Abdelal Randa, Banerjee A Raja, Carlberg-Racich Suzanne, Darwaza Neyla, Ito Diane, Epstein Josh
Hikma Pharmaceuticals USA Inc, Berkeley Heights, NJ, USA.
Hikma Specialty USA Inc, Berkeley Heights, NJ, USA.
Subst Abus. 2022;43(1):774-784. doi: 10.1080/08897077.2021.2010252.
A growing challenge in the opioid epidemic is the rise of highly potent synthetic opioids, (i.e., illicitly manufactured fentanyl [IMF]) entering the US non-prescription opioid market. Successful reversal may require multiple doses of naloxone, the standard of care for opioid overdose. We conducted a narrative literature review to summarize the rates of multiple naloxone administrations (MNA) for opioid overdose reversal. : A MEDLINE search was conducted for published articles using MESH search terms: opioid overdose, naloxone and multiple naloxone administration. Of the 2,101 studies identified, articles meeting inclusion/exclusion criteria were reviewed, categorized by primary and secondary outcomes of interest and summarized by data source and study design. : A total of 24 articles meeting eligibility criteria were included. Among EMS-based studies, MNA rates ranged from 9% to 53%; in general, bystander-reported studies were notably higher, from 16% to 89%. Variation in study design, data sources, year and geography, may have contributed to these ranges. Three studies that included longitudinal results reported a significant percent increase between 26% and 43% in annual MNA rates or a significant increase in mean naloxone doses over time ( < .001). : This summary found that multiple naloxone administrations during opioid overdose encounters vary widely, have occurred in up to 89% of all opioid overdoses, and have significantly increased over time. Higher naloxone formulations may fulfill an unmet need in opioid overdose reversals, given the rising rates of overdoses involving IMF. Further studies are needed to gain a better understanding of MNA during opioid overdose encounters, particularly across a wider geographic region in the US in order to inform continuing efforts to combat the opioid epidemic.
阿片类药物流行中一个日益严峻的挑战是，高效合成阿片类药物（即非法制造的芬太尼[IMF]）进入美国非处方阿片类药物市场。成功逆转可能需要多次使用纳洛酮，这是阿片类药物过量的标准治疗方法。我们进行了一项叙述性文献综述，以总结阿片类药物过量逆转时多次使用纳洛酮（MNA）的比例。：使用医学主题词（MESH）检索词对MEDLINE上发表的文章进行检索：阿片类药物过量、纳洛酮和多次使用纳洛酮。在检索到的2101项研究中，对符合纳入/排除标准的文章进行了综述，根据感兴趣的主要和次要结果进行分类，并按数据来源和研究设计进行总结。：总共纳入了24篇符合资格标准的文章。在基于紧急医疗服务（EMS）的研究中，MNA比例从9%到53%不等；一般来说，旁观者报告的研究比例明显更高，从16%到89%。研究设计、数据来源、年份和地理位置的差异可能导致了这些范围。三项包含纵向结果的研究报告称，年度MNA比例显著增加了26%至43%，或者随着时间的推移平均纳洛酮剂量显著增加（P<0.001）。：本综述发现，阿片类药物过量事件中多次使用纳洛酮的情况差异很大，在所有阿片类药物过量事件中高达89%，并且随着时间的推移显著增加。鉴于涉及IMF的过量用药率不断上升，更高剂量的纳洛酮制剂可能满足阿片类药物过量逆转中未得到满足的需求。需要进一步研究，以更好地了解阿片类药物过量事件中的MNA情况，特别是在美国更广泛的地理区域，以便为抗击阿片类药物流行的持续努力提供信息。
