Deal Us In
What You Need To Know
Higher dose naloxone is expensive and dangerous. People deserve a choice in formulation, but in order to reach naloxone saturation IM naloxone should be prioritized.
We should be funding the purchase of formularies that effectively meet the needs of individuals that have overdosed and invest back into the harm reduction community such as RiViveTM and Remedy Alliance
One common misunderstanding is that a higher dose, or multiple doses in quick succession, makes naloxone work faster or that the overdose reversal was only successful based on the number of doses used. This misunderstanding is exploited by manufacturers of higher-dose naloxone products.
All formulations and potencies of naloxone take 1-3 minutes (average) to begin to take effect–sometimes longer–and any form of naloxone may possibly require a subsequent dose after the first few minutes, depending on the overdose.
When the naloxone reaches peak concentration (approximately 30 mins for 4mg nasal and 25 mins for IM) an opioid dependent person may feel varying intensity of withdrawal symptoms depending on the quantity of naloxone administered.
Bigger doses cause worse withdrawal symptoms. Extreme withdrawal experiences are potentially dangerous, painful and traumatizing. It can result in negative feelings towards naloxone and people who administered it, or result in more concealment of drug use to avoid having naloxone administered.
The introduction of an 8 mg IN naloxone product and the potential future introduction of a similarly potent nalmefene product with longer duration of action could plausibly lead some people who use opioids to avoid carrying it.
Here is what participants told Michigan Drug Users Health Alliance about how it felt to be revived with high dose naloxone:
Where to Go for More Information
High Dose Naloxone: Is It Evidence Based? - While fentanyl and its analogs are extremely potent, there is little to no evidence to validate the claim that high-dose naloxone is useful.
Programs To Know
Research
Survey participants with lived/living experience chose commonly used naloxone products over an alternative longer acting and/or stronger overdose reversal agent. - Michigan Drug Users Health Alliance
Increasingly powerful opioid antagonists are not necessary. Hill LG, Zagorski CM, Loera LJ.Int J Drug Policy. 2022 Jan;99:103457
American College of Medical Toxicology and the American Academy of Clinical Toxicology Position Statement: Nalmefene Should Not Replace Naloxone as the Primary Opioid Antidote at This Time Position Statement. Journal of Medical Toxicology, 12 October 2023
Amount of naloxone used to reverse opioid overdoses outside of medical practice in a city with increasing illicitly manufactured fentanyl in illicit drug supply. Bell A, Bennett AS, Jones TS, Doe-Simkins M, Williams LD. Subst Abus. 2019;40(1):52-55.
Examination of naloxone dosing patterns for opioid overdose by emergency medical services in Kentucky during increased fentanyl use from 2018 to 2021. Peter Rock, Svetla Slavova, Philip M. Westgate, Aisaku Nakamura, Sharon L. Walsh, Drug and Alcohol Dependence, Volume 255, 2024.
Post-Naloxone Symptoms Among People Administered 8mg vs. 4mg Intranasal Naloxone—New York State (NYS), 2022-23 Data Brief—September 2023.
NEMSIS Naloxone Administrations (average 1.2 doses)
Naloxone Dosing After Opioid Overdose in the Era of Illicitly Manufactured Fentanyl. Carpenter J, Murray BP, Atti S, Moran TP, Yancey A, Morgan B. J Med Toxicol. 2020 Jan;16(1):41-48.
Adverse events related to bystander naloxone administration in cases of suspected opioid overdose in British Columbia: An observational study. Moustaqim-Barrette A, Papamihali K, Williams S, Ferguson M, Moe J, Purssell R, et al PLOS ONE 16(10 2021.
Modeling of overdose and naloxone distribution in the setting of fentanyl compared to heroin
Comparison of rates of opioid withdrawal symptoms and reversal of opioid toxicity in patients treated with two naloxone dosing regimens: a retrospective cohort study2021, Clinical toxicology (Philadelphia, Pa.)
Naloxone–does over-antagonism matter? Evidence of iatrogenic harm after emergency treatment of heroin/opioid overdose. 2015, Addiction (Abingdon, England)
Nobody wants to be Narcan'd: A pilot qualitative analysis of drug users’ perspectives on naloxone. 2021, The western journal of emergency medicine
Reasons people who use opioids do not accept or carry no-cost naloxone: Qualitative interview study. 2020, JMIR formative research