Randomised trial of intranasal versus intramuscular naloxone in prehospital treatment for suspected opioid overdose

Kelly, Anne-Maree, Kerr, Debra, Dietze, Paul, Patrick, Ian, Walker, Tony and Koutsogiannis, Zeff 2005, Randomised trial of intranasal versus intramuscular naloxone in prehospital treatment for suspected opioid overdose, Medical journal of Australia, vol. 182, no. 1, pp. 24-27.

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Title Randomised trial of intranasal versus intramuscular naloxone in prehospital treatment for suspected opioid overdose
Author(s) Kelly, Anne-Maree
Kerr, DebraORCID iD for Kerr, Debra orcid.org/0000-0002-2956-2432
Dietze, Paul
Patrick, Ian
Walker, Tony
Koutsogiannis, Zeff
Journal name Medical journal of Australia
Volume number 182
Issue number 1
Start page 24
End page 27
Total pages 4
Publisher Australasian Medical Publishing Company
Place of publication Sydney, N.S.W.
Publication date 2005-01-03
ISSN 0025-729X
Keyword(s) Administration, Intranasal
Drug Overdose
Emergency Medical Services
Injections, Intramuscular
Middle Aged
Prospective Studies
Respiratory Insufficiency
Treatment Outcome
Summary OBJECTIVE: To determine the effectiveness of intranasal (IN) naloxone compared with intramuscular (IM) naloxone for treatment of respiratory depression due to suspected opiate overdose in the prehospital setting. DESIGN: Prospective, randomised, unblinded trial of either 2 mg naloxone injected intramuscularly or 2 mg naloxone delivered intranasally with a mucosal atomiser. PARTICIPANTS AND SETTING: 155 patients (71 IM and 84 IN) requiring treatment for suspected opiate overdose and attended by paramedics of the Metropolitan Ambulance Service (MAS) and Rural Ambulance Victoria (RAV) in Victoria. MAIN OUTCOME MEASURES: Response time to regain a respiratory rate greater than 10 per minute. Secondary outcome measures were proportion of patients with respiratory rate greater than 10 per minute at 8 minutes and/or a GCS score over 11 at 8 minutes; proportion requiring rescue naloxone; rate of adverse events; proportion of the IN group for whom IN naloxone alone was sufficient treatment. RESULTS: The IM group had more rapid response than the IN group, and were more likely to have more than 10 spontaneous respirations per minute within 8 minutes (82% v 63%; P = 0.0173). There was no statistically significant difference between the IM and IN groups for needing rescue naloxone (13% [IM group] v 26% [IN group]; P = 0.0558). There were no major adverse events. For patients treated with IN naloxone, this was sufficient to reverse opiate toxicity in 74%. CONCLUSION: IN naloxone is effective in treating opiate-induced respiratory depression, but is not as effective as IM naloxone. IN delivery of naxolone could reduce the risk of needlestick injury to ambulance officers and, being relatively safe to make more widely available, could increase access to life-saving treatment in the community.
Language eng
Field of Research 1117 Public Health And Health Services
1103 Clinical Sciences
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2005, Medical Journal of Australia
Persistent URL http://hdl.handle.net/10536/DRO/DU:30089912

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