Naloxone Should Be Administered in Prehospital Settings, but Evidence for Optimal Management Is Lacking

The use of naloxone for the reversal of opioid overdose is standard practice in emergency departments and by emergency medical services (EMS) personnel. However, questions regarding specific aspects of its use in prehospital settings remain. These authors conducted a high-quality systematic review to address the comparative benefits and harms of (1) various routes of administration, (2) various doses, (3) different timing of repeat doses, and (4) transporting versus not transporting patients to a healthcare facility after overdose reversal.

Of 13 studies identified, all were methodologically flawed, and none addressed dosing or timing of repeat doses. One randomized controlled trial showed that higher-concentration 2-mg/mL intranasal naloxon…