Take home naloxone for opiate addicts

BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7318.934 (Published 20 October 2001) Cite this as: BMJ 2001;323:934

Drug misusers may benefit from training in cardiopulmonary resuscitation

  1. Colin A Graham, specialist registrar in accident and emergency medicine (ColinGraham@bigfoot.com),
  2. Gordon W McNaughton, consultant in accident and emergency medicine,
  3. Alastair J Ireland, consultant in accident and emergency medicine,
  4. Kerry Cassells, staff nurse
  1. Victoria Infirmary, Glasgow G42 9TY
  2. Royal Alexandra Hospital, Paisley PA2 9PN
  3. Glasgow Royal Infirmary, Glasgow G4 0SF
  4. Glasgow Drug Problem Service, Woodside Health Centre, Glasgow G20 7LR
  5. Emergency Medicine Department, Sir Charles Gairdner Hospital, Perth 6009, Western Australia, Australia
  6. General Hospital, St Helier, Jersey JE1 3QS
  7. Forth Valley Community Drug and Alcohol Service, Bannockburn Hospital, Bannockburn FK7 8AH
  8. National Addiction Centre (Institute of Psychiatry and the Maudsley), London SE5 8AF

    EDITOR—Dettmer et al report encouraging initial results of a scheme to give take home naloxone to opiate addicts.1 They also refer to training opiate misusers in resuscitation as part of the project. In 1997 we conducted a pilot study of cardiopulmonary resuscitation training in Glasgow, where the incidence of sudden death due to drug misuse is high.

    Of the nine volunteers who agreed to participate in the study (all opiate misusers), eight had witnessed a drug overdose. Six described unconsciousness and seven described cyanosis in the victims. The methods used to stimulate the victims ranged from physical stimulation (for example, slapping) (n=6) to injecting intravenous amphetamine (n=1) or using a spoon to prevent tongue swallowing (n=1). Emergency services had been called in five cases. Only one volunteer reported attempting cardiopulmonary resuscitation.

    All volunteers were assessed with a validated scoring system before and after a standard basic life support teaching session.2 The group's mean penalty score fell from 94 (range 25-120) to 11 (range 0-20) (P<0.001, paired t test for sample means). The two instructors who did the testing and training confirmed that in the test after the instruction all volunteers performed to the standard expected for the Resuscitation Council (UK) advanced life support course.

    Most drug misusers in our pilot study had witnessed an overdose, and take home naloxone or cardiopulmonary resuscitation may therefore be useful in Glasgow. We are concerned that not all the misusers called for immediate help, but other studies have suggested that this may be due to fear of the police becoming involved.3

    Our pilot study showed that this vulnerable group can be trained in basic life support to an acceptable level. If enough drug misusers could be trained in cardiopulmonary resuscitation this might be …

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