Intended for healthcare professionals

Rapid response to:


Emergency naloxone for heroin overdose

BMJ 2006; 333 doi: (Published 21 September 2006) Cite this as: BMJ 2006;333:614

Rapid Response:

Sould it be available over the counter? Not without proper evidence!

While Naloxone is a good drug for resuscitation we should beware its
other characteristics. Naloxone has a short half life and so may give
unskilled users a false sense of security, introducing a “secondary opiate
overdose” particularly when used to treat overdose with a long acting
opiate such as Methadone.
The authors cite 440 “reversals” (an unfortunate misnomer for a
competitive antagonist) of 6,000 doses distributed: what happened to the
other 5,560 doses? There is a risk that these were used to avoid calling
emergency services (Drug users associate emergency ambulance services with
police),or that unsuccessful use was unreported and that some patients
died despite attempted inhibition: how many died after “reversal” or
required further “reversal”?. Furthermore, opiate blocking drugs can
provide a useful punishment tool for drug dealers who may use the drug as
a method of ensuring compliance with their demands.
Elsewhere in this issue Professor Ian Roberts, an epidemiologist, (1)
warns that “anecdotal evidence could be highly misleading” citing the use
of albumin in resuscitation and steroids in head injury. Richard Lehman
(2) opines that “In the current political climate it would take
considerable optimism to expect that health policy might be governed by
evidence alone. It is the urgent responsibility of our professional
leadership to mark out where the evidence lies.”
While it may be reasonable to research the wider availability of Naloxone,
we need to understand the overall clinical effect, addressing the negative
as well as the positive effects of such a change before adding to the
illicit drug cocktail available on the street.

(1) Dyer O “British Soldiers are guinea pigs for use of new clotting
agent" BMJ volume 333 p 616 23 Sep 2006

(2) Lehman R “ Doctors Must debate hospital closures” BMJ volume 333
p 661 23 Sep 2006

Competing interests:
None declared

Competing interests: No competing interests

23 September 2006
Andrew J Ashworth
General Practitioner
Davidsons Mains Medical Centre, 5 Quality Street, EDINBURGH EH4 5BP