Randomized controlled trial comparing the effectiveness and safety of intranasal and intramuscular naloxone for the treatment of suspected heroin overdose

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Kerr, Debra, Kelly, Anne-Maree, Dietze, Paul, Jolley, Damien and Barger, Bill (2009) Randomized controlled trial comparing the effectiveness and safety of intranasal and intramuscular naloxone for the treatment of suspected heroin overdose. Addiction, 104 (12). pp. 2067-2074. ISSN 0965-2140 (Print), 1360-0443 (Online)

Abstract

Aims Traditionally, the opiate antagonist naloxone has been administered parenterally; however, intranasal (i.n.) administration has the potential to reduce the risk of needlestick injury. This is important when working with populations known to have a high prevalence of blood-borne viruses. Preliminary research suggests that i.n. administration might be effective, but suboptimal naloxone solutions were used. This study compared the effectiveness of concentrated (2 mg/ml) i.n. naloxone to intramuscular (i.m.) naloxone for suspected opiate overdose. Methods This randomized controlled trial included patients treated for suspected opiate overdose in the pre-hospital setting. Patients received 2 mg of either i.n. or i.m. naloxone. The primary outcome was the proportion of patients who responded within 10 minutes of naloxone treatment. Secondary outcomes included time to adequate response and requirement for supplementary naloxone. Data were analysed using multivariate statistical techniques. Results A total of 172 patients were enrolled into the study. Median age was 29 years and 74% were male. Rates of response within 10 minutes were similar: i.n. naloxone (60/83, 72.3%) compared with i.m. naloxone (69/89, 77.5%) [difference: −5.2%, 95% confidence interval (CI) −18.2 to 7.7]. No difference was observed in mean response time (i.n.: 8.0, i.m.: 7.9 minutes; difference 0.1, 95% CI −1.3 to 1.5). Supplementary naloxone was administered to fewer patients who received i.m. naloxone (i.n.: 18.1%; i.m.: 4.5%) (difference: 13.6%, 95% CI 4.2–22.9). Conclusions Concentrated intranasal naloxone reversed heroin overdose successfully in 82% of patients. Time to adequate response was the same for both routes, suggesting that the i.n. route of administration is of similar effectiveness to the i.m. route as a first-line treatment for heroin overdose.

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Item type Article
URI https://vuir.vu.edu.au/id/eprint/4378
DOI 10.1111/j.1360-0443.2009.02724.x
Official URL http://onlinelibrary.wiley.com/doi/10.1111/j.1360-...
Subjects Historical > FOR Classification > 1199 Other Medical and Health Sciences
Historical > Faculty/School/Research Centre/Department > School of Nursing and Midwifery
Keywords ResPubID19192, heroin, intranasal, naloxone, opioid, overdose, resuscitation
Citations in Scopus 120 - View on Scopus
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