Letters

Data on take home naloxone are unclear but not condemnatory

BMJ 2002; 324 doi: https://doi.org/10.1136/bmj.324.7338.678 (Published 16 March 2002) Cite this as: BMJ 2002;324:678
  1. Dan Bigg, director (cra{at}attglobal.net)
  1. Chicago Recovery Alliance, PO Box 368069, Chicago, IL 60636, USA

    EDITOR—In Chicago we have been teaching active opiate injectors how to manage overdoses for some time, providing naloxone to appropriate people, as has been discussed in these letters columns.1 This programme now uses two physician volunteers who fill in the legally required prescription.

    To date, we have reached over 550 people with this intervention and have received reports of 52 uses of naloxone in physically unresponsive and usually cyanotic peers. All the uses were successful, but people were disturbed by the experience. They may have been intellectually pleased that their peer was alive and that they had helped in such a way, but both the person who had taken the overdose and the person who had given naloxone were in no hurry to repeat the incident. Expecting the availability of naloxone to minimise someone's inhibitions about using it ignores the fact that using naloxone is unpleasant for all. An intramuscular dose of 1 ml greatly reduces aftereffects and, in our programme, did not produce an opiate use response thanks to peer support during the interval from naloxone use to its wearing off.

    Also, the availability of naloxone is something most people writing to the BMJ would probably not think about twice if it were for their own protection. How could such a clear personal protection be distorted into such maltreatment of others?

    The science of the practice is limited, and there are few well-designed studies on this work. This is a result of not just its novelty but also the resistance of funding bodies and many researchers to study this controversial practice. Funding of good research on and practice in using a strategy based on common sense such as take home naloxone is in short supply. Our programme receives no external funding, but it needs such attention to grow and develop. Being opposed to a potentially life saving practice in the absence of data proving it wrong is a dangerous proposition. Unclear data should lead to unclear conclusions, not condemnation.

    References

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