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Clinical Toxicology Volume 59, 2021 - Issue 1
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Clinical Research

Comparison of rates of opioid withdrawal symptoms and reversal of opioid toxicity in patients treated with two naloxone dosing regimens: a retrospective cohort study

Roy Purssella Department of Emergency Medicine, University of British Columbia, Vancouver, Canada;b British Columbia Drug and Poison Information Centre, British Columbia Centre for Disease Control, Vancouver, CanadaCorrespondence[email protected]
,
Jesse Godwina Department of Emergency Medicine, University of British Columbia, Vancouver, Canada;b British Columbia Drug and Poison Information Centre, British Columbia Centre for Disease Control, Vancouver, Canada
,
Jessica Moea Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
,
Jane Buxtonc School of Population and Public Health, University of British Columbia, Vancouver, Canada
,
Alexis Crabtreec School of Population and Public Health, University of British Columbia, Vancouver, Canada
,
Andrew Kestlera Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
,
Chris DeWitta Department of Emergency Medicine, University of British Columbia, Vancouver, Canada;b British Columbia Drug and Poison Information Centre, British Columbia Centre for Disease Control, Vancouver, Canada
,
Frank Scheuermeyera Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
,
Shannon Erdelyia Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
,
Robert Balshawd Department of Community Health Sciences, Faculty of Health Sciences, College of Medicine, University of Manitoba, Winnipeg, Canada
,
Adrianna Rowea Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
,
Christopher K. Cochranea Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
,
Benjamin Nga Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
,
Andy Jianga Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
,
Alessia Risie Faculty of Pharmacy, University of British Columbia, Vancouver, Canada
,
Vi Hoa Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
&
Jeffrey R. Brubachera Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
 show all
Pages 38-46 | Received 17 Dec 2019, Accepted 14 Apr 2020, Published online: 13 May 2020
 
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Abstract

Introduction

When managing opioid overdose (OD) patients, the optimal naloxone regimen should rapidly reverse respiratory depression while avoiding opioid withdrawal. Published naloxone administration guidelines have not been empirically validated and most were developed before fentanyl OD was common. In this study, rates of opioid withdrawal symptoms (OW) and reversal of opioid toxicity in patients treated with two naloxone dosing regimens were evaluated.

Methods

In this retrospective matched cohort study, health records of patients who experienced an opioid OD treated in two urban emergency departments (ED) during an ongoing fentanyl OD epidemic were reviewed. Definitions for OW and opioid reversal were developed a priori. Low dose naloxone (LDN; ≤0.15 mg) and high dose naloxone (HDN; >0.15 mg) patients were matched in a 1:4 ratio based upon initial respiratory rate (RR). The proportion of patients who developed OW and who met reversal criteria were compared between those treated initially with LDN or HDN. Odds ratios (OR) for OW and opioid reversal were obtained via logistic regression stratified by matched sets and adjusted for age, sex, pre-naloxone GCS, and presence of non-opioid drugs or alcohol.

Results

Eighty LDN patients were matched with 299 HDN patients. After adjustment, HDN patients were more likely than LDN patients to have OW after initial dose (OR = 8.43; 95%CI: 1.96, 36.3; p = 0.004) and after any dose (OR = 2.56; 95%CI: 1.17, 5.60; p = 0.019). HDN patients were more likely to meet reversal criteria after initial dose (OR = 2.73; 95%CI: 1.19, 6.26; p = 0.018) and after any dose (OR = 6.07; 95%CI: 1.81, 20.3; p = 0.003).

Conclusions

HDN patients were more likely to have OW but also more likely to meet reversal criteria versus LDN patients.

Disclosure statement

No potential conflict of interest was reported by the author(s).

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