Key Considerations for Providing Naloxone

SEPTEMBER 07, 2016
Katie Eder, Director of Content
The opioid overdose death toll has been steadily increasing for more than a decade, making it a leading cause of accidental death in the United States.
In an effort to help reduce opioid-related death, the FDA approved naloxone auto-injector (Evzio) and naloxone nasal spray (Narcan) for take-home use for the emergency treatment of opioid overdose (Table). Both products can reverse the effects of opioids, including respiratory depression, sedation, and hypotension.
Table: Evzio and Narcan Comparison
  Evzio Narcan
Administration Auto-injector Intranasal
Key Attributes ·  Audio directions guide caregivers on proper administration
·  Trainer device accompanies each carton
·  Manufacturer has offered a free carton to all US high schools
·  Ease of administration + low cost
Potential Disadvantages ·  Audio directions only available in English
·  High cost
·  Intranasal adverse effects
·  Potential absorption concern in users whose nasal mucosa may be damaged from drug snorting, obstructed by vomit during overdose, or experiencing severe rhinitis
Notably, naloxone has been used for more than 40 years to reverse respiratory depression during opioid-related emergencies. Prior to the approval of Evzio and Narcan, the medication had to be administered as an intravenous (IV) injection, which was problematic for 2 reasons: 1) peripheral venous access may be difficult to obtain in IV drug abusers, making the medication difficult to administer, and 2) exposure to the affected patient’s blood could mean exposure to a blood-borne disease like hepatitis or HIV.
All forms of naloxone carry a warning of causing withdrawal in opioid-dependent patients, but as Juliana Zschoche, PharmD, emergency medicine clinical pharmacy specialist at Johns Hopkins Hospital, put it during PAINWeek 2016, “I would rather a patient be in withdrawal than not breathing.”