Background Naloxone, an opioid antagonist, is commonly used in acute care settings to reverse the effects of opioid toxicity. It is nevertheless recognised that managing respiratory depression in patients on long-term opiates should be different to managing an acute opioid overdose in adults. It is not clear, however, whether this is observed in our 1200-bed hospital.
Methods A list of all inpatients who received naloxone whilst at our hospital during 2019 was procured. Only records of patients either known to our service or with an underlying life-limiting condition were selected for analysis. Data obtained included age, sex, diagnosis, opioid and CNS depressant history, indication for, and dose(s) of, naloxone, and outcome. Descriptive statistics obtained on Microsoft Excel.
Results Twenty-eight out of 159 patients met our inclusion criteria. Twelve patients had a cancer diagnosis; 23 were on any opioid or CNS depressant prior to admission. Forty-two doses of naloxone were given overall, with reduced consciousness/GCS being the most common recorded reason for its use. Twenty-four patients had a respiratory rate recorded and in only five patients was it ever eight or fewer breaths per minute. Doses of naloxone ranged from 100 to 400 mcg (mode 100 mcg). Fifteen patients received only a single dose.
Discussion In our hospital the use of naloxone to reverse the effects of opioid toxicity is inconsistent, with wide variations in practice. Although local and regional guidelines are readily available on the Trust Intranet, there was little adherence to them, particularly with respect to record keeping. It is concerning that naloxone may have been advised inappropriately in a majority of palliative patients. There is a clear need both for further education of prescribers and for research into the human factors associated with naloxone use.
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