What are the guidelines for prescribing naloxone to patients at risk of opioid overdose?

Current guidelines recommend prescribing naloxone to patients at risk of opioid overdose as a harm reduction measure, particularly for those who have reduced opioid tolerance following detoxification or are using high doses of opioids or concomitant sedatives such as benzodiazepines or alcohol. This is because loss of opioid tolerance after detoxification significantly increases the risk of fatal overdose, and naloxone can rapidly reverse opioid toxicity if administered promptly.

Healthcare professionals should provide detailed information to patients about the risks of overdose, signs of opioid toxicity, and how to use naloxone effectively, ensuring informed consent and engagement in their care plan.

Prescribing naloxone should be part of a broader strategy that includes psychosocial support, education on safer opioid use, and regular review of opioid therapy to minimise overdose risk.

In clinical practice, naloxone is often prescribed alongside opioid treatment for patients identified as high risk, including those on high-dose opioids, those with a history of overdose, or those using opioids in combination with other central nervous system depressants.

Staff should also consider the patient's environment and support network, involving families or carers where appropriate, to ensure naloxone is accessible and can be administered quickly in an emergency.

While UK guidelines emphasise these points within the context of opioid detoxification and drug misuse services NICE CG52,NICE CG51, recent literature also supports naloxone distribution in clinical and hospital settings as a critical intervention to prevent opioid overdose deaths Peglow & Binswanger 2018.