Administration of naloxone to prevent opioid overdose

Intranasal administration of naloxone was found in a review with meta-analysis (Yousefifard et al., 2020) to be as effective as intramuscular/intravenous administration in the pre-hospital management of opioid overdose:

• the success rate (defined as the recovery of patients’ consciousness and spontaneous respiration) of the intranasal and intramuscular/intravenous administration of naloxone was 82.54% (95% CI: 57.97 to 97.89%) and 80.39% (95% CI: 57.38 to 96.04%) respectively with no difference between the two routes (OR=1.01; 95% CI: 0.42 to 2.43; P=0.98).
• the prevalence of major side-effects was non-significant for both intranasal (0.00%) and intramuscular/intravenous (0.05%) routes and there was no difference in the prevalence of major (OR=1.18; 95% CI: 0.38 to 3.69; P=0.777) and minor (OR=0.64; 95% CI: 0.17 to 2.34; P=0.497) side-effects between the two routes.

The odds of needing a rescue dose was 2.17 times higher for intranasal naloxone than intramuscular/intravenous naloxone (OR=2.17; 95% CI: 1.53 to 3.09; P<0.0001), however since it does not require intravenous access and its re-administration does not cause serious complications, this limitation does not seem major enough to prevent its use.