I NTRANASAL A DMINISTRATION OF N ALOXONE BY P ARAMEDICS

Abstract

Introduction. Naloxone is a medication that is frequently administered in the field by paramedics for suspected opioid overdoses. Most prehospital protocols, however, require this medication to be given to patients intravenously (IV) or intramuscularly (IM). Unfortunately, intravenous line placement may be problematic and time-consuming in chronic IV drug users. There may also be a delay in patient response to opioid reversal with IM absorption of naloxone. Additionally, routine use of needles in high-risk populations poses an increased risk of occupational blood exposures to paramedics. Objective. To prospectively test the effectiveness of intranasal (IN) naloxone administration by paramedics. This preliminary report summarizes the first month's experience in the city of Denver. Methods. Naloxone was first administered to patients found unconscious in the field using a nasal mucosal atomizer device (MAD). Patients were then treated using standard prehospital protocols, which included IV line placement and medications, if they did not immediately respond to IN naloxone. Time to patient response was recorded. Results. A total of 30 patients received IN naloxone in the field over a one-month period. Of these, 11 patients responded to either IN or IV naloxone. Ten (91%) patients responded to IN naloxone alone, with an average response time of 3.4 minutes. Seven patients (64%) did not require an IV in the field after response to IN naloxone. Conclusions. Intranasal naloxone may provide a safe, rapid, effective way to manage suspected opioid overdoses in the field. Use of this route may decrease paramedic exposures to blood-borne diseases. The addition of IN naloxone administration to prehospital protocols should be considered as an initial therapy for suspected opioid abusers.