Volume 182 - Issue 8
Randomised trial of intranasal versus intramuscular naloxone in prehospital treatment for suspected opioid overdose
Authors: Ariella Glaser, Dwight Arakaki, Gar Ming Chan and Robert S Hoffman
Med J Aust 2005; 182 (8): 427-429. || doi: 10.5694/j.1326-5377.2005.tb06765.x
Published online: 18 April 2005
Published online: 18 April 2005
Ariella Glaser,* Dwight Arakaki,† Gar Ming Chan,‡ Robert S Hoffman§
* Resident, Mount Sinai Medical Center, New York City, NY, USA; † Resident, Beth Israel Medical Center, New York City, NY, USA; ‡ Fellow (and corresponding author), § Director, New York City Poison Control Center, New York City, NY, USA. garchanATpol.net
To the Editor: Two aspects of the recent article by Kelly et al comparing intranasal with intramuscular naloxone in suspected opioid overdose1 make their study difficult to interpret. The methods allowed for a great deal of bias. There was no attempt to blind evaluators to therapy, and knowing which therapy is to be used a priori may influence both therapy selection and perceived outcome.
The second flaw we noted was the use of the Glascow Coma Scale (GCS) in a non-trauma patient.2 An improvement in GCS score may represent increased wakefulness or even withdrawal. The use of the GCS does not make it possible to determine what degree of improvement or worsening the therapy resulted in. In the opioid-intoxicated patient, the “alert/verbal/pain/unresponsive” (AVPU) scale is more appropriate.
We agree that the use of needles in a high-risk patient is dangerous. However, if these patients do not respond to painful stimuli, there should be no danger at all.
References
- Kelly AM, Kerr D, Dietze P, et al. Randomised trial of intranasal versus intramuscular naloxone in prehospital treatment for suspected opioid overdose. Med J Aust 2005; 182: 24-27. <eMJA full text>
- Fulton JA, Greller HA, Hoffman RS. GCS and AVPU: the alphabet soup doesn’t spell “C-O-M-A” in toxicology. Ann Emerg Med 2005; 45: 224-225; author reply 225. i1085694