Naloxone dosing in the era of synthetic opioids: Applying the Goldilocks principle [Addiction opinion and debate] (2025)

Auteur(s) : GONZALEZ UTRILLA, M. ; CHESNEY, E. ; NEALE, J. ; METREBIAN, N. ; KALK, N. ; SKULBERG, A. K. ; DIETZE, P. ; SMITH, M. ; STRANG, J.

Dans : Addiction (Vol.120, n°11, November 2025)

Année 2025

Page(s) : 2165-2172

Sous-type de document : Revue de la littérature / Literature review

Langue(s) : Anglais

Refs biblio. : 65

Domaine : Autres substances / Other substances ; Drogues illicites / Illicit drugs

Discipline : PRE (Prévention - RdRD / Prevention - Harm reduction)

Thésaurus mots-clés

NALOXONE ; OPIOIDES ; POSOLOGIE ; SURDOSE ; ANTAGONISTE ; FACTEUR DE RISQUE

Note générale :

Commentaries:
Coffin P.O. (2025) Everything in moderation, even naloxone. Addiction, Vol. 120, n° 11, p. 2173-2174. https://doi.org/10.1111/add.70096
Morgan J.R., Walley A.Y. (2025) You have to be alive to enjoy the porridge: The role of Goldilocks naloxone dosing in a world of hungry bears. Addiction, Vol. 120, n° 11, p. 2175-2176. https://doi.org/10.1111/add.70101
Wong J.S.H., Lau A., Azar P. (2025) Naloxone dosing: An evolving unregulated drug landscape, care setting considerations, and the need for research. Addiction, Vol. 120, n° 11, p. 2177-2178. https://doi.org/10.1111/add.70144
Gonzalez Utrilla M., Chesney E., Neale J., Metrebian N., Kalk N., Skulberg A.K., Dietze P., Smith M., Strang J. (2025) From fairytale to clinical practice: A response to commentaries. Addiction, Vol. 120, n° 11, p. 2179-2180. https://doi.org/10.1111/add.70206

Résumé :

The opioid overdose epidemic remains a critical public health crisis. In recent years, synthetic opioids like fentanyl and nitazenes, have driven a sharp rise in deaths. Naloxone, an opioid receptor antagonist, has