There was a recent research paper released in DDN Magazine that focused on non fatal overdoses which was carried out by a group of academics in the University of South Wales. Which can be found here….
Following on from this I decided to do a little non-academic research for myself to look primarily at the possible effects of a non fatal overdose on the individual, Firstly from a physical / medical perspective. In the UNODC discussion paper released in 2013, “Opioid overdose: preventing and reducing opioid overdose mortality” (http://www.unodc.org/docs/treatment/overdose.pdf) it states that….
“Non-fatal overdose can significantly contribute to morbidity, including cerebral hypoxia, pulmonary oedema, pneumonia and cardiac arrhythmia, that may result in prolonged hospitalizations and brain damage”
Asphyxia and hypoxia lead to a redistribution of cerebral blood flow. This can result in a 25% reduction in oxygen saturation (in lambs, no human research found). Research has found that naloxone can quite significantly reverse this redistribution, this has a massive effect on the oxygen in the brain and therefore, as an opioid-mediated homeostatic mechanism, in hypoxia promotes preferential perfusion of the vital structures of the brain. During severe prolonged asphyxia there was an increase of cerebral blood flow which was more prominent in new born lambs with hypoxia. As opioids play a role in the regulation of cerebral circulation the potential in a non fatal overdose for cerebral redistribution stemmed by naloxone was proven to be significant in redistributing and therefore reducing the the hypertension, increasing the oxygen levels in the brain, reducing arterial blood pressure and reducing the risk of any longer lasting effects. Full recovery and reversal possible if naloxone is administered as soon as is possible after signs appear. For a clear understanding of the signs, symptoms of hypoxia please follow the hyper link below….
Pulmonary Oedema is fluid accumulation in the air spaces and the lungs which leads to respiratory failure. There are a number of reports published around possible adverse effects of naloxone and most of these include pulmonary oedema, however, most were also highlighted in the presence of an underlying cardiorespiratory disease which has made it impossible to differentiate between what the underlying cause of the pulmonary oedema. “Many episodes of pulmonary oedema secondary to opioid toxicity have been published since it was first noted by William Osler in the 1880s and it has been suggested that naloxone simply reveals the opioid induced pulmonary oedema that had been masked by the already existing respiratory depression”
Seizures and arrhythmias have also been recorded in pulmonary oedema but ths is more likely to be caused by hypoxia. Which in previous paragraph is reversed by naloxone. Further research around this has shown that hyperventilating patients prior to administration of naloxone could reduce the risk of sympathetic mediated adverse effects. All studies based on this and the findings from those studies were conducted in early trial periods where the main reason for research was to find out what dose of naloxone would be most effective in treatment of non fatal overdose situations to prevent them from becoming fatal. Out of 185 papers on the subject matter, studies were only deemed to be relevant if they compared doses and routes of administration of naloxone or if they produced evidence about rates and timing of complications. This comment is a summarised account of those that were accepted. For signs and symptoms of pulmonary oedema please follow the hyper link below….
Pneumonia Opioid analgesia impairs gastrointestinal motility. Enteral administration of naloxone allows selective blocking of intestinal opioid receptors caused by extensive presystemic metabolism. Therefore, the effect of enteral naloxone on the amount of gastric tube reflux, the frequency of pneumonia, Results on studies around this particular subject provided evidence that the administration of enteral opioid antagonists in ventilated patients with opioid analgesia might be a simple—and possibly preventive—treatment of increased gastric tube reflux and reduces frequency of pneumonia. This study was carried out on 84 fentanyl treated human patients and was a prospective, randomised, double blind study with 43% given a placebo. For more information on pneumonia please follow hyper link below…..
Therefore the conclusion of my research is that…again…naloxone is effective in reducing the risks associated with non fatal overdose as well as reducing the risks of the overdose situation becoming fatal. Not bad for a non academic, done in the space of three hours and didn’t cost a penny.