Emergency naloxone for heroin overdose: Beware of naloxone's other characteristics

doi:10.1136/bmj.333.7571.754-a

BMJ 2006;333:754 (7 October), doi:10.1136/bmj.333.7571.754-a

Letter

Emergency naloxone for heroin overdose

Beware of naloxone's other characteristics

The first 150 words of the full text of this article appear below.

EDITOR—While naloxone is a good drug for resuscitationwe should beware its other characteristics.¹ Naloxone has ashort half life and so may give unskilled users a false senseof security, introducing a "secondary opiate overdose," particularlywhen used to treat overdose with a long acting opiate such asmethadone. The authors cite 440 "reversals" (an unfortunatemisnomer for a competitive antagonist) of 6000 doses distributed:what happened to the other 5560 doses? There is a risk thatthese were used to avoid calling emergency services as drugusers associate emergency ambulance services with police. Orunsuccessful use may have been unreported and some patientsdied despite attempted inhibition. How many died after "reversal"or required further "reversal"? Furthermore, opiate blockingdrugs can provide a useful punishment tool for drug dealerswho may use the drug as a method of ensuring compliance withtheir demands.

In the same . . . [Full text of this article]

Andrew J Ashworth, general practitioner

Davidson's Mains Medical Centre, Edinburgh EH4 5BP Andrew.Ashworth@lothian.scot.nhs.uk

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