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Heroin Addiction and Related Clinical Problems: 2019, 21, N1 (pages: 5 - 10)

Improving Response Capacities in Opioid Overdose Management

Cozzolino E., D'Egidio P.F., De Facci R., Leonardi C., Nava F., Stella L., and Maremmani I.

Summary: The recreational use of opioids is increasing in Italy as elsewhere in Europe and so the prevention of opioid overdose (OD) deaths remains a major challenge for addiction services. In Italy, the availability of the opiate antagonist naloxone, the standard treatment for OD, is generally limited to the emergency and first aid system with an uneven distribution of Take Home Naloxone programmes (THN). Naloxone rapidly counteracts opiate overdose; it is non-addictive and generally safe with no side effects. The availability of naloxone in the shortest possible time is directly associated with subject survival. The new intranasal formulation of naloxone offers an easier and safer administration compared with previous injectable formulations. It has a rapid onset of effect and its pharmacokinetic profile is similar to intramuscularly administered naloxone. However, it is more acceptable due to the elimination of needles for administration and this also eliminates the concept of restriction of expanded access based on the provision of needles. The OD epidemic is fought not only by distributing naloxone, but also through complex educational and social strategies. THN programs have overcome legal barriers in many countries. The intranasal formulation has the potential to further simplify the process of access. This paper discusses the existing barriers to wider access of naloxone, including misconceptions about naloxone. It describes how the advent of intranasal naloxone can help to simplify the delivery process by providing a more effective and appropriate solution to OD. In turn, this may also facilitate the implementation of THN programmes that reach more affected individuals and help to save more lives. More extensive distribution of naloxone (including of the intranasal spray formulation) to target groups and populations has the potential to reduce mortality and other consequences of OD.