Most people mention the overdose scene in Pulp Fiction, but the one in Bringing Out the Dead is far more accurate

Born Jacob Fiszman in 1930
fled the Nazis when he was 8 part of his childhood in Shanghai before earning his doctorate in Chemistry in America

While working in a private lab on opiate derivatives, he and his colleagues discovered naloxone a relatively pure antagonist

Stepson died of a heroin overdose in Florida, a state where acess to naloxone is still restricted

Lock and key for receptors, gas as effect.
Heroin - gassed up and ready for Vegas (have to refuel)
Morphine - shorter trip, turn down the volume on the radio
Buprenorphine - speed limiter

Along with speed and distraction come rise in death - respiratory depression, forget to breathe.

Lock and key for receptors, gas as effect.
Heroin - gassed up and ready for Vegas (have to refuel)
Morphine - shorter trip, turn down the volume on the radio
Buprenorphine - speed limiter

Along with speed and distraction come rise in death - respiratory depression, forget to breathe.

Rapidly absorbed.
Multiple routes of administration
Virtually no side effects
Non toxic if given for the wrong reasons
Cheap
0.4 to 2 mg to as much as needed for methadone, buprenorphine overdose. Repeat in 1 hour or use infusion.
Disadvantages
Not well absorbed through the gut
Lasts for one hour.
Not effective against coingestants.

Intranasal naloxone is the way forward.

The use of needles increases the barriers for naloxone use by first responders. The response to this has been automated and protected needle systems such as the .... plus intranasal delivery.

Intranasal delivery offers rapid absorption, with clinical efficacy similar to that of the subcutaneous route.

Intranasal delivery is less likely to precipitate withdrawal

Less is more - results can be achieved with as little as 0.04 mg iv naloxone.

Focus on reversal of respiratory drive, less on CNS.

Concerns about increased sympathetic drive after reversal of overdose - decrease acidemia prior to reversal by bagging patient.

Discharge after 1 hour

For patients that have a decreased level of consciousness but are still ventilating. Patients can remove the mask when they are sufficiently awake.

http://www.ncbi.nlm.nih.gov/pubmed/10601678
Oral naloxone reverses opioid-associated constipation

http://blog.ercast.org/the-constipation-manifesto/

120 Deaths from Fentanyl in Alberta in 2014, 50 in the first two months of 2015

The introduction of Oxyneo brought more people to heroin, hydromorphone and fentanyl

Distributing naloxone involves a significant paradigm shift. As opposed to virtually all other medications, naloxone is rarely administered by the person for whom it is prescribed.

Introduces liability, legal and philosophical issues.

Ideally should be OTC, but difficult with needled systems.

EHS services - still limited in scope of practice

RNs in BC - just given approval from their College for naloxone

Pharmacy issued -problems with FDA
Community naloxone distribution
stigma
Providing access to prescription drug users

Automatic systems vs intranasal

Doctor vs nurse vs pharmacist vs community volunteer.

Just getting out of jail or halfway house.

Prescription opiate users, particularly opiate, benzodiazepine coingestors

EHS and first respinders are concerned about refusal of transport after reversal of opiate overdose. There has not been an increased mortality found in those who refuse transport, although observation and reassessment at one hour has been demonstrated to be sound clinical practice.

Good Samaritan legislation must protect first responder as well as community naloxone administration.

Decreased cost of transport

Evzio costs $30 to manufacture and contains $00.30 of naloxone. The Evzio was being priced at $600 for distribution to first responders.

Even the cost of nasal kits has risen significantly with the adoption by first responder services.

Danish design company has a prototype for a wearable naloxone device.