Accurate Education – Naloxone

For the Emergency Management of Opioid Overdose

Due to the nationwide increase in accidental or unintentional overdoses from opioid pain medications, it is now recommended that anyone prescribed opioid pain medications be provided with an emergency treatment option to prevent unnececessary death from overdose. The purpose in providing this emergency treatment option to pain management patients is not necessarily based on the likelihood of the pain patient overdosing, since they are well-educated and informed regarding the safe dosing of opioids. Rather, it is related to the accidental, unexpected or unintended ingestion of the medications by someone else in the household such as a house guest, family member or visitor to the home that somehow acquires access to the medication. Even a family dog or cat!

In the event of overdose, a lay-person can treat the victim with the naloxone which reverses the overdose effects of the opioid, including impaired breathing and low blood pressure. This action when performed in a timely manner can save someone’s life by providing the time necessary for EMTs to arrive and provide definitive management for the victim. And yes, the medicine is safe and effective for dogs and cats  also.

Injectable Versions

Evzio® (Rx)

Similar to the concept of providing patients with a history of life-threatening allergic reactions with “Epi-pen” kits for use in a life-threatening allergic reaction, patients treated with opioids can be prescribed pre-filled  device containing Naloxone (Evzio®). The Evzio device is a self-contained injectable version of naloxone with a retracted needle that allows for safe injection with minimal risk to the provider for accidental needle stick. The Evzio kit comes with two single-use devices to allow for a second dose to be given when necessary. The Evzio device is covered with minimal to no co-pay (less than $10 in most cases) with most insurers including many medicaid and medicare policies. 

Compounded Naloxone (Rx)

The most inexpensive version of naloxone can be purchased with a prescription from a compounding pharmacy that will provide a needle, syringe and vial of naloxone that can be drawn up and injected intramuscularly into the victim’s thigh as needed. The usual cost will be in the neighborhood of $30.

Intranasal Spray Naloxone (OTC and Rx)

Another convenient option for delivering naloxone is a nasal spray version that is available by prescription or OTC. This option can be purchased at any CVS pharmacy in LA. without a prescription for about $35. This option offers the advantage of being needle-less but may not provide as good systemic availability in the event of significant nasal obstruction due to excessive nasal secretions. It may be more difficult to administer to a small dog or cat.

Recommendations

Whatever affordable option proves best, it is strongly recommended that every patient prescribed opioids in monthly quantities consider keeping one in their home. When possible, Dr. Ehlenberger advises the use of the Evzio device because of the added convenience and safety with its use. Our staff can provide instructions for the easy administration of the medication.

Recognizing the Life-threatening Opioid Overdose

Naloxone is indicated as an emergency intervention only in the case of severe opioid overdose. Mild symptoms of excessive opioid dosing that is associated with slurred speech, impaired coordination and mild drowsiness do not require naloxone. When signs of life-threatening opioid overdose are present, however, one should not hesitate to provide naloxone.

Signs and symptoms of life-threatening opioid overdose may include:

•            Cold, clammy skin

•            Weakness

•            Constricted, pin-point pupils

•            Hypotension (low blood pressure)

•            Loss of consciousness/unresponsiveness

•            Respiratory depression – slow and/or shallow breathing

Most life-threatening overdoses involve more than one drug. If it is uncertain which drug or drugs are involved, it is still appropriate to consider using naloxone if the severity of overdose appears life-threatenng. In the case of a mixed overdose with an opioid plus an additional sedative(s) such as alcohol, Soma or a benzodiazepine like Xanax, Valium or Klonopin, while the naloxone will not reverse the additional sedatives, just reversing the contribution of the opioid component to the overdose symptoms may still provide an improved outcome and reduced risk of fatality. In the event that an overdose of unknown sedatives in the absence of opioids is treated with naloxone, there will be no benefit but also no harm. When in doubt, it is therefore best to err on the side of possible benefit rather than withold treatment.

In the absence of opioids, naloxone is safe and will have no effect when given to someone. The only exception to this is when it is given to someone physically dependent on opioids, such as the chronic pain patient who takes daily opioids for pain management or who takes Suboxone daily for opioid addiction. The use of naloxone in such an opioid-dependent individual will precipitate an immediate, severe opioid withdrawal syndrome in the individual. While not likely to result in life-threatening results, the recipient of the naloxone in this circumstance will experience severe nausea, vomiting, diarrhea and feel really bad. They will not be happy about receiving the naloxone but their symptoms will resolve within the hour.

Good Samaritan Law

For those who fear the possibility of being sued in the event of a naloxone intervention with an undesirable outcome, relax. Good Samaritan laws hold a person harmless and immune against lawsuit or criminal charges as long as the individual acts in good faith with reasonable cause.