In the January 2015 ACEP Now article “True Cost of Stopping Overdoses,” Paul Kivela, MD, MBA, PhD, discussed several issues related to naloxone administration and sustainability of naloxone programs.1 Many of his concerns are the focus of existing and emerging policies and research. His piece highlighted how important it is for emergency physicians to be familiar with the literature and practice regarding prehospital naloxone use.
Naloxone has been used for more than 40 years and distributed through community-based programs since 1996. Many emergency physicians have worked with first responders to expand naloxone access. Recognizing the lifesaving potential of increased naloxone access, ACEP approved two related resolutions in 2014: to train and equip first responders with naloxone and to expand pharmacy-based naloxone provision and education. This year, ACEP will develop a clinical policy on emergency physicians’ prescribing naloxone.2 As we move forward in supporting expanded naloxone use, it is critically important for us to have a nuanced understanding of the existing literature.
Few Dangers With Prehospital Administration
Emergency medical services (EMS) providers are very experienced and familiar with naloxone administration and side effects. Research on EMS prehospital naloxone use has shown that serious complications, including violence and needle sticks, are rare.3 The most common side effect is precipitated opioid withdrawal, which is not life-threatening and is less likely with lower doses and intranasal administration.4,5