title: Intranasal naloxone is a viable alternative to intravenous naloxone for prehospital narcotic overdose.
abstract: OBJECTIVE
  To compare the prehospital time intervals from patient contact and medication administration to clinical response for intranasal (IN) versus intravenous (IV) naloxone in patients with suspected narcotic overdose.
  
  
  METHODS
  This was a retrospective review of emergency medical services (EMS) and hospital records, before and after implementation of a protocol for administration of intranasal naloxone by the Central California EMS Agency. We included patients with suspected narcotic overdose treated in the prehospital setting over 17 months, between March 2003 and July 2004. Paramedics documented dose, route of administration, and positive response times using an electronic record. Clinical response was defined as an increase in respiratory rate (breaths/min) or Glasgow Coma Scale score of at least 6. Main outcome variables included time from medication to clinical response and time from patient contact to clinical response. Secondary variables included numbers of doses administered and rescue doses given by an alternate route. Between-group comparisons were accomplished using t-tests and chi-square tests as appropriate.
  
  
  RESULTS
  One hundred fifty-four patients met the inclusion criteria, including 104 treated with IV and 50 treated with IN naloxone. Clinical response was noted in 33 (66%) and 58 (56%) of the IN and IV groups, respectively (p = 0.3). The mean time between naloxone administration and clinical response was longer for the IN group (12.9 vs. 8.1 min, p = 0.02). However, the mean times from patient contact to clinical response were not significantly different between the IN and IV groups (20.3 vs. 20.7 min, p = 0.9). More patients in the IN group received two doses of naloxone (34% vs. 18%, p = 0.05), and three patients in the IN group received a subsequent dose of IV or IM naloxone.
  
  
  CONCLUSIONS
  The time from dose administration to clinical response for naloxone was longer for the IN route, but the overall time from patient contact to response was the same for the IV and IN routes. Given the difficulty and potential hazards in obtaining IV access in many patients with narcotic overdose, IN naloxone appears to be a useful and potentially safer alternative.
authors.affiliation: Department of Emergency Medicine, UCSF-Fresno, Medical Education Program, Fresno, California 93701, USA.
authors.forename: Tania Mieke
authors.initials: TM
authors.lastname: Robertson
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Hendey
authors.forename: Geoff
authors.initials: G
authors.lastname: Stroh
authors.forename: Marc
authors.initials: M
authors.lastname: Shalit
mesh_terms: D000281:Administration, Intranasal; D000293:Adolescent; D000328:Adult; D000368:Aged; D002140:California; D062787:Drug Overdose / Q000628:therapy*; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009270:Naloxone / Q000008:administration & dosage*; D009292:Narcotic Antagonists / Q000008:administration & dosage*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D009292:Narcotic Antagonists; D009270:Naloxone