title: Intravenous use of intranasal naloxone: A case of overdose reversal.
abstract: Opioid overdose is a growing concern in the United States and internationally. Prehospital or pre-medical personnel (layperson) administration of naloxone, an opioid antagonist, to reverse overdose, is an expanding mode of harm reduction. Recently, community clinics, methadone clinics, needle exchanges, some pharmacies, and other health care facilities have made naloxone available to the community.
  
  
  
  This case describes heroin overdose reversal of a 28-year-old male who had been using about a gram of heroin intravenously for 3 years but recently reduced frequency of use in an attempt to stop. He was seen initially 1 week prior to a buprenorphine induction in our clinic. After the initial intake, he used intravenous heroin, a larger amount than over the past several weeks in anticipation of abstinence, lost consciousness, and was difficult to arouse. A friend with him noted the patient's respirations to become shallow and administered naloxone nasal spray that the patient had obtained from a needle exchange, but did so intravenously by attaching an unused drug needle to the syringe barrel in place of the nasal atomizer. The patient's overdose was reversed and he recovered.
  
  
  
  This is the first known published case of a community-distributed naloxone nasal spray being used intravenously by a layperson (bystander). The case emphasizes the efficacy of naloxone in overdose reversal and also the need for education or instructions on naloxone use by others (not just the user). Finally, it highlights the risk of overdose in those entering treatment, seeking intoxication one last time.
authors.affiliation: a Department of Addiction Psychiatry , University of California San Francisco , San Francisco , California , USA.|b Department of Psychiatry and Behavioral Sciences , Stanford University School of Medicine , Palo Alto , California , USA.|c Department of Psychiatry , University of California San Francisco , San Francisco , California , USA.|d San Francisco VA Medical Center , San Francisco , California , USA.
authors.forename: Smita
authors.initials: S
authors.lastname: Das
authors.affiliation: e Chemical Dependency Recovery Program, Kaiser Permanente San Francisco Medical Center , San Francisco , California , USA.
authors.forename: Nina
authors.initials: N
authors.lastname: Shah
authors.affiliation: a Department of Addiction Psychiatry , University of California San Francisco , San Francisco , California , USA.|f Department of Addiction Medicine , Kaiser Permanente San Francisco Medical Center , San Francisco , California , USA.
authors.forename: Murtuza
authors.initials: M
authors.lastname: Ghadiali
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D062787:Drug Overdose / Q000188:drug therapy*; D003932:Heroin / Q000008:administration & dosage / Q000037:antagonists & inhibitors* / Q000633:toxicity; D006801:Humans; D008297:Male; D009270:Naloxone / Q000008:administration & dosage / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D059085:Nasal Sprays
chemical_list: D009292:Narcotic Antagonists; D059085:Nasal Sprays; D009270:Naloxone; D003932:Heroin
keywords: Drug overdose; harm reduction; naloxone; opiate dependence