| Background The illicit drug supply across the United States and in Michigan has become increasingly adulterated with fentanyl and other synthetic opioids which in turn has led to higher rates of overdoses. The prevalence and potency of these drugs has raised national concern over the effectiveness of standard dose naloxone (4mg) for opioid overdose reversal. Get Naloxone Now! Key Takeaways Standard dose naloxone (4mg) is a proven and effective opioid overdose reversal medication. It is the most cost-effective and evidence-based medication available for management of acute opioid overdose.New high dose naloxone formulation and non-naloxone opioid reversal medications are not proven to be any more effective at increasing rates of opioid overdose reversal and are associated with more withdrawal symptoms. They should not be considered replacements for naloxone at standard doses. New Opioid Overdose Reversal Medications (OORMS) Several new medications are available and being marketed as better agents to manage opioid overdose as fentanyl use has increased nationally. These agents include high dose naloxone formulations and non-naloxone opioid overdose reversal medications, namely nalmefene. However, current data suggests these medications: Are no more effective at increasing overdose reversal rates than naloxone 4mg. Can increase the likelihood of experiencing opioid withdrawal symptoms. Are more expensive than naloxone 4mg, even if multiple repeat doses are needed to achieve overdose reversal. Naloxone is Still Effective! Get Naloxone Now! A recently published report by the Michigan Department of Health and Human Services that analyzed EMS responses to opioid overdoses in Michigan (2019-2023) found that despite the increase in fentanyl-related fatal overdoses, paramedics continued to administer an average of 2.7mg of naloxone per patient and treat and transport well over 80% of patients. This report indicates the continued effectiveness of standard formulations of naloxone, regardless of changes in the illicit drug supply. Conclusions Providers should continue to prescribe naloxone 4mg for all patients who use opioids. Providers can assure and educate patients and their families on the effectiveness of naloxone for overdose reversal, even with increased fentanyl presence in the illicit drug supply. Additional Resources Fentanyl and Naloxone – What You Need to KnowTrends in Paramedic Naloxone Administration and Patient Outcomes Throughout Increased Fentanyl UseAmerican College of Medical Toxicology & American Academy of Clinical Toxicology Joint Position Statement: Nalmefene Should Not Replace Naloxone as the Primary Opioid Antidote at This Time. ReferencesData Brief on post-naloxone Symptoms Among People Administered 8mg vs. 4mg Intranasal Naloxone – New York State (NYS), 2022-23 https://www.health.ny.gov/diseases/aids/general/opioid_overdose_prevention/docs/naloxone_data_brief.pdfPayne ER, Stancliff S, Rowe K, Christie JA, Dailey MW. Comparison of Administration of 8-Milligram and 4-Milligram Intranasal Naloxone by Law Enforcement During Response to Suspected Opioid Overdose – New York, March 2022 – August 2023. MMWR Morb Mortal Wkly Rep 2024;73:110-113. DOI:https://dx.doi.org/10.15585/mmwr.mm7305a4Lemen, P.M., Garrett, D.P., Thompson, E. et al. High-dose naloxone formulations are as not essential as we thought. Harm Reduct J 21, 93 (2024). https://doi.org/10.1186/s12954-024-00994-zAlexander F. Infante, Abigail T. Elmes, Renee Petzel Gimbar, Sarah E. Messmer, Christine Neeb, Jennie B. Jarrett, Stronger, longer, better opioid antagonists? Nalmefene is NOT a naloxone replacement, International Journal of Drug Policy, Volume 124, 2024, 104323, ISSN 0955-3959, https://doi.org/10.1016/j.drugpo.2024.104323Michigan Department of Health and Human Services. Trends in paramedic naloxone administration and patient outcomes throughout increased fentanyl use. Retrieved from https://www.michigan.gov/opioids/-/media/Project/Websites/opioids/documents/Trends-in-Paramedic-Naloxone-Administration-and-Patient-Outcomes-Throughout-Increased-Fentanyl-Use.pdf?rev=ea27b2337933494ea2980e978b02a5db |
