INTRODUCTION:
Naloxone is an opioid antagonist that is used for the reversal of opioid toxicity as it binds to the same opioid receptors but instead of activating it, it blocks the activation and produces a reverse effect. Naloxone challenge test is used for the assessment of opioid dependence (Resources, February 20, 2020).
One of the three routes can administer naloxone: Intravenous, Subcutaneous, or Intramuscular. When a patient reports an adequate period of abstinence also has a negative report of a urine test for morphine, methadone, buprenorphine, and oxycodone then this test is performed to confirm the abstinence (Wermeling, 2015).
In a 20 to 30-minute time period, if the patient does not suffer from withdrawal effects, that means the report is negative. Once negative does not give the guarantee that the patient will not experience withdrawal effects when tested with naltrexone (SAMHSA, 2018).
The symptoms to be monitored are sneeze, cough, yawn, lacrimation, shivering, restlessness, sweating, vomiting, gooseflesh (Judson, Himmelberger, & Goldstein, 1980).
INTRAVENOUS ADMINISTRATION:
1. 0.8 mg of naloxone is drawn into a sterile syringe then injected 0.2 of it intravenously.
2. Wait for 30 seconds for the symptoms to appear, if they do appear stop injecting and treat the signs or symptoms.
3. If no symptoms occur, inject the remaining 0.6 mg and wait for 20 minutes. Vitals should be checked regularly in between and monitor for withdrawal symptoms.
4. If withdrawal occurs, stop naloxone challenge and treat symptomatically and repeat the test in 24 hours or otherwise start the opioid agonist treatment.
5. If there are no withdrawal symptoms, naltrexone should be started at a 25 mg dose for two consecutive days followed by 50 mg daily.
6. Instruct the patient for the risk of overdose and death if they tend to use the opioids again.
SUBCUTANEOUS ADMINISTRATION:
1. First, inject the naloxone at 0.8 mg dose subcutaneously
2. Wait for 20 minutes, check all the vitals in between, and observe the symptoms of withdrawal.
3. If they appear, stop the test and treat symptomatically, the test can be repeated in 24 hours.
4. If there are no withdrawal symptoms, naloxone is injected at 25 mg dose for the first two days and then 50 mg afterward daily.
Immediate response on overdose patients:
The patient can face unconsciousness, hypoxic, and can be unable to attend in case of overdose or discontinuation of medicine. The quick care for the first responder suspecting an opioid overdose patient are as follows:
1. Sense opioid overdose: check for sub consciousness, pale color, slow breathing
2. Call EMS (emergency medical service) to get the medical attention
3. Administer Naloxone
4. Do passive breathing in case the patient could hardly breath
5. Repeat the dose after 5 min until the EMS arrives in case the situation isn’t under control
Naloxone is currently only available is injection form which is proving to be a hindrance in its expansion. There are certain risks implied by injection administration e.g. needlestick injury, HIV infection. Thus, it raises concerns with the application via medical providers, or at home family member or even by first responders. Medical directors to choose a needle free way of administration e.g. nasal spray are investigating alternative routes. However, all the alternatives must have a safe way to go about and be effective.
