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Rapid response to:

Editorials

Emergency naloxone for heroin overdose

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7569.614 (Published 21 September 2006) Cite this as: BMJ 2006;333:614

Rapid Response:

Risk Versus Benefit of Naloxone

Sir,

We have concerns regarding the potential side-effects resulting from
widespread use of naloxone in the drug-using community, as reported by
Strang et al.(1) Naloxone is a potent opiate antagonist with a relatively
short half-life compared to street heroin, as has already been highlighted
in earlier correspondance.(2) Previous case reports (3-5) have reported
severe pulmonary oedema, hypertensive crises and arrhythmias, all related
in time to naloxone use. Good evidence is lacking as not only can heroin,
(and its cutting agents), cause similar presentations, but furthermore the
patients involved are a difficult group to study.

Before we make naloxone freely available to the drug-using community,
it is imperative we are confident that the risks of widespread use, by
this particular patient group, do not outweigh the benefits. Furthermore,
we would suggest that, prior to introduction of this scheme, there is
clear evidence supporting over-the-counter naloxone compared to paramedic
use alone.

Dr Kate Tatham, SHO

Dr Nick Bunker, SpR

Anaesthetics & ITU, Ealing Hospital

1. Strang J, Kelleher M, Best D, Mayet S, Manning V. Emergency
naloxone for heroin overdose. BMJ 2006;333: 614-5. (23 September.)

2. A. J Ashworth. Emergency naloxone for heroin overdose: Beware of
naloxone's other characteristics. BMJ, October 7, 2006; 333(7571): 754 -
754.

3. Flacke JW, Flacke WE, Williams GD. Acute pulmonary edema following
naloxone reversal of high-dose morphine anesthesia. Anesthesiology
1977;47:376–8.

4. Lawrence JR, Lee FR. Ventricular fibrillation after narcotic
withdrawal (letter). Lancet 1975;2:717

5. Levin ER, Sharp B, Drayer JIM, et al. Case report: severe
hypertension induced by naloxone. Am J Med Sci 1985;290:70–2.

Competing interests:
None declared

Competing interests: No competing interests

25 October 2006
Kate C Tatham
SHO Anaesthetics & ITU
Nick J Bunker
Ealing Hospital, UB1 3HW