Talk:Naloxone/Archive 1

Archive 1

Naloxone and NMDA receptor

As naloxone is a mu-opioid receptor antagonist, can someone explain why it should counteract the effects of ketamine, a NMDE receptor antagonist? Doesn't seem very plausible. Dr evi 666 (talk) 09:33, 21 January 2008 (UTC)

Ketamine is far from a selective NMDA antagonist it has a numerous set of binding sites including the mu opioid receptor - a pubmed search for ketamine mu opioid will find the relevant research. Mu opioid receptors are also involved in facilitating reward in general and mu opioid antagonists can reduce the rewarding effects of some drugs that have no direct affinity for that receptor, for example chocolate, cannabis and psychostimulants such as amphetamine and cocaine. I do not know where you came to the conclusion that ketamine is a selective NMDA antagonist, if it did not have an affinity for the sigma receptor it would be neurotoxic and ketamine is a strongly neuroprotective drug - particularly used in situations like head injury to prevent neuronal damage, it is also anti-inflammatory and can reduce brain swelling. Again if you want references you can search pubmed because this is all quite common knowledge and I don't particularly feel like searching for it right now. —Preceding unsigned comment added by 78.145.92.251 (talk) 01:18, 22 February 2008 (UTC)

"common knowledge" is quite an easy term, isn't it? I never used the word selective, it's just that the involvement of MOR in ketamine's pharmacological actions is so small, I doubt addition of naloxone will counteract them. I merely reacted to the fact that references are needed for the statement regarding naloxone and ketamine in the main article and I could not find appropriate ones. But you did not or could not supply them either. On top of that, there is evidence for neurotoxic effects of racemic ketamine on the developing brain, as the following references will show:

• Ke JJ, Chen HI, Jen CJ, Kuo YM, Cherng CG, Tsai YP, Ho MC, Tsai CW, Yu L.Mutual enhancement of central neurotoxicity induced by ketamine followed by methamphetamine.Toxicol Appl Pharmacol. 2008 Mar 1;227(2):239-47. Epub 2007 Nov 1. PMID: 18076959 [PubMed - in process]
• Soriano SG, Anand KJ. Anesthetics and brain toxicity.Curr Opin Anaesthesiol. 2005 Jun;18(3):293-7.PMID: 16534354 [PubMed]

I would not be as quick to say ketamine is not neurotoxic... Dr evi 666 (talk) —Preceding comment was added at 11:44, 25 February 2008 (UTC)

Naxolone and Childbirth

I removed the line: "In one experiment, women treated with naloxone reported higher pain levels during childbirth than women not so treated" Because it has been dated as uncited since july 2007, and seems very unlikely given the ethical consideration involved.Halogenated (talk) 00:13, 20 January 2008 (UTC)

I don't have a citation for you, but from my antenatal classes I can tell you it is known that people treated with naloxone experience higher levels of pain, childbirth or not. this is because it binds to the same receptors that pain relieving hormones do. Also any woman treated with naloxone during childbirth is either a drug addict, and drug addicts have a much lower pain tolerance than the general population, or has been admistered too much pain relief during childbirth which needs to be rapidly reversed to prevent respiratory distress to the baby. Obviously reversing pain relief is going to cause higher pain levels. Naloxone is administered during childbirth all the time. 58.168.235.171 (talk) 10:13, 18 August 2008 (UTC)

Qualitative effects of naloxone versus naltrexone

Can someone who actually knows, say what the qualitatively different effects are between these two drugs? It is not obvious to the reader what they might be, as the drugs have such similar modes of action —Preceding unsigned comment added by Woodcore (talk • contribs) 17:01, 27 February 2008 (UTC)

Your mistaken, someone I know sees one every month — Preceding unsigned comment added by 24.98.250.155 (talk) 05:01, 26 September 2011 (UTC)

Heading

Citation about naloxone's side-effects should be inserted. The side-effects listed here can all be caused by withdrawal syndrome, except the 'infection', which is a side-effect I for one have never heard of for naloxone. It can be caused by subcutaneous/intramuscular/ injection of grinded down Suboxone, but not of naloxone itself. So either a good citation for these side-effects is needed, or some serious editing should be underway.

Dr evi 666 08:41, 30 August 2007 (UT hh The stuff about naloxone's activity in Suboxone is mostly untrue. Naloxone does nothing to prevent IV or intranasal abuse, except by scaring people away from trying it. Buprenorphine's much higher affinity for opioid receptors makes the naloxone irrelevant. Most of the side effects/withdrawal symptoms attributed to naloxone are in fact caused by buprenorphine itself. Naloxone is hardly absorbed sublingually. Buprenorphine, with or without naloxone, will cause someone on pure agonist opioids to experience withdrawal. Also, naloxone will not cause someone on buprenorphine to go into withdrawal.

Flopster2 12:16, 21 October 2007 (UTC)

@ Flopster2: Naloxone is added to the suboxone tablet for scaring people, that much is true. But there is a rationale behind all this: because of the large difference in bioavailability in different modes of administration; if a drug user takes suboxone sublingually so little naloxone is absorbed (due to low bioavailability of naloxone), no effect will be noticed. However, if it is injected intravenously or intramuscular, the naloxone in the tablet (now much more naloxone is available) causes an acute withdrawal syndrome. See also the following articles JOHNSON RE MCKAGH J: Buprenorphine and Naloxone for heroin dependence. Curr Psychiatry Rep (2000) 2: 519-526 and STOLLER KB BIGELOW GE WALSH SL STRAIN EC: Effects of buprenorphine/naloxone in opioid-dependent humans. Psychopharmacology (Berl) (2001) 154: 230-242.

