Newer Opioids May Require Higher or More Frequent Naloxone Dosing

Background: In the United States, opioid deaths have decreased in recent years, partially because of the wider availability and use of the opioid antagonist, naloxone. Naloxone was originally used in the early 1960s to reverse the effects of heroin, but questions have been raised regarding its effect in the setting of synthetic opioid toxicity, particularly involving newer, higher-affinity drugs, such as fentanyl, and its very potent analogs. Objective: To study the efficacy of the 4-mg intranasal naloxone dose in reversing respiratory depression induced by fentanyl and sufentanil, a drug with higher affinity for opioid receptors, in both opioid-naïve and daily opioid-using adults. Design: Prospective crossover trial. Participants/Methods: 12 opioid-naïve and 18 daily opioid-using people were experimentally administered fentanyl or sufentanil infusions to receive a 30% to 40% reduction in minute ventilation (V E ). The 4-mg dose of nasal naloxone was then administered. Results: Nalox more...