Emergency naloxone for heroin overdose: Naloxone is not the only opioid antagonist

doi:10.1136/bmj.333.7571.754-b

BMJ 2006;333:754-755 (7 October), doi:10.1136/bmj.333.7571.754-b

Letter

Emergency naloxone for heroin overdose

Naloxone is not the only opioid antagonist

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

EDITOR—Strang et al say that naloxone is an extraordinarilyeffective drug, presumably meaning that at adequate doses italways reverses opioid effects.¹ (Incidentally, why does one400 µg ampoule cost the NHS about £5 when it sellsfor a small fraction of that in other European countries?) Whethernaloxone saves lives in opioid overdose when publicly distributedis, as they recognise, still unproved. Intuitively, it seemsworth doing (and monitoring), especially if combined with educatingrelevant peer groups about airways and resuscitation.

However, naloxone is not the only extraordinarily effectiveopioid antagonist. Apart from the possible advantages in acuteopioid overdose of nalmefene, with its longer half-life, almostcomplete prevention of opioid overdose and of relapse to heroinfor many months after detoxification are now demonstrably possiblewith long-acting naltrexone implants.² Since the authors notethat opioid overdose is particularly dangerous in detoxified,non-tolerant addicts, and since naltrexone . . . [Full text of this article]

Colin Brewer, research director

Stapleford Centre, London SW1W 9NP cbrewer@doctors.net.uk

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