And on a minor note: naloxone IS able to reverse several of buprenophine's effects, such as respiratory depression, analgesia and sedation albeit in high doses (much higher than in the suboxone tablet). I'm not sure how the mu-opioid receptor changes with addiction, but I reckon addicted people on buprenorphine (and possibly many more drugs acquired illegally) could go into withdrawal from naloxone. Dr evi 666 14:44, 1 November 2007 (UTC)

I suppose this would be original research, but it really doesn't cause any withdrawal whatsoever either intranasally or intravenously (tested in both opioid naive people and buprenorphine maintenance patients). Both of those routes feel more effective overall than sublingual, but because there's no rush, IV isn't worth the risk. Sure it will cause withdrawal in anyone on other opioids, but buprenorphine alone will do that. I have read reports to this effect online, and if I come across them again I'll cite them here. --Flopster2 22:55, 4 November 2007 (UTC)

The Stoller paper is about hydromorphone dependent people. In the "Nondependent" section of the Johnson paper, it states that "the combination (1:1 ratio) attenuated the acute opioid agonist effects." Note that the amount of naloxone used is much greater than in Suboxone. In the "Dependent" section, it states that those on Suboxone maintenance chose money over IV buprenorphine/naloxone (which is quite understandable), but it doesn't mention withdrawal. For those on all of the other opioids tested, it did cause withdrawal. Neither of these papers say anything about precipitated withdrawal due to buprenorphine alone, but there are plenty of others that do, e.g. [1], [2].

In [3], a pretty large dose of naloxone given a day after the last dose of a relatively low amount of buprenorphine produces withdrawal. [4] indicates that IV buprenorphine/naloxone, while less desirable than buprenorphine alone, produces similar effects. The difference in perception of the effects decreases with time, presumably as the naloxone wears off. While [5] mentions precipitated withdrawal in some abusers, it does not indicate whether they were on other opioids at the time. Inclusion of naloxone does succeed at making IV Suboxone abuse less attractive than IV Subutex.

It appears that, when used IV, the naloxone Suboxone attenuates the buprenorphine's effects somewhat and may contribute to (or cause) the withdrawal experienced by those dependent on full agonists. The dose of naloxone is insufficient to cause withdrawal, and the increased bioavailability of buprenorphine likely makes up for any antagonist effects. I'd like to see a study comparing desirability of SL vs. IV in opioid naive or buprenorphine maintenance patients. It's arguable which method is more effective, but IV (or IN) use does not lead to withdrawal. --Flopster2 00:50, 5 November 2007 (UTC)

I agree. Still, all so-called naloxone side-effects are not related to the drug itself and therefore irrelevant. Dr evi 666 (talk) 09:33, 21 January 2008 (UTC)

Dr Evi 666, References http://www.sciencedirect.com/science/article/pii/S0376871603000589 absorption of naloxone "was 9 and 7% for the 4 and 8 mg naloxone doses" it is established that ~10% of naloxone _WILL_ ABSORB SUBLINGUALLY.

http://www.sciencedirect.com/science/article/pii/0376871690901363 "Naloxone is sufficiently absorbed sublingually to precipitate abstinence(wtF? thought Elsevier had proofreaders i think they intentionally rewrote withdrawal so a text search wouldnt find it, haha) in dependent subjects"

Flopster YES in a 1:1 ratio the naloxone clearly has an effect, and in other studies the amount absorbed is quantified, but there is intentional confusion created when parties who have an LUCRATIVE FINANCIAL INTEREST assert that in a 1:4 ratio the naloxone does "nothing" orally. I've been in multiple trials where subutex was compared with suboxone and found researchers were very eager to disqualify people who reacted badly to the suboxone, this is a HUGE scientific fraud! also i've been on subutex for 5 years and know it well. Ive genuinely tried to switch to suboxone because it would save me almost $50/week and save me UNREASONABLE amounts of time, hours of the best part of everyday, but suboxone gives me severe chills, weakness and severe sleep difficulties, and significant amplification of pain. Then there are the psychological effects, oh god! Others specifically mention being SUICIDAL and DEREALISED for the first time in their lives after being switched from bupe to SUBOXONE, with no dose change no abuse no misuse no objectionable alterations to the standard procedure, just switching from long term stable consistent bupe to suboxone. i've personally done it about 4 times, plus multiple studies. Once because i was admitted to hospital with pneumonia because i came in on suboxone i couldnt change while i was there, i didnt sleep for a month despite drs giving me benzos and more benzos. Other times ive been in hospital for a similar amount of time on bupe (same dose of bupe just without the naloxone) and when the nurse would bring my dose after breakfast time i would have pass out and have a great nap for most of the day, and sleep like a baby at night too, without any benzos which i do not need. I resent being forced to take NALOXONE with my bupe while i was SICK, you EVIL IGNORANT PURITANS.

Consider that the ENZYME(s) that turns buprenorphine into NORBUPRENORPHINE which is a POTENT FULL AGONIST is competitively inhibited by naloxone! BUPE is a PRODRUG, and there are mechanisms whereby naloxone can significantly alter the effect of the bupe even if the naloxone has a shorter halflife and lower bioavailability. the fact is ive meet a minority of others that react the same as me, but for some reason we are ACTIVELY REPRESSED.

Parties willfully pushing someone elses agenda to convince people that 1/4 of significant is insignificant, that relative is absolute, JUST to allow BIG PHARMA to justify a new formulation under all new PATENTS really is EVIL. that is all that this is actually about bupe would have been an extremely cheap generic otherwise threatening a billion$$$ oportunity.

