Naloxone: Silver Bullet or Tool in the Shed?

Is naloxone the silver bullet? Well maybe the silver bullet du jour. I think the biggest challenges with respect to naloxone are the educational hurdles because unlike the EpiPen, naloxone is intended to be administered by someone else not the patient. So that means that the burden of determining an appropriate candidate for administration, determining the fact that naloxone needs to be administered has to be done by someone who is not the patient and the question in my mind is, how does that education take place? How does it take place on a wide enough spectrum to enable somebody to administer it in the correct setting at the right time in the right place? It’s a big challenge and I don’t see a lot taking place with respect to education about the administration of the medication, let alone what the potential risks are to giving it to someone who is physiologically dependent on an opioid medication. The administration of naloxone could precipitate withdrawal instantaneously and somebody needs to know how to deal with the consequences of that.

It's important to remember that reversing respiratory depression does not equal reversing overdose. Prince, for example, experienced a respiratory arrest on a plane and naloxone was administered to him. He got to a hospital, where presumably he was on naloxone infusion and then he checked himself out of the hospital a day and a half later and overdosed. Naloxone can be a component of a broader risk management strategy due to what I call the new math of risk benefit analysis that says we need to consider the societal impact of the prescription. And when you think about the societal impact, that could mean that you need to think about when you’re writing the opioid prescription that you may bring up naloxone to be kept in the household in the event that somebody gets their hand on that medication and suffers unintended consequences. So it’s a component but it’s only a component in the context of a much, much broader initiative.