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Wodarz, Norbert; Wolstein, Jörg; Wodarz-von Essen, Heike; Pogarell, Oliver (2019): Naloxon – Medizinische Grundlagen und internationale Erfahrungen. In: Sucht-Zeitschrift für Wissenschaft und Praxis, Vol. 65, No. 5: pp. 335-342
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Abstract

Introduction: Opioid addiction is associated with substantial morbidity rates while opioid overdoses carry a high risk of mortality. The so-called "opioid crisis" is a major issue in the USA;however, in Germany a steady rise in deaths by opioid overdoses has been reported in recent years as well. The death rate by overdose is mainly related to a respiratory depression which requires immediate emergency treatment. Apart from conventional first aid the use of opioid antagonists, such as naloxone, has to be considered. Methods: Literature search via PubMed, Cochrane Library and International Standard Randomized Controlled Trial Number (ISRCTN) Register. Results: Due to ethical reasons, there are few systematic studies with some limitations covering the non-medical use of naloxone in opioid overdose. Nevertheless, intranasal naloxone seems to have similar efficacy to that of intramuscular naloxone. Considering the limited evidence, there seems to be a low mortality rate (1 %) after successful reversal of opioid overdose without hospital transport or close monitoring and a low risk of rebound, if vital parameters are normal and the Glasgow Coma Scale scores 15 or higher 60 min after naloxone administration. Prevalence of naloxone-induced opioid withdrawal depends on dose and consumed opioid, and the dose of naloxone administered. Conclusions: Recently developed novel routes of administration of naloxone (e.g. via nasal spray) may complement actions of first aid by laypersons. Supporting measures might be very helpful, such as specific trainings for different target groups to promote a broad implementation of "Take-Home Naloxone" as one measure to reduce mortality from opioid overdose.