Intranasal administration of naloxone by paramedics

Naloxone is a medication that is frequently administered in the field by paramedics for suspected opioid overdoses. Most prehospital protocols, however, require this medication to be given to patients intravenously (i.v.) or intramuscularly (i.m.). Unfortunately, intravenous line placement may be problematic and time-consuming in chronic i.v. drug users. There may also be a delay in patient response to opioid reversal with i.m. absorption of naloxone. Additionally, routine use of needles in high-risk populations poses an increased risk of occupational blood exposures to paramedics.

To prospectively test the effectiveness of intranasal (i.n.) naloxone administration by paramedics. This preliminary report summarizes the first month's experience in the city of Denver.

Naloxone was first administered to patients found unconscious in the field using a nasal mucosal atomizer device (MAD). Patients were then treated using standard prehospital protocols, which included i.v. line placement and medications, if they did not immediately respond to i.n. naloxone. Time to patient response was recorded.

A total of 30 patients received i.n. naloxone in the field over a one-month period. Of these, 11 patients responded to either i.n. or i.v. naloxone. Ten (91%) patients responded to i.n. naloxone alone, with an average response time of 3.4 minutes. Seven patients (64%) did not require an i.v. in the field after response to i.n. naloxone.

Intranasal naloxone may provide a safe, rapid, effective way to manage suspected opioid overdoses in the field. Use of this route may decrease paramedic exposures to blood-borne diseases. The addition of i.n. naloxone administration to prehospital protocols should be considered as an initial therapy for suspected opioid abusers.