Prescribing Naloxone to Actively Injecting Heroin Users

Abstract Heroin overdose deaths have increased alarmingly in Chicago over the past decade. Naloxone, an opioid antagonist with no abuse potential, has been used to reverse opiate overdose in emergency medical settings for decades. We describe here a program to educate opiate users in the prevention of opiate overdose and its reversal with intramuscular naloxone. Participant education and naloxone prescription are accomplished within a large comprehensive harm reduction program network. Since institution of the program in January 2001, more than 3,500 10 ml (0.4 mg/ml) vials of naloxone have been prescribed and 319 reports of peer reversals received. The Medical Examiner of Cook County reported a steady increase in heroin overdose deaths since 1991, with a four-fold increase between 1996 and 2000. This trend reversed in 2001, with a 20% decrease in 2001 and 10% decreases in 2002 and 2003.

[1]  A. Moss,et al.  Fatal heroin-related overdose in San Francisco, 1997–2000: a case for targeted intervention , 2003, Journal of Urban Health.

[2]  G. Woody,et al.  One-year mortality rates following methadone treatment discharge. , 1998, Drug and alcohol dependence.

[3]  S. Galea,et al.  Preliminary evidence of health care provider support for naloxone prescription as overdose fatality prevention strategy in New York City , 2003, Journal of Urban Health.

[4]  K. Seal,et al.  Attitudes about prescribing take-home naloxone to injection drug users for the management of heroin overdose: a survey of street-recruited injectors in the San Francisco Bay Area , 2003, Journal of Urban Health.

[5]  L. Degenhardt,et al.  Opioid overdose mortality in Australia, 1964–1997: birth‐cohort trends , 1999, The Medical journal of Australia.

[6]  P. Oliver,et al.  Concomitant drugs of misuse and drug using behaviours associated with fatal opiate-related poisonings in Sheffield, UK, 1997-2000. , 2003, Addiction.

[7]  R. Hoffman,et al.  The poisoned patient with altered consciousness. Controversies in the use of a 'coma cocktail'. , 1995, JAMA.

[8]  A. Ritter.  Naltrexone in the Treatment of Heroin Dependence: Relationship with Depression and Risk of Overdose , 2002, The Australian and New Zealand journal of psychiatry.

[9]  J. H. Day,et al.  Diagnosis and management of anaphylaxis. , 2003, CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne.

[10]  T. Chan,et al.  Are heroin overdose deaths related to patient release after prehospital treatment with naloxone? , 1999, Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors.

[11]  T. Chan,et al.  Assessment for deaths in out-of-hospital heroin overdose patients treated with naloxone who refuse transport. , 2003, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[12]  L. Degenhardt,et al.  Ambulance calls to suspected overdoses: New South Wales patterns July 1997 to June 1999 , 2001, Australian and New Zealand journal of public health.

[13]  A. Preti,et al.  Deaths by unintentional illicit drug overdose in Italy, 1984-2000. , 2002, Drug and alcohol dependence.

[14]  P. Dargan,et al.  Discharge of patients who have taken an overdose of opioids , 2002, Emergency medicine journal : EMJ.

[15]  J. Spinelli,et al.  Early discharge of patients with presumed opioid overdose: development of a clinical prediction rule. , 2000, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[16]  D. Bigg.  Data on take home naloxone are unclear but not condemnatory , 2002, BMJ : British Medical Journal.

[17]  J. Strang,et al.  Loss of tolerance and overdose mortality after inpatient opiate detoxification: follow up study , 2003, BMJ : British Medical Journal.

[18]  K. Mackway-Jones.  Towards evidence-based emergency medicine: best BETs from the Manchester Royal Infirmary , 2000, Emergency Medicine Journal.

[19]  W. Hall,et al.  Trends in opiate overdose deaths in Australia 1979-1995. , 1998, Drug and alcohol dependence.

[20]  G. Eisenbarth,et al.  MICA polymorphism is associated with type 1 diabetes in the Korean population. , 2001, Diabetes care.

[21]  S. Lenton,et al.  Should we conduct a trial of distributing naloxone to heroin users for peer administration to prevent fatal overdose? , 2000, The Medical journal of Australia.

[22]  T. Chan,et al.  Assessment for Deaths in Out-of-hospital Heroin Overdose Patients Treated with Naloxone Who Refuse Transport , 2003 .

[23]  R. Nicklas.  The diagnosis and management of anaphylaxis , 2005 .

[24]  S. Burris,et al.  Legal aspects of providing naloxone to heroin users in the United States , 2001 .

[25]  W. Hall,et al.  The distribution of naloxone to heroin users. , 1997, Addiction.