Here are some rough figures, if the 10% which has been established gets to the CNS (lets not go into +- yet), of the Naloxone is absorbed and you are on a dose of 32mg bupe:8mg naloxone a day then you get 0.8mg of naloxone into the CNS, there are plenty of studies showing significant effects at the 1mg level. yes i realise there will be an equilibrium reached, and that the presence of of ~ 20% of the bupe that absorbs to go along with the 10% of the naloxone will alter the receptor occupancy. All im saying is that there are too many studies skirting around the central issue, all to produce "favourable results" that can be compiled into "metaresearch" and reworded and manipulated to force public policy. Buprenorphine is a miracle treatment, now it will ONLY be AVAILABLE if you are PREGENANT ! why is that i wonder, because the naloxone is known to absorb and would cause catastrophic harm to a developing brain. WAR is PEACE, FOUR legs GOOD. 220.101.100.14 (talk) 15:16, 29 April 2012 (UTC) keep fighting the shills

Suboxone

I know it was mentioned above, but the article should be amended to make clear that Naloxone in Suboxone is clinically irrelevant.As the poster said, buprenorphine alone will can cause withdrawal in those dependent on full agonists.And Suboxone used IV has no ill effects, in the sense that the Naloxone does nothing to effect the action of Buprenorphine, is the dose present is not nearly high enough.As the definitive web encyclopedia(at least in terms of the public using the site) I believe Wiki has a duty to make clear that Nalaxone's role in Suboxone is non-existent except as a scare tactic, since there is no medical difference between Suboxone and Subutex unless you happen to hav a Naloxone allergy I suppose. On a side note, Suboxone seems to exist soley for making money(since it is not generic) but that is mostly irrelevant to the article... — Preceding unsigned comment added by 24.98.250.155 (talk) 03:09, 26 August 2011 (UTC)

The naloxone is clinically relevant due to its antagonistic effect on mu-opioid receptors in the gut. This will have the effect of a local withdrawal, inducing diarrhea in most patients with opioid-induced bowel disease. § — Preceding unsigned comment added by 108.183.202.73 (talk) 03:07, 11 November 2014 (UTC)

References

Pharmacodynamics[edit]

"in contrast to direct opiate agonists which will elicit opiate withdrawal symptoms of both opiate-tolerant and opiate-naive patients" -- This comment makes no sense. Can the person who wrote it please explain, or provide a reference? Markcymru (talk) 16:04, 17 September 2014 (UTC)

Hi, I know this was a while ago, but I think that means that when you give someone a Direct Opioid Agonist, they will definitely go into opiate withdrawal and show withdrawal symptoms, and it doesn't matter whether the patient is used to having opiates or not. I guess usually you would expect opiate-naive patients (who haven't had opiates before) would not experience withdrawals, but they do when given a Direct Opioid Agonist. Does that make sense? Knittea (talk) 10:33, 21 May 2016 (UTC)

addiction...ology...

"only certified addictionologists (physicians specializing in the treatment of drug addiction and dependence)"

Is it just me or did the person who wrote that just make it up on the spot... where exactly does one go to train to become an "addictionologist"? surely the term 'addiction specialist' is the appropriate term, additionologist makes about as much sense as drugologist, brainologist and fruitologist. If I am mistaken on this then do put me straight but that sounds bloody ridiculous to me. —Preceding unsigned comment added by 78.145.92.251 (talk) 01:08, 22 February 2008 (UTC)

That term actually exists. Here's a link: http://medical-dictionary.thefreedictionary.com/addictionologist Jtpaladin (talk) 22:52, 5 August 2016 (UTC)

Administration (edit)

The following sentence appears second-to-last in this section. It seems to be oddly specific and to promote a certain interpretation of claims made therein (weasel words?), and I suggest it be revised. I'll leave it to an admin to decide on this one.

"Naloxone can be used orally along with oxycontin controlled release and helps in reducing the constipation associated with opioids. "

A possible revision might read as follows:

"Studies have found that oral coadministration of Naloxone alongside select opioids may aid in reducing symptoms of constipation associated with their use." — Preceding unsigned comment added by 2601:282:503:A480:F50B:8B90:1526:16E7 (talk) 23:57, 24 October 2016 (UTC)

Adjusted Doc James (talk · contribs · email) 01:54, 25 October 2016 (UTC)

"Studies show that to give this to a person in severe pain would be unethical and inhumane."?

What does this mean? It has no source, and no clarification, and doesn't make much sense.

While this was a long abandoned question, the answer is simple enough. Administer naloxone to a patient who is in severe pain and has received an opioid analgesic, their pain relief would immediately end and the patient would be suddenly in excruciating pain.Wzrd1 (talk) 06:45, 26 February 2017 (UTC)

Addressing Proposed Edits/Suggestions

For the side effects section that I edited, I took the suggestions of switching the order of the paragraphs and moving the last paragraph to the first paragraph in order to improve structure and flow of the section. Another suggestion was to add citations to the last sentence of the first paragraph after switching the paragraph order, so I found a study from PubMed as well as a Harvard article to support that sentence regarding placebo effect. In response to a suggestion regarding the drugs.com citation, I did not create that citation or edit, and I ensured and verified my sources to be reputable and verifiable sources. In addition, drugs.com is a HON certified website, which is considered a certification for human health information.Anniechang17 (talk) 21:37, 14 November 2017 (UTC)

I edited the cardiovascular section. Based on the very helpful peer edits, I decided to make this section and my further sections a bit more organized, readable, and expanded on terminology so that someone with a non-medical background could read them. Instead of including some monitoring parameters in the administration section, I made this its own section as you monitor patients after administration of the drug. I also expanded on these monitoring parameters, adding a bit about monitoring in pediatric populations, citing a study on this. One of our goals was to expand a bit more on the history of naloxone as well, so I added a bit about the FDA and when naloxone kits were distributed to the public, expanding on the history section as well. I also double checked the quality of citations and sources as noted by the peer edits to ensure quality of information (no drugs.com as a source for example, although that edit was not from our group). Vchopra86 (talk) 21:43, 14 November 2017 (UTC)

