Changes Over Time in Naloxone Dosing and Route in Adolescent Opioid Toxicity

Adolescent opioid overdoses have increased over the past two decades. As overdoses and emergency department (ED) presentations have increased, the opioids used have changed as well. Fentanyl has replaced both oral prescription opioids and heroin as the primary drugs being used. There is debate as to the appropriate dose of naloxone needed in cases of overdose with more potent opioids.

Our objective was to characterize the use of naloxone in adolescents with opioid toxicity and determine if there was any change in use as fentanyl became more prevalent.

We performed a retrospective chart review of adolescent opioid overdoses receiving naloxone from 2014 to 2022 in eleven EDs in one health system. We compared total naloxone dose during hospitalization across the entire cohort from 2014 to 19 vs. 2020-22 and from 2014 to 20 vs. 2021-22. We additionally analyzed doses of naloxone, route of administration, initial ED dose, prehospital dose, lay dose, and whether an infusion of naloxone was started.

We identified 49 patient encounters representing 38 unique patients. Mean total naloxone dose did not differ between groups (3.1 mg (2014-20) vs. 4.4 (2021-22); p = 0.2) and neither did the number of repeat doses nor the initial ED dose. The route chosen did change over time with increased use of intranasal naloxone.

With increasing cases of opioid overdose in adolescents and despite increasing fentanyl involvement, there was no increase in the amount of naloxone used for adolescent opioid overdoses. Standard dosing of naloxone appeared to be adequate for reversal of opioid toxicity.