Intravenous vs Subcutaneous Naloxone for Out-of-hospital Management of Presumed Opioid Overdose

Authors

  • Karen Wanger MDCM,

    Corresponding author
    1. British Columbia Ambulance Service, Vancouver, BC, Canada
    2. St. Paul's Hospital, Vancouver, BC, Canada, Department of Emergency Medicine
    3. University of British Columbia, Vancouver, BC, Canada.
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  • Laura Brough BSc, EMA II,

    1. British Columbia Ambulance Service, Vancouver, BC, Canada
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  • Ian Macmillan EMA II,

    1. British Columbia Ambulance Service, Vancouver, BC, Canada
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  • Jim Goulding MD,

    1. British Columbia Ambulance Service, Vancouver, BC, Canada
    2. St. Paul's Hospital, Vancouver, BC, Canada, Department of Emergency Medicine
    3. University of British Columbia, Vancouver, BC, Canada.
    4. Capital Health Region, Victoria, BC, Canada, Department of Emergency Medicine.
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  • Iain MacPhail MD, MHSc,

    1. Paramedic Academy, Justice Institute of British Columbia, Vancouver, BC, Canada
    2. University of British Columbia, Vancouver, BC, Canada.
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  • James M. Christenson MD

    1. British Columbia Ambulance Service, Vancouver, BC, Canada
    2. St. Paul's Hospital, Vancouver, BC, Canada, Department of Emergency Medicine
    3. University of British Columbia, Vancouver, BC, Canada.
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Regional Medical Consultant, B.C. Ambulance Service, 1203–601 West Broadway, Vancouver, BC, V5Z 4C2, Canada. Fax: 604–660–6702; e-mail: karen.wanger@moh.hnet.bc.ca

ABSTRACT

Objective: To determine whether naloxone administered IV to out-of-hospital patients with suspected opioid overdose would have a more rapid therapeutic onset than naloxone given subcutaneously (SQ).

Methods: A prospective, sequential, observational cohort study of 196 consecutive patients with suspected opioid overdose was conducted in an urban out-of-hospital setting, comparing time intervals from arrival at the patient's side to development of a respiratory rate ≥10 breaths/min, and durations of bag-valve-mask ventilation. Subjects received either naloxone 0.4 mg IV (n= 74) or naloxone 0.8 mg SQ (n= 122), for respiratory depression of <10 breaths/min.

Results: Mean interval from crew arrival to respiratory rate ≥ 10 breaths/min was 9.3 ± 4.2 min for the IV group vs 9.6 ± 4.58 min for the SQ group (95% CI of the difference -1.55, 1.00). Mean duration of bag-valve-mask ventilation was 8.1 ± 6.0 min for the IV group vs 9.1 ± 4.8 min for the SQ group. Cost of materials for administering naloxone 0.4 mg IV was $12.30/patient, compared with $10.70/patient for naloxone 0.8 mg SQ.

Conclusion: There was no clinical difference in the time interval to respiratory rate ≥10 breaths/min between naloxone 0.8 mg SQ and naloxone 0.4 mg IV for the out-of-hospital management of patients with suspected opioid overdose. The slower rate of absorption via the SQ route was offset by the delay in establishing an IV.

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