I edited and added information to the "Other" section. I would like to thank the group and Doc James for the feedback provided for us to improve our edit submissions, they were very helpful. Because of the suggestions, I was very conscious to citing pages that was open access to the public like Cochrane. Information that was added this time included the administration of Naloxone to infants that are exposed to high amounts of endogenous opiates to improve outcomes. I also added a hyperlink if people reading this section wants to read up further on perinatal asphyxia. Nguyenpe (talk) 08:02, 15 November 2017 (UTC)

Proposal for Additions

1. Add a section on dosage forms that includes common usage. 2.Add a subsection detailing administration and common indications. 3. Find citations for information that still needs citations. Nguyenpe (talk) 05:33, 18 October 2017 (UTC) 2. Correct/cite/and add to the talk suggestions noted. For example, exploring "addictionology" for abuse potential as well as expanding historical context of drug. — Preceding unsigned comment added by Vchopra86 (talk • contribs) 08:40, 18 October 2017 (UTC)

Peer Review Prompt: Is there any evidence of plagiarism or copyright violation?

First of all, I want to thank you for the necessary edits to this article. The additions made added insights and pertinent information regarding the current role of naloxone in therapy. I strongly believe that this article is more complete with the edits recently made. In regards to plagiarism or copyright violation, I did not detect any violation or plagiarism after cross-checking with the sources cited. Great job! Thanhtu92 (talk) 04:24, 7 November 2017 (UTC)

Peer Review Response to Proposal for Additions: Overall, I think the proposed additions helped tie in the importance of naloxone given the current environment of the opioid epidemic and it's important to update this article for the public, as naloxone is a key player in combating opioid abuse. The content goals have been reached in terms of usage, indications, administration, but there are still articles that need citations and verification, such as:

:Lazarus P (2007). "Project Lazarus, Wilkes County, North Carolina: Policy Briefing Document Prepared for the North Carolina Medical Board in Advance of the Public Hearing Regarding Prescription Naloxone". Raleigh, NC.[page needed][verification needed]

My critique will be specific to secondary sources that were cited.

For the "Other" Section under medical uses, all sources are clearly accessible, and trials that are referenced are linked with a reviewable abstract, summary, results/conclusions, and PMID. One citation is needed in the second sentence (perhaps an UpToDate Reference). I appreciated the UptoDate reference over drug database sources such as Lexicomp that may be harder to understand or navigate in layman's terms for those not in the healthcare field.

For the side effects section, "Drugs.com" is referenced for citation 19 and I do not think this is a reliable source- UpToDate would be a better alternative. One citation is missing from the last sentence. As far as organization of this section, I think the last paragraph should be moved to be the first paragraph because it references naloxone's mechanism of action which helps the reader understand what aspects in its action may lead to side effects.

For the "Special Populations" section, I think a reference would be needed for the sentence "Whether naloxone is excreted in breast milk is unknown." Even though its unknown, it would help to show studies that state this claim. This same rationale goes for the Kidney/liver dysfunction section as well.

For the "Administration" section, all sources were cited and appropriate. The only comment I would have is organization (maybe move the second paragraph about repeated dosing to the first paragraph and make sure to group the discussion about the Nasal spray together so it flows through the discussion of each administration form in sequence.) Also, if any of these products have a popular brand name I would add them (and maybe a photo for reference for the newly approved product if you'd like?)

Other than some minor additions of citations/citation changes and rearrangement of paragraph structure, the current edits have reflected the proposed plan.

Angelalee102 (talk) 09:58, 4 November 2017 (UTC)

Peer Review Response to Proposal for Additions:

My critique will be specific on the drafts neutrality point of view

The edits made were well researched and informative to the reader. The edits will make a considerable addition to the current page by making sure the information and cited references are current and up to date. The members proposing the edits are not affiliated with a pharmaceutical a company. The overall content seems to be organized and put together in layman terms in which a healthcare provider or non-healthcare provider could comprehend. One suggestion I would like to recommend would be on Preventing Opioid Abuse section with going into a little more depth of the combination of naloxone with linking suboxone. Overall the edits seemed appropriate and non bias.Aarz1111 (talk) 00:22, 5 November 2017 (UTC)

My critique will be specific to the consistency with Wikipedia's manual of style for medicine-related articles

The edits made for the most part follow Wikipedia's manual style for medicine-related articles with the monitoring parameters and history sections cleaned up and expressed in more simpler terms. In terms of 1. Technical Jargon/Medical Abbreviations: I do believe the edits avoided any undefined medical abbreviations except for the CDC should be written out in the history section and CNS under the other medical uses section however, the cardiovascular side effects section may have a little too much medical jargon with describing the cardiovascular side effects and possibly each could be expanded briefly to elaborate each effect in more simpler terms. 2. Formal Tone: I feel all edits are neutral without inadvertently introducing bias, but the two sentences edited under the history section could possibly be edited to have a smoother flow it seems to be slightly an incomplete thought. 3. Capitalizations: CNS under the other medical uses section can just be written out and not abbreviated and capitalized. Overall very good edits!Jydeguzm (talk) 09:06, 15 November 2017 (UTC)

• Comment Uptodate as a source is not very good. Some of the reasons for this is that one cannot link to a static version (unlike WP). Doc James (talk · contribs · email) 06:36, 5 November 2017 (UTC)

Chemistry

The article states that Naloxone is a racemic mixture, i. e., an equal mixture of two enantiomers. This is incorrect. A contributor cited two sources that discuss the two enantiomers of Naloxone and their differential pharmacology. The fact that both enantiomers have been synthesized and studied does not mean that the Naloxone used as a drug exists as an equal mixture of the two, and the cited sources do not support the existence of the drug Naloxone as a racemic mixture any more than an article which discusses matter and antimatter implies that everything is an equal mixture of both.

