Health Management Associates, 2501 Woodlake Cir Suite 100, Okemos, MI 48864, USA.
University of Pittsburgh School of Public Health, Behavioral and Community Health Sciences, 130 DeSoto Street 6127 Public Health, Pittsburgh, PA 15261, USA.
Int J Drug Policy. 2024 Nov;133:104587. doi: 10.1016/j.drugpo.2024.104587. Epub 2024 Sep 18.
High dose and long-acting opioid overdose reversal drugs can precipitate withdrawal in people who are opioid dependent. Products recently brought to market for community use in the United States (US) have drawn international concern because of their increased risk of withdrawal. At the March 18-19, 2024, Compassionate Overdose Response Summit & Naloxone Dosing Meeting, a panel of harm reduction experts issued the following call to action: 1) people who use drugs should be directly involved in decisions regarding the research, development, selection, and distribution of opioid overdose reversal products; 2) regulatory agencies and pharmaceutical manufacturers should carefully consider and communicate the risk and duration of withdrawal associated with higher dose and longer-acting opioid antagonists; 3) take-home naloxone kits should include at least two doses of an intramuscular (IM) product containing 0.4 mg or an intranasal (IN) product containing ≤4 mg; 4) At this time, high dose and long-acting opioid antagonists have no use in acute opioid overdose response; and, 5) overdose response educational materials, instructions on overdose response, and training should emphasize the restoration of breathing, avoiding withdrawal, and compassionate post-overdose support and care. High dose and long-acting opioid overdose reversal drugs were approved without testing for withdrawal and are often aggressively marketed despite decades of evidence from naloxone distribution programs worldwide that the ideal dose of naloxone is one that restores breathing without inducing withdrawal. Government agencies should direct resources to harm reduction programs to make standard dose take-home naloxone products widely available among people who use drugs. Lay bystanders, people who use drugs, their families, and professional first responders can learn and apply a compassionate approach to opioid overdose response.
高剂量和长效阿片类药物过量逆转药物可导致阿片类药物依赖者戒断。最近在美国推向市场的用于社区使用的产品引起了国际关注，因为它们增加了戒断的风险。在 2024 年 3 月 18 日至 19 日的富有同情心的过量反应峰会和纳洛酮给药会议上，一组减少伤害专家发出了以下行动呼吁：1）使用毒品的人应直接参与有关阿片类药物过量逆转产品的研究、开发、选择和分发的决策；2）监管机构和制药商应仔细考虑并沟通与更高剂量和更长作用阿片类拮抗剂相关的戒断风险和持续时间；3）带回家的纳洛酮套件应至少包含两剂含有 0.4 毫克的肌肉内（IM）产品或含有 ≤4 毫克的鼻内（IN）产品；4）目前，高剂量和长效阿片类拮抗剂在急性阿片类药物过量反应中没有用途；5）过量反应教育材料、过量反应说明和培训应强调恢复呼吸、避免戒断以及富有同情心的事后支持和护理。高剂量和长效阿片类药物过量逆转药物在没有测试戒断的情况下获得批准，并且尽管全球数十年的纳洛酮分发计划都有证据表明，理想的纳洛酮剂量是一种既能恢复呼吸又不引起戒断的剂量，但它们仍经常被积极推销。政府机构应将资源用于减少伤害计划，以使标准剂量的家用纳洛酮产品在使用毒品的人中广泛可用。旁观者、使用毒品的人、他们的家人和专业急救人员可以学习并应用富有同情心的阿片类药物过量反应方法。
