title: Can nebulized naloxone be used safely and effectively by emergency medical services for suspected opioid overdose?
abstract: BACKGROUND
  Emergency medical services (EMS) traditionally administer naloxone using a needle. Needleless naloxone may be easier when intravenous (IV) access is difficult and may decrease occupational blood-borne exposure in this high-risk population. Several studies have examined intranasal naloxone, but nebulized naloxone as an alternative needleless route has not been examined in the prehospital setting.
  
  
  OBJECTIVE
  We sought to determine whether nebulized naloxone can be used safely and effectively by prehospital providers for patients with suspected opioid overdose.
  
  
  METHODS
  We performed a retrospective analysis of all consecutive cases administered nebulized naloxone from January 1 to June 30, 2010, by the Chicago Fire Department. All clinical data were entered in real time into a structured EMS database and data abstraction was performed in a systematic manner. Included were cases of suspected opioid overdose, altered mental status, and respiratory depression; excluded were cases where nebulized naloxone was given for opioid-triggered asthma and cases with incomplete outcome data. The primary outcome was patient response to nebulized naloxone. Secondary outcomes included need for rescue naloxone (IV or intramuscular), need for assisted ventilation, and adverse antidote events. Kappa interrater reliability was calculated and study data were analyzed using descriptive statistics.
  
  
  RESULTS
  Out of 129 cases, 105 met the inclusion criteria. Of these, 23 (22%) had complete response, 62 (59%) had partial response, and 20 (19%) had no response. Eleven cases (10%) received rescue naloxone, no case required assisted ventilation, and no adverse events occurred. The kappa score was 0.993.
  
  
  CONCLUSIONS
  Nebulized naloxone is a safe and effective needleless alternative for prehospital treatment of suspected opioid overdose in patients with spontaneous respirations.
authors.affiliation: Department of Emergency Medicine, Cook County Hospital, Chicago, IL 60612, USA. josephmweber@yahoo.com
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Weber
authors.forename: Katie L
authors.initials: KL
authors.lastname: Tataris
authors.forename: Joyce D
authors.initials: JD
authors.lastname: Hoffman
authors.forename: Steven E
authors.initials: SE
authors.lastname: Aks
authors.forename: Mark B
authors.initials: MB
authors.lastname: Mycyk
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000368:Aged; D000701:Analgesics, Opioid / Q000506:poisoning*; D015331:Cohort Studies; D062787:Drug Overdose / Q000188:drug therapy; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000008:administration & dosage*; D009292:Narcotic Antagonists / Q000008:administration & dosage*; D009330:Nebulizers and Vaporizers; D009293:Opioid-Related Disorders / Q000188:drug therapy; D012189:Retrospective Studies; D018570:Risk Assessment; D017751:Safety Management; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone