Naloxone Infusions for Opioid Overdose: A 10-Year Retrospective Analysis

While most clinicians are familiar with the use of naloxone in the setting of opioid overdose, little is published regarding the real-world use of naloxone infusions.

To describe naloxone infusion use over a 10-year period as well as the clinical decision-making surrounding their utilization.

All cases of naloxone infusions administered at two academic medical centers from January 1, 2014 to January 31, 2023 were reviewed and the medical records abstracted for demographics and naloxone infusion data. Patients less than 18 years old, administered naloxone infusions for indications other than opioid overdose, or not initially emergency department patients were excluded.

In total, 43 patients constituting 44 cases were identified, with a median age of 36 years; 83.7% were male. The most self-reported exposure was fentanyl, most commonly by ingestion. The majority (93.2%) received in-hospital naloxone, with a median total dose of 2 mg. The median time from arrival to initiation was 151 minutes and the median duration of infusion was 284 minutes. The infusion dose remained unchanged until discontinuation for a majority (70.5%) of infusions. The median naloxone infusion dose administered was 4 mg, with a median 8 mg wasted. In terms of disposition, 20 were discharged from the emergency department, three left against medical advice, and one expired. Eighteen were admitted: six to intensive care, 11 to the intermediate care/stepdown, and one to medical-surgical/floor. The mean hospitalization was 1.7 days. Two patients were transferred and lost to follow up.

Naloxone infusions were uncommon but associated with drug waste and high resource utilization. Further studies are needed to optimize treatment strategies for prolonged opioid toxicity.