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EMedHome's Clinical Pearl

A Needleless Approach for Reversing Opioid OD

Emergency Medicine News: May 2020 - Volume 42 - Issue 5 - p 22
doi: 10.1097/01.EEM.0000666340.83094.1f


    The nebulization of naloxone provides a unique and effective way to reverse opioid intoxication by a needleless and noninvasive approach. (Am J Emerg Med. 2013;31[3]:585.) Nebulized naloxone allows the patient to self-titrate the administration and take off the mask when awake and alert, avoiding violent withdrawal symptoms. (J Community Hosp Intern Med Perspect. 2019;9[5]:422;; J Emerg Med. 2003;24[2]:185.)

    Peripheral IV access can also be difficult to obtain in patients with a history of IV drug abuse, making needleless routes of naloxone administration useful. Naloxone administration via the intranasal and sublingual routes is limited by lack of titration to patients' response, so withdrawal is precipitated or an inadequate reversal response is produced. (J Community Hosp Intern Med Perspect. 2019;9[5]:422;

    Nebulized naloxone has been reported to have a time of onset of two to five minutes. (Prehosp Emerg Care. 2012;16[2]:289.) Naloxone, when administered by the nebulized route, acts at the pulmonary opioid receptors and has systemic absorption, both playing a role in reversing intoxication. Usually 2 mg naloxone is added to 5 mL of normal saline and administered using a standard nebulizer mask (the side ports are partially occluded with tape to decrease the escape of nebulized naloxone). (Ann Pharmacother. 2018;52[5]:495.)

    The minimum respiratory rate that will still allow successful resuscitation with nebulized naloxone administration has yet to be determined.

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