
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    ABSTRACT: Patients with symptoms of opiate withdrawal, after the administration of opiate antagonist by paramedics, are a common presentation in the emergency department of hospitals. Though most of opiate withdrawal symptoms are benign, rarely they can become life threatening. This case highlights how a benign opiate withdrawal symptom of hyperventilation led to severe respiratory alkalosis that degenerated into tetany and cardiac arrest. Though this patient was successfully resuscitated, it is imperative that severe withdrawal symptoms are timely identified and immediate steps are taken to prevent catastrophes. An easier way to reverse the severe opiate withdrawal symptom would be with either low dose methadone or partial opiate agonists like buprenorphine. However, if severe acid-base disorder is identified, it would be safer to electively intubate these patients for better control of their respiratory and acid-base status.
    Full-text · Article · Jun 2014
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    • "and prevents fatalities (Buajordet et al., 2004; Clarke et al., 2005; Dahan et al., 2010; Boyer, 2012). In 1996, communitybased programs, often referred to as opioid overdose prevention programs (OOPPs), began naloxone distribution directly to patients at high risk for overdose (Sporer and Kral, 2007; Wheeler et al., 2012). "
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    ABSTRACT: Community-based opioid overdose prevention programs (OOPPs) that include the distribution of naloxone have increased in response to alarmingly high overdose rates in recent years. This systematic review describes the current state of the literature on OOPPs, with particular focus on the effectiveness of these programs. We used systematic search criteria to identify relevant articles, which we abstracted and assigned a quality assessment score. Nineteen articles evaluating OOPPs met the search criteria for this systematic review. Principal findings included participant demographics, the number of naloxone administrations, percentage of survival in overdose victims receiving naloxone, post-naloxone administration outcome measures, OOPP characteristics, changes in knowledge pertaining to overdose responses, and barriers to naloxone administration during overdose responses. The current evidence from nonrandomized studies suggests that bystanders (mostly opioid users) can and will use naloxone to reverse opioid overdoses when properly trained, and that this training can be done successfully through OOPPs.
    Full-text · Article · Jan 2014 · Journal of Addiction Medicine
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