Intranasal naloxone and related strategies for opioid overdose intervention by nonmedical personnel: a review.

IF 5.1 Q1 SUBSTANCE ABUSE
Substance Abuse and Rehabilitation Pub Date : 2017-10-11 eCollection Date: 2017-01-01 DOI:10.2147/SAR.S101700
Christa R Lewis, Hoa T Vo, Marc Fishman
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引用次数: 39

Abstract

Deaths due to prescription and illicit opioid overdose have been rising at an alarming rate, particularly in the USA. Although naloxone injection is a safe and effective treatment for opioid overdose, it is frequently unavailable in a timely manner due to legal and practical restrictions on its use by laypeople. As a result, an effort spanning decades has resulted in the development of strategies to make naloxone available for layperson or "take-home" use. This has included the development of naloxone formulations that are easier to administer for nonmedical users, such as intranasal and autoinjector intramuscular delivery systems, efforts to distribute naloxone to potentially high-impact categories of nonmedical users, as well as efforts to reduce regulatory barriers to more widespread distribution and use. Here we review the historical and current literature on the efficacy and safety of naloxone for use by nonmedical persons, provide an evidence-based discussion of the controversies regarding the safety and efficacy of different formulations of take-home naloxone, and assess the status of current efforts to increase its public distribution. Take-home naloxone is safe and effective for the treatment of opioid overdose when administered by laypeople in a community setting, shortening the time to reversal of opioid toxicity and reducing opioid-related deaths. Complementary strategies have together shown promise for increased dissemination of take-home naloxone, including 1) provision of education and training; 2) distribution to critical populations such as persons with opioid addiction, family members, and first responders; 3) reduction of prescribing barriers to access; and 4) reduction of legal recrimination fears as barriers to use. Although there has been considerable progress in decreasing the regulatory and legal barriers to effective implementation of community naloxone programs, significant barriers still exist, and much work remains to be done to integrate these programs into efforts to provide effective treatment of opioid use disorders.

鼻内纳洛酮和相关策略对非医务人员阿片类药物过量干预:综述
处方和非法阿片类药物过量造成的死亡一直在以惊人的速度上升,特别是在美国。虽然纳洛酮注射是一种安全有效的阿片类药物过量治疗方法,但由于法律和实际限制,外行人使用纳洛酮往往无法及时获得。因此,经过几十年的努力,已经开发出了使纳洛酮可供外行人使用或“带回家”使用的策略。这包括开发对非医疗使用者更容易管理的纳洛酮配方,例如鼻内和自动注射肌内给药系统,努力将纳洛酮分发给潜在的高影响类别的非医疗使用者,以及努力减少监管障碍,以更广泛地分发和使用。在这里,我们回顾了关于纳洛酮非医务人员使用的有效性和安全性的历史和当前文献,提供了关于不同配方的纳洛酮带回家安全性和有效性的争议的循证讨论,并评估了目前努力增加其公共分配的状况。当非专业人员在社区环境中给药时,带回家的纳洛酮对治疗阿片类药物过量是安全有效的,缩短了阿片类药物毒性逆转的时间,减少了阿片类药物相关死亡。补充战略共同显示出增加纳洛酮带回家传播的希望,包括1)提供教育和培训;2)分发给关键人群,如阿片类药物成瘾者、家庭成员和急救人员;3)减少处方障碍;4)减少法律上的指责恐惧作为使用的障碍。尽管在减少有效实施社区纳洛酮项目的监管和法律障碍方面取得了相当大的进展,但仍存在重大障碍,将这些项目纳入有效治疗阿片类药物使用障碍的努力中仍有许多工作要做。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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16 weeks
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