title: Intranasal naloxone delivery is an alternative to intravenous naloxone for opioid overdoses.
abstract: BACKGROUND
  This study proposes that intranasal (IN) naloxone administration is preferable to intravenous (IV) naloxone by emergency medical services for opioid overdoses. Our study attempts to establish that IN naloxone is as effective as IV naloxone but without the risk of needle exposure. We also attempt to validate the use of the Glasgow Coma Scale (GCS) in opioid intoxication.
  
  
  METHODS
  A retrospective chart review of prehospital advanced life support patients was performed on confirmed opioid overdose patients. Initial and final unassisted respiratory rates (RR) and GCS, recorded by paramedics, were used as indicators of naloxone effectiveness. The median changes in RR and GCS were determined.
  
  
  RESULTS
  Three hundred forty-four patients who received naloxone by paramedics from January 1, 2005, until December 31, 2007, were evaluated. Of confirmed opioid overdoses, change in RR was 6 for the IV group and 4 for the IN group (P = .08). Change in GCS was 4 for the IV group and 3 for the IN group (P = .19). Correlations between RR and GCS for initial, final, and change were significant at the 0.01 level (rho = 0.577, 0.462, 0.568, respectively).
  
  
  CONCLUSIONS
  Intranasal naloxone is statistically as effective as IV naloxone at reversing the effects of opioid overdose. The IV and IN groups had similar average increases in RR and GCS. Based on our results, IN naloxone is a viable alternative to IV naloxone while posing less risk of needle stick injury. Additionally, we demonstrated that GCS is correlated with RR in opioid intoxication.
authors.affiliation: Department of Emergency Medicine and Pediatrics, University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School, New Brunswick, USA. merlinma@umdnj.edu
authors.forename: Mark A
authors.initials: MA
authors.lastname: Merlin
authors.forename: Matthew
authors.initials: M
authors.lastname: Saybolt
authors.forename: Raffi
authors.initials: R
authors.lastname: Kapitanyan
authors.forename: Scott M
authors.initials: SM
authors.lastname: Alter
authors.forename: Janos
authors.initials: J
authors.lastname: Jeges
authors.forename: Junfeng
authors.initials: J
authors.lastname: Liu
authors.forename: Susan
authors.initials: S
authors.lastname: Calabrese
authors.forename: Kevin O
authors.initials: KO
authors.lastname: Rynn
authors.forename: Rachael
authors.initials: R
authors.lastname: Perritt
authors.forename: Peter W
authors.initials: PW
authors.lastname: Pryor
mesh_terms: D000281:Administration, Intranasal; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D062787:Drug Overdose / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000008:administration & dosage*; D009292:Narcotic Antagonists / Q000008:administration & dosage*; D009293:Opioid-Related Disorders / Q000188:drug therapy*; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
chemical_list: D009292:Narcotic Antagonists; D009270:Naloxone