To be sold as a drug in the United States, Naloxone must meet the specifications in the United States Pharmacopeia. These specifications require that a 25 mg/mL solution in water have an optical rotation of -170 to -181 degrees. A racemic mixture would not rotate plane polarized light at all. It would fail the USP optical rotation specification, and it would be illegal to sell it as a drug.

I have deleted the incorrect statement that Naloxone is racemic, and an editor has restored it. The editor incorrectly states that the cited sources support the claim that Naloxone is racemic. The editor does not know what he is talking about.

Naloxone, without further context, does refer to a racemic mixture of (+)-naloxone and (−)-naloxone. The INN "naloxone" refers to a specific enantiomer of naloxone: "(−)-naloxone". I actually mentioned this issue previously on this talk page, but ended up deleting the section since I figured I was being too pedantic. I'll just copy/paste what I wrote originally though:

This is sort of unusual; apparently naloxone's INN – which also happens to be "naloxone" – refers to a specific enantiomer of naloxone: "(−)-naloxone". The (−)-naloxone enantiomer is what's currently FDA-approved and used in pharmaceuticals (i.e., Narcan) since it's roughly 1000-fold more active at the opioid receptors relative to (+)-naloxone, which is fairly inactive at opioid receptors. Should this be indicated in the lead, or just the drugbox?
— Seppi333 (Insert 2¢) 03:32, 16 November 2017 (UTC)

I suppose it may be worth clarifying this in the article now since it's apparently an issue for others though. Seppi333 (Insert 2¢) 20:47, 25 January 2018 (UTC)

Agreed. The statement that Naloxone exists as a racemic mixture is the part I have the most trouble with. It would be better to say that Naloxone has two enantiomers or that it can exist as either of two enantiomers or optical isomers or whatever we want to call them. That would be brief and accurate. "Naloxone exists as a racemic mixture" means that an equal mixture of the two enantiomers is how Naloxone occurs. That is an over-generalization of one possibility, like saying people have blue eyes. Sure, some people do, but there are better ways of talking about eye color.

Section reflist

References

EMS1.com

Is not a reliable source.[6]

Would need a better source to support this "Even small doses can have a profound effect on patients requiring long term opioids. Since its function is to restore respiratory drive, naloxone should never be given when a patient is conscious or breathing, as it may unnecessarily trigger a life threatening side effects."

Other issue is that that content is wrong. Doc James (talk · contribs · email) 20:23, 21 February 2019 (UTC)

Mediating against constipation

Resolved

 – Suggestion for edit was incorporated into the article.

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

Doc put me on a oxycodone/naloxone combination pill, with the reasoning being that the naloxone reverses the constipation effect (Im post-op on a procedure where constipation is very much an unwanted effect. Now, googling, produces this https://www.ncbi.nlm.nih.gov/pubmed/10601678 so its not a doctor brain-fart , but is this an off-label bit of inventive medicine, or is it a legit useand if so should that be in the article? It seems to be working, however anecdote!=data . 59.167.111.232 (talk) 22:47, 7 July 2017 (UTC)

That is indeed a use of naloxone! The indication of naloxone for opioid-induced constipation has been added to the page. Thanks! ―Biochemistry🙴❤ 13:12, 10 June 2019 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

CP133 2019 Group #21 Proposed Edits

1. Reorganize “ Routes of Administration” section 2. “Administration” or “Available Forms:" Narcan Nasal Spray, Evzio Auto-Injector, Luer-Lock Nasal Atomizer, Injection via Syringe 3. Dosing 4. Black Box Warning 5. Special Populations: Pregnancy + Lactation, Pediatric use, Geriatric Use 6. Add “Opioid Withdrawal” in side effects 7. Remove “Kidney and Liver Dysfxn” or find good citation, currently is not backed by source 8. Contraindications 9. Who Can Prescribe Naloxone: Pharmacists, Physicians 10. Pharmacogenetics KBielaski (talk) 22:17, 16 October 2019 (UTC)

I added a "hypersensitivities," "children," "geriatric use," and "storage" section. I also reorganized the information under "medical uses" and added a sentence about patients taking naloxone with liver dysfunction. KBielaski (talk) 17:45, 3 November 2019 (UTC)

/* CP133 2019 Group 20 Proposed Edits */

The group’s edits substantially improve the article, as described in the Wikipedia peer review guiding framework. The Naloxone wikipedia page was incredibly dense and content rich, prior to the health policy group’s intervention. However, these substantial improvements are seen through their additions regarding max dose of naloxone, local training programs, and Good Samaritan Laws. It is important to consider good samaritan laws, as patients undergoing opioid overdose may have difficulty self-administering naloxone. With these additions, the group was able to achieve its overall goals for improvement, increasing access to quality content regarding appropriate naloxone use.

Does the draft submission reflect a neutral point of view? If not, specify…

Yes, the draft submission reflects a neutral point of view. Tone and content do not suggest bias from perspective of authors. In addition, there are no conflicts of interest in terms of funding. The information is presented in a non-partisan manner, in order to assure the reader of its validity. Ryan.Thaliffdeen (talk) 23:21, 5 November 2019 (UTC)Ryan Thaliffdeen

Part 1: Notably, the group's edits have greatly improved the organization of the article. The sections are organized well in a sensible and understandable order. Moreover, the descriptions that were added are appropriately relevant to the respective sections and the article topic as a whole. There does not seem to be any apparent off-topic or redundant elements in their edits. The added content is described in a neutral manner and is built on good references. Although the many of the edits warrant fine-tuning and proofreading (e.g., grammatical errors, description-related inaccuracies, formatting inconsistencies), the general function of the group's edits are meaningful and valuable. The contributions/edits in the Prehospital access section were especially noteworthy!

Part 2: (Q - Are the points included verifiable with cited secondary sources that are freely available? If not, specify…). All of the attributed sources are both verifiable and reliable. The cited references are all secondary resources e.g., information and/or websites sponsored by Federal Government agencies, large professional organizations, bipartisan organizations, reliable drug information resources, among others. A minor note is that some of the citations did not have a hyperlink even though a link was available. I think the group was very good about contributing acceptable content from highly reliable, unbiased, authoritative sources.

Other: I would like to share one of my edit suggestions (grammatical and description-related notes), specifically for the "Hypersensitivity" section:

→ [Original text] "Naloxone contains methylparaben and propylparaben and is inappropriate for use by people with a paraben hypersensitivity. If a person is sensitive to nalmefene or naltrexone, naloxone should be used with caution as these three medications are structurally similar. Cross-sensitivity between these drugs is unknown."

→ [Comments] Naloxone, in and of itself, does not 'contain methylparaben and propyl propylparaben.' Rather, certain naloxone preparations (e.g., multi-dose solutions) are what contain these preservatives. It may be more accurate to say, “Some/certain naloxone formulations/preparations contain preservatives such as methylparaben and propylparaben…” To note, preservative- and paraben-free formulations of naloxone are available (e.g., single-dose solutions, ampules). Given this, it may also be beneficial to add a subsequent statement stating the availability of preservative-free formulations of naloxone for those with paraben hypersensitivities. → One extra minor grammatical edit suggestion - “Cross-sensitivity among these drugs is unknown." Gracibae (talk) 19:08, 6 November 2019 (UTC) Grace Bae

Group 21 vastly improved the Naloxone article by incorporating information about special populations, including geriatrics, pregnant women, and children. This is useful information because these are groups that are not usually considered when learning about the administration of Naloxone. It is possible for children to need Naloxone under special circumstances, and pregnant women as well. In addition, geriatric patients are at an increased risk of adverse events.

Are the edits formatted consistent with Wikipedia's manual of style? If not, specify...

Yes, the edits are formatted consistent with Wikipedia's manual of style. The group added headings and provided information that is relevant to each heading. Dylannand (talk) 22:22, 6 November 2019 (UTC)

Part 1: When the edits are compared with their proposed goals, this group has completed the intended task. The group clarified key points on naloxone use by adding onset, duration, and the different parameters that vary by formulations. They deleted information that did not have good sources/citations. They also added details to make it more comprehensive, user-friendly, and up-to-date (recent legislation). I would recommend proof-reading the article in its entirety to remain consistent in formatting as well as to correct minor grammatical errors. I also suggest moving the "Names" and "Identification" section closer to the introductory paragraph, rather than keeping it under the "Society & Culture" subheading. Part 2: There is no evidence of plagiarism since most ideas are written in easy-to-understand format with some use of technical terms. No use of excessive quotes identified. NishaMJohn (talk) 05:25, 7 November 2019 (UTC)

Thank you for your peer review feedback, we have made the edits you suggested. KBielaski (talk) 06:00, 13 November 2019 (UTC)

The article content is currently likely to present imaginable hazards to some unfortunate users!

   I'm not sure i need help in ameliorating the harm, and i don't have the wisdom nor daring to risk acting definitively to try to state or execute the action called for; my opinion that those tasks are "above my pay grade", but i think completely foregoing partial harm-reduction is not something the non-existent gods would approve of, even in the implausible case where there are gods out there somewhere, lacking in any power to affect any aspect of life on this blue globe.
   I don't think you're crazy to suggest my imagination and ego are running away with what good sense i possess. On the other hand, there important legal and human issues that are not obviously taken adequate care of in this article, and stakes may be high. I hope not, but my time and effort are very cheap, and you know the one about the little Dutch boy (not Hans Brincker) who allegedly became a hero bcz of a leaky dike.
   Anyhow, major WP foundations include WP:RS and i think Don't be Evil. I judged, in light of my brief acquaintances with pharmacology, and with torts, and WP:CENSOR, that neither removal of parts of the accompanying article nor letting them stand without better oversight ( call in the lawyers, and Call in the Doctor) was sure to be effected before some users might suffer from lack of the accompanying article (and perhaps others that don't quickly jump to my mind) being adequately overseen. I don't claim the wisdom to state the proper course of action, but a logical precautionary discipline came to mind: as removal and waiting for the Wheels of Wisdom to slowly grind may be harmful, how's about we (if not I, then who?) add some hard-to-ignore labelling: Some kin'a obtrusive labelling, marking baby and bathwater each with the same mark of doubt, or maybe even with complementary marks, urging readers against both unwelcome risk and equally risky over-cautions.
   The objects of the two targets of concern seem to me to call for either

• just plain individual strokes for individual folks, or
• means to help users identify objectively measurable factors that rationally may objectively, rationally push differently situated people in objectively opposite directions.

TOO TIRED TO TUNE THE FOLLOWING TO CATCH MY CLEAR IDENTIFICATION OF VARIABLE AND THEIR RELATIONS

to label or identify arguable polarities that either might limit harm in two opposite directions or counsel caution about each of those two. The perhaps comparable harms of two hard-to-definitely-identify (let alone measure)

ONe matter that stands out clearly in my mind at this point: its unsuitable in my opinion to try to tell users what their values should be Another: we currently, i'm pretty sure, have unsourced or subjectively described assertions that eventuallycould be sourced instead of just asserted, about things only doctors can try to put in perspective, while we don't even have reliable sources about how one-sided doctors are judging some of the mentioned factors relevance or the degree of unanimity or diversity of Wild-Ass-Guesses, nor of the risk factors that they judge should be important in treatment recommendations or are too subjective state any facts about.

Look, i gotta sleep. The world is going mad, assertions in the article have no refs attached, let alone sufficient perspective to be useful, and I hope this article won't fester on without competent authorities making themselves heard. It has unsourced assertions, and their truth or falsehood may be undecidable without professional rewording and nuance; i'm not prepared to tamper even where assertions are novel and/or implausible to non-exoerts,

My temptation or fantasy was to put dubious unsourced material into italics to contrast with reliably sourced, but i frankly don't know whether surprising assertions are outrages or still hard to source insights or glimmers. guess i can quit here with a clear conscience, for now.
--JerzyA (talk) 08:56, 28 May 2020 (UTC)

Wiki Education Foundation-supported course assignment

This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Anniechang17, Nguyenpe, Vchopra86, Nvyates. Peer reviewers: Thanhtu92, Aarz1111, Nvyates.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 04:48, 17 January 2022 (UTC)

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 23 September 2019 and 13 December 2019. Further details are available on the course page. Student editor(s): KBielaski, Celiahoang, DavidSuSOP, Azengvoong. Peer reviewers: Ryan.Thaliffdeen.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 01:23, 18 January 2022 (UTC)

North-America-centric legal status section

The section Legal status and availability to law enforcement and emergency personnel is entirely about the US and Canada and should provide a more worldwide perspective, or be divided into regional subsections. The Community access section below it is somewhat better but still only focusses on Western countries. If I have time soon I'll try and improve them, but if you come across this before then feel free to have a go! tamasys (talk) 08:17, 2 September 2022 (UTC)

"Naloxone generally has no effect on those not using opioids"

Can we get a reference for this? jae (talk) 10:57, 23 December 2022 (UTC)

New article on harm reduction efforts in the U.S.

I am creating a new Wikipedia article on harm reduction in the U.S., which of course will heavily discuss and include references to naloxone. If anyone has any good sources or anything they think I should include, please let me know! Both community access and legality are two big things I will need to consider and I would love any advice you have. --Skyef25 (talk) 23:47, 21 February 2023 (UTC)

Enabling!

Since narcan became more widely available there have been people (mostly outside the addiction medicine/public health field, but maybe not entirely) arguing that it "enables" addiction. My perception is that there were more "experts" (police officers, economists) making this criticism in the 2010s, then the public health authorities pushed back against it strongly and you hear it less now, though I'm sure there are still plenty of regular people who feel this way. But of course I can't find a source that lays out that recent history clearly. Prezbo (talk) 14:22, 19 June 2023 (UTC)

police officers - the same people that claim touching fentanyl will make you OD. --WikiLinuz {talk} 18:00, 19 June 2023 (UTC)

When there are several prevailing ideas as covered in reliable sources, the overall ideas of all sides should be given a recap in the article. Graywalls (talk) 20:32, 14 July 2023 (UTC)

Is the underlying problem that narcan prevents addicts from dying, so whatever saves their lives is "enabling" their addictions? I would expect such a sentiment to have been thoroughly excoriated and debunked in the proper literature. WhatamIdoing (talk) 13:49, 17 July 2023 (UTC)

I think that’s one version of this idea. Another less reprehensible version is the idea that people will use drugs in more unsafe ways because they have the safety net of naloxone—a moral hazard kind of argument. This is kind of like arguing that people will ride bikes less safely if they have helmets, but it could be true for all I know. Finally there’s the argument (leveled against all harm reduction interventions) that making naloxone more available sends a harmful message that drug use is safe or acceptable. Prezbo (talk) 16:06, 17 July 2023 (UTC)

Or that people will drive unsafely if they have an Anti-lock braking system, which has been true in (at least) one study, but not overall.

I wonder if the people who believe that having naloxone available makes it sound like drug use is safe feel the same way about other life-threatening remedies. We could ban firefighters, to reinforce the message that fires are unsafe and unacceptable. WhatamIdoing (talk) 17:19, 17 July 2023 (UTC)

naming projects, organizations agencies that hand them out

This page is about the medication. Naming various agencies that hand them out is WP:UNDUE. If laundromats were handing out Tide for free and that happens to be covered in the media, you wouldn't put that in Tide, or laundry detergent page. Graywalls (talk) 20:40, 14 July 2023 (UTC)

If detergent was regulated the way that naloxone is regulated, and there was one laundromat distributing it by mail in the United States, and it had received a lot of media coverage...it probably would be appropriate to mention it by name. Prezbo (talk) 20:43, 14 July 2023 (UTC)

I've requested Wikiproject Medicine for additional perspectives. Thanks, Graywalls (talk) 21:05, 14 July 2023 (UTC)

Thus far, I'm seeing no consensus in favor of mentioning by name, ON POINT NYC. They're just one of many organizations around the world who hands out naloxone. Certainly not the first, nor were they the pioneer. I strongly object to including their mention by name in this article, or in harm reduction Graywalls (talk) 07:59, 16 July 2023 (UTC)

This comment at WT:MED from @Vontheri seems to me to be a good path forward. We shouldn't list every org, or even dozens of them, but I think that the article will be incomplete until it mentions a few milestones (e.g., the first orgs to distribute it in a few key countries, or the one that does the most work in this area). WhatamIdoing (talk) 14:00, 17 July 2023 (UTC)

Is this organization the only organization that distributes naloxone by mail? If so, then that is something that makes it unique, so it could possibly be notable due to it being the only organization to distribute naloxone in that manner. If other organizations also distribute naloxone by mail, then this specific organization would be just one of many, and would probably not be notable in this article. However, I don't see any reason why a new article in list form couldn't be started called something like "list of naloxone distributors" which could include this organization along with any other organizations that distribute naloxone. Vontheri (talk) 15:01, 17 July 2023 (UTC)

NEXT Harm Reduction was the first org to do this in the US and remains the leader in this area, though it has partnerships with state-specifics organizations. It’s probably not literally the only one. Prezbo (talk) 15:47, 17 July 2023 (UTC)

I believe NEXT is a dropship fulfillment service that started to send out "harm reduction" supplies to clients on behalf of state syringe exchange services due to in-person service suspension during COVID. Putting specific vendors that did X in Y place or in Z way is undue. Sweetwater Sound has been known to include candy with every order. Even with sources, saying they're the first to do so, longest etailer to do so, in United States.. into the article candy could be truthful, yet undue. If the person who created the article did so to both candy, and eCommerce, well that's even more undue. This aside, this sort of trivia attracts more such thing. It would be unreasonable to be ok with some including "first in US" and not allow the same for "first in China", "first in India" if the "first in US" was not the first in the world. Since trivia like this doesn't add value to the article candy, omitting is the right answer. Graywalls (talk) 18:10, 17 July 2023 (UTC)

Reaction following reversal with naloxone

A study was conducted with sufficient number of patients by a study that I believe rage reaction was adequately documented. The sources are mainstream as opposed to advocacy groups like Drug Free Australia or Harm Reduction International. They're scholarly journals and mainstream media. One editor says these are undue. Since the reactions follow reversal specifically after administration of naloxone, I think it is relevant and on topic. The sources used are credible. Trimming out contents that are based on pro-harm reduction advocacy or anti-harm reduction oppositional groups as POV would be reasonable. My addition may need some copy-editing but I believe the general contents is reasonable to have in here. Graywalls (talk) 07:05, 5 September 2023 (UTC)

I’m sure there are situations where people have become violent after receiving naloxone, but having a lengthy section devoted to this phenomenon, with multiple examples, seems undue to me, not to say stigmatizing. However I don’t expect to convince you of this, so I’m more interested in hearing other people’s opinions. Prezbo (talk) 08:10, 5 September 2023 (UTC)

• Came here after seeing this at WT:MED. So far as I could see, all the sourcing for this was unreliable (we would need WP:MEDRS). Thus removed. Why are we using rubbish sources when there are recent quality review articles available (I added one such)? Bon courage (talk) 08:24, 5 September 2023 (UTC)

  Why do you say The International Journal on Drug Policy would be unreliable? Graywalls (talk) 08:27, 5 September 2023 (UTC)

  If you mean PMID:32304981, then that's primary research. Bon courage (talk) 08:32, 5 September 2023 (UTC)

  PMC7572435 Graywalls (talk) 08:35, 5 September 2023 (UTC)

  Yes: Parkin S, Neale J, Brown C, Campbell AN, Castillo F, Jones JD, Strang J, Comer SD (April 2020). "Opioid overdose reversals using naloxone in New York City by people who use opioids: Implications for public health and overdose harm reduction approaches from a qualitative study". Int J Drug Policy. 79: 102751. doi:10.1016/j.drugpo.2020.102751. PMC 7572435. PMID 32304981. Bon courage (talk) 08:37, 5 September 2023 (UTC)

  And something like this, along with rxlist.com, drugs.com materials in article is acceptable?

  Some poison control centers recommend naloxone in the setting of clonidine overdose, including intravenous bolus doses of up to 10 mg naloxone. Graywalls (talk) 08:38, 5 September 2023 (UTC)

References

Graywalls (talk) 08:38, 5 September 2023 (UTC)

References

The article is full of junk; it needs a major raking through with an eye to sourcing. I'll tag it. Bon courage (talk) 08:40, 5 September 2023 (UTC)

Why did you not remove those specifics mentioned above despite removing the others? Graywalls (talk) 08:58, 5 September 2023 (UTC)

WP:CHOICE. Bon courage (talk) 09:01, 5 September 2023 (UTC)

I think it's important to note the potential for adverse effects, but I don't think we need stories about individual incidents.

An ideal source would be a practice guideline (e.g., from American College of Emergency Physicians) about naloxone. I don't know if any such sources exist, but provider safety is not an unusual thing for such guidelines to cover. WhatamIdoing (talk) 16:54, 5 September 2023 (UTC)

There's honestly no reliability issues with the sources I've used as long as it isn't framed as "medical claim". Do we really need to use highest of the highest standard source to cite caustic soda may burn you? I doubt it! Graywalls (talk) 02:37, 6 September 2023 (UTC)

It's an obscure primary source. We won't be using it. Bon courage (talk) 04:45, 6 September 2023 (UTC)

I disagree with your most recent addition calling it "misinformation". We won't be using it without some of what you've removed adding it so both sides are presented. Graywalls (talk) 07:02, 6 September 2023 (UTC)

See WP:GEVAL. We're not going to be putting unreliable sources against reliable ones. Bon courage (talk) 07:04, 6 September 2023 (UTC)

Then, I OPPOSE your most recently added contents. Graywalls (talk) 07:46, 6 September 2023 (UTC)

You've said you don't agree with what it says. But that doesn't count towards WP:CONSENSUS so can be disregarded. Bon courage (talk) 07:51, 6 September 2023 (UTC)

I disagree with your accusation of "POV pushing". Advocacy coalition source you're adding is POV. As you demonstrated in Special:Diff/1174083816, establishing consensus falls on those wishing to include stuff. Graywalls (talk) 18:14, 7 September 2023 (UTC)

We have consensus. Your obvious personal views don't count. Bon courage (talk) 18:17, 7 September 2023 (UTC)

I don't believe that we do, with regard to the newest example related to Canadian universities following up in certain ways, which you sourced to an advocacy coalition. Please look closely at what I've removed. Graywalls (talk) 18:32, 7 September 2023 (UTC)

The Canadian Mental Health Association is good source, for reasons that people have tried to explain to you at RSN. But other sources are available. I added one such. Bon courage (talk) 18:39, 7 September 2023 (UTC)

The text you introduced in Special:Diff/1174321452 is more reasonable and general enough, so I have no objection to this. Graywalls (talk) 18:42, 7 September 2023 (UTC)