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

TLDR

The study aimed to determine whether intravenous naloxone produces a faster therapeutic onset than subcutaneous naloxone in out‑of‑hospital patients with suspected opioid overdose. A prospective, sequential observational cohort of 196 patients compared 0.4 mg IV naloxone to 0.8 mg SQ naloxone by measuring time from crew arrival to respiratory rate ≥10 breaths/min and bag‑valve‑mask ventilation duration. Results showed no clinically significant difference in time to respiratory rate ≥10 breaths/min (9.3 ± 4.2 min IV vs 9.6 ± 4.6 min SQ) or ventilation duration (8.1 ± 6.0 min IV vs 9.1 ± 4.8 min SQ), with IV costing $12.30 versus $10.70 per patient, leading to the conclusion that IV and SQ routes are equivalent in out‑of‑hospital overdose management.

Abstract

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.