"Traditionally, the opiate antagonist naloxone has been administered parenterally; however, intranasal (i.n.) administration has the potential to reduce the risk of needlestick injury. This is important when working with populations known to have a high prevalence of blood-borne viruses," investigators in Australia report (see also Naloxone Therapy).

"Preliminary research suggests that i.n. administration might be effective, but suboptimal naloxone solutions were used. This study compared the effectiveness of concentrated (2 mg/ml) i.n. naloxone to intramuscular (i.m.) naloxone for suspected opiate overdose. This randomized controlled trial included patients treated for suspected opiate overdose in the pre-hospital setting. received 2 mg of either i.n. or i.m. naloxone. The primary outcome was the proportion of patients who responded within 10 minutes of naloxone treatment. included time to adequate response and requirement for supplementary naloxone. Data were analysed using multivariate statistical techniques. A total of 172 patients were enrolled into the study. Median age was 29 years and 74% were male. Rates of response within 10 minutes were similar: i.n. naloxone (60/83, 72.3%) compared with i.m. naloxone (69/89, 77.5%) [difference: -5.2%, 95% confidence interval (CI) -18.2 to 7.7]. No difference was observed in mean response time (i.n.: 8.0, i.m.: 7.9 minutes; difference 0.1, 95% CI -1.3 to 1.5). Supplementary naloxone was administered to fewer patients who received i.m. naloxone (i.n.: 18.1%; i.m.: 4.5%) (difference: 13.6%, 95% CI 4.2-22.9). Concentrated intranasal naloxone reversed heroin overdose successfully in 82% of patients," wrote D. Kerr and colleagues, Victoria University.

The researchers concluded: "Time to adequate response was the same for both routes, suggesting that the i.n. route of administration is of similar effectiveness to the i.m. route as a first-line treatment for heroin overdose."

Kerr and colleagues published their study in Addiction (Randomized controlled trial comparing the effectiveness and safety of intranasal and intramuscular naloxone for the treatment of suspected heroin overdose. Addiction, 2009;104(12):2067-2074).

For additional information, contact D. Kerr, Victoria University, School Nursing & Midwifery, Bldg 4, McKechnie St., St. Albans, Vic 3021, Australia.

The publisher of the journal Addiction can be contacted at: Wiley-Blackwell Publishing, Inc., Commerce Place, 350 Main St., Malden 02148, MA, USA.