“Quick, Grab the Naloxone”: Overdose Preparedness for Ambulatory Clinics

 

With opioid overdoses rising, practices should consider stocking this safe rescue drug alongside other emergency devices and medications.

Fam Pract Manag. 2021 Jan-Feb;28(1):17-22.

Author disclosures: no relevant financial affiliations disclosed.

Imagine you are finishing up a busy clinic session when you hear a cry for help. Rushing out of the exam room, you see a patient collapsed in the hallway. He is lethargic, with slow and irregular breathing. Instinctively, you tell a staff member to call 911 and grab the automated external defibrillator (AED) and CPR bag valve mask. Then you notice a hypodermic needle lying on the floor.

“Get the naloxone in here, stat!” you say.

Would your staff know what to do next?

Opioid overdoses have surpassed motor vehicle crashes as the second-leading cause of preventable death (behind suicides) in the United States, according to the National Safety Council.1 Naloxone, an opioid antagonist, can rapidly reverse the symptoms of opioid overdose and save lives.2 The American Heart Association includes naloxone administration in its basic life support guidelines whenever opioid-associated respiratory or cardiac arrest is suspected.3 In 2018, U.S. Surgeon General Jerome Adams issued an advisory emphasizing the importance of health care professionals having naloxone on hand and being trained in how to use it.4

An overdose inside your medical clinic may not be a common occurrence, but it's still one to be prepared for. This article outlines the evidence for storing naloxone alongside other emergency medicines and devices in primary care clinics, and provides practical advice for practices looking to add it.

KEY POINTS

  • Given the increasing incidence of opioid overdoses, primary care clinics should stock naloxone alongside other emergency devices and medications.

  • Naloxone can be administered in several forms. Intramuscular injection with a common vial and syringe is the most affordable form, but nasal sprays and auto-injectors are easier to use, especially for non-medical staff.

  • Naloxone is a very safe medication but can send patients into immediate withdrawal with severe symptoms. Most patients should be transferred to an Emergency Department after it is administered.

FEW CLEAR GUIDELINES FOR CLINICS

In assessing our large academic primary care clinic (University of California – San Francisco) for overdose preparedness, we found that naloxone was not included in the emergency kit. When we looked for guidance about whether to add it, we were surprised to find few recommendations.

The Joint Commission has no mandates, and the American College of Physicians has not issued official guidelines. The American Academy of Family Physicians supports expanding access to naloxone for patients, medical professionals, and community members, but it does not have an official position on whether primary care clinics should stock it for emergencies. The only definitive recommendation we found came from the American Academy of Pediatrics, which formally r

ABOUT THE AUTHORS

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Dr. Leyde is a clinical instructor at the University of Washington School of Medicine's Division of General Internal Medicine in Seattle....

Dr. Rife is academic detailing program manager and clinical pharmacy specialist in the San Francisco Veterans Affairs Health Care System and clinical assistant professor at the University of California — San Francisco (UCSF) School of Pharmacy.

Dr. Kryzhanovskaya is an assistant professor at the UCSF School of Medicine Division of General Internal Medicine. The opinions and assertions contained herein are the private views of the authors and do not reflect the official policy or position of the U.S. Department of Veterans Affairs or the U.S. government.

Author disclosures: no relevant financial affiliations disclosed.

References

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