Higher Doses of Opioid Reversal Agent Offer No Clear Benefit


TOPLINE:

A new report from the US Centers for Disease Control and Prevention (CDC) showed that administering an 8 mg dose of intranasal naloxone does not increase the odds of surviving an opioid overdose; a higher dose than the usual 4 mg may result in a greater risk for onset of opioid withdrawal symptoms.

METHODOLOGY:

  • The Morbidity and Mortality Weekly Report from the CDC presents data from a New York State Department of Health initiative.
  • New York State Police troops administered either 8 mg or 4 mg doses of intranasal naloxone in response to suspected opiate overdose cases between March 2022 and August 2023.
  • People who had died before the administration of the naloxone were excluded from the study.
  • A total of 354 people were included in the study, 101 of whom received an 8 mg dose, while the others received the usual 4 mg dosage.
  • Police officers documented the behavior and symptoms of people after receiving each dose, which could have included vomiting, disorientation, refusal to be transported to an emergency department, lethargy, and anger or combativeness.

TAKEAWAY:

  • Survival rates were nearly identical regardless of intranasal naloxone dosage: 99% of people who received 8 mg compared with 99.2% of those who received 4 mg of the drug.
  • Opioid withdrawal signs, including vomiting, were more prevalent among 8 mg naloxone recipients (37.6%) than among 4 mg recipients (19.4%) (risk ratio [RR], 2.51; P < .001).
  • Police officers documented that people who received 8 mg were more frequently displayed anger or combativeness after revival than those who received the lower dose (RR, 1.42; P = .37).

IN PRACTICE:

The study “suggests that there are no benefits to law enforcement administration of higher-dose naloxone…even in light of the increased prevalence of synthetic opioids, including fentanyl, in the drug supply.”

SOURCE:

Emily R. Payne, MSPH, of the New York State Department of Health was the lead author of the study published in the Morbidity and Mortality Weekly Report on February 8, 2024.

LIMITATIONS:

The sample size of people receiving 8 mg doses was not equal to that of those receiving the usual dosage. Additionally, medical professionals did not report on the symptoms and behavior of people after receiving naloxone, law enforcement workers did, and may not have accurately captured what was occurring. In addition, researchers lacked complete data on the substances people used before an overdose, and the results may only be generalizable to New York State.

DISCLOSURES:

Study author Sharon Stancliff reported institutional support from the New York State Stewardship Funding Harm Reduction. No other potential conflicts of interest were disclosed.



Source link : https://www.medscape.com/viewarticle/higher-dose-naloxone-has-no-impact-overdose-survival-2024a10002yj?src=rss

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Publish date : 2024-02-12 06:52:15

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