King's College London, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, Addiction Sciences Building, 4 Windsor Walk, Denmark Hill, London, SE5 8BB, UK.
South London and Maudsley NHS Foundation Trust, London, UK.
Drugs. 2019 Sep;79(13):1395-1418. doi: 10.1007/s40265-019-01154-5.
Naloxone is a well-established essential medicine for the treatment of life-threatening heroin/opioid overdose in emergency medicine. Over two decades, the concept of 'take-home naloxone' has evolved, comprising pre-provision of an emergency supply to laypersons likely to witness an opioid overdose (e.g. peers and family members of people who use opioids as well as non-medical personnel), with the recommendation to administer the naloxone to the overdose victim as interim care while awaiting an ambulance. There is an urgent need for more widespread naloxone access considering the growing problem of opioid overdose deaths, accounting for more than 100,000 deaths worldwide annually. Rises in mortality are particularly sharp in North America, where the ongoing prescription opioid problem is now overlaid with a rapid growth in overdose deaths from heroin and illicit fentanyl. Using opioids alone is dangerous, and the mortality risk is clustered at certain times and contexts, including on prison release and discharge from hospital and residential care. The provision of take-home naloxone has required the introduction of new legislation and new naloxone products. These include pre-filled syringes and auto-injectors and, crucially, new concentrated nasal sprays (four formulations recently approved in different countries) with speed of onset comparable to intramuscular naloxone and relative bioavailability of approximately 40-50%. Choosing the right naloxone dose in the fentanyl era is a matter of ongoing debate, but the safety margin of the approved nasal sprays is superior to improvised nasal kits. New legislation in different countries permits over-the-counter sales or other prescription-free methods of provision. However, access remains uneven with take-home naloxone still not provided in many countries and communities, and with ongoing barriers contributing to implementation inertia. Take-home naloxone is an important component of the response to the global overdose problem, but greater commitment to implementation will be essential, alongside improved affordable products, if a greater impact is to be achieved.
纳洛酮是一种经过充分验证的基本药物，可用于治疗急诊医学中危及生命的海洛因/阿片类药物过量。二十多年来，“携带纳洛酮回家”的概念不断发展，包括向可能目睹阿片类药物过量（例如，使用阿片类药物的人的同龄人及家庭成员以及非医务人员）的人预先提供紧急供应品，并建议在等待救护车的同时，将纳洛酮给予过量用药者作为临时护理。鉴于全球每年有超过 100,000 人死于阿片类药物过量，需要更广泛地获得纳洛酮，因为阿片类药物过量死亡的问题日益严重。在北美，死亡率上升尤其明显，那里持续存在的处方类阿片类药物问题现在因海洛因和非法芬太尼导致的过量死亡人数迅速增加而加剧。单独使用阿片类药物是危险的，死亡率风险集中在某些时间和环境中，包括在监狱释放和从医院和住所护理中出院时。携带纳洛酮回家的要求引入了新的立法和新的纳洛酮产品。这些产品包括预填充注射器和自动注射器，以及至关重要的新型浓缩鼻喷雾剂（最近在不同国家批准的四种配方），其起效速度与肌肉内纳洛酮相当，相对生物利用度约为 40-50%。在芬太尼时代，选择正确的纳洛酮剂量是一个持续存在的争论，但批准的鼻喷雾剂的安全裕度优于临时制作的鼻套件。不同国家的新立法允许在柜台销售或其他无需处方的提供方式。然而，获取纳洛酮的机会仍然不平衡，许多国家和社区仍未提供携带纳洛酮回家，而且持续存在的障碍也阻碍了实施。携带纳洛酮是应对全球过量问题的重要组成部分，但如果要取得更大的影响，就需要对实施做出更大的承诺，同时还需要改进负担得起的产品。
