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

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, vol. 104, no. 12, pp. 2067-2074, doi: 10.1111/j.1360-0443.2009.02724.x.

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Title Randomized controlled trial comparing the effectiveness and safety of intranasal and intramuscular naloxone for the treatment of suspected heroin overdose
Author(s) Kerr, DebraORCID iD for Kerr, Debra orcid.org/0000-0002-2956-2432
Kelly, Anne-Maree
Dietze, Paul
Jolley, Damien
Barger, Bill
Journal name Addiction
Volume number 104
Issue number 12
Start page 2067
End page 2074
Total pages 8
Publisher Wiley-Blackwell
Place of publication Chichester, Eng.
Publication date 2009-12
ISSN 0965-2140
1360-0443
Keyword(s) heroin
intranasal
naloxone
opioid
overdose
resuscitation
Summary 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.
Language eng
DOI 10.1111/j.1360-0443.2009.02724.x
Field of Research 119999 Medical and Health Sciences not elsewhere classified
Socio Economic Objective 929999 Health not elsewhere classified
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2009, The Authors
Persistent URL http://hdl.handle.net/10536/DRO/DU:30089872

Document type: Journal Article
Collection: School of Nursing and Midwifery
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