Opioid overdoses are sometimes fatal due to respiratory and then cardiac arrest. Overdoses can occur with all opioids, whether illicit or prescribed: heroin, morphine, oxycodone, methadone, codeine, tramadol, etc.

Naloxone, an opioid antidote, is effective in reducing mortality from opioid overdose, provided it is administered promptly. Often, opioid overdoses occur in the presence of witnesses. Several countries have developed programmes to provide naloxone intramuscular injection kits to persons likely to witness an opioid overdose, in particular the families and friends of opioid-dependent individuals. The aim is to enable them to administer naloxone quickly, before the arrival of the emergency services. These programmes have shown that naloxone kits help reduce mortality.

In France, a naloxone spray is now available. The onset of action of naloxone by the nasal route appears to be a few minutes slower than that of the intramuscular route. However, according to several studies in real-life situations, when naloxone is made available to those likely to witness an opioid overdose, the efficacy of nasal administration in reducing mortality is similar to that of intramuscular administration.

This spray should to be offered to patients at risk of overdose and those close to them, with precise instructions on its use. In practice, it would be useful to facilitate access to it for all those in a position to act, including opioid users, their families, healthcare professionals, teachers, firefighters, police and nightclub personnel.

©Prescrire 1 December 2018

"Nasal naloxone (Nalscue°) in opioid overdose. Opioid antidote nasal spray, useful and convenient in an emergency" Prescrire Int 2018; 27 (199): 285-287. (Pdf, subscribers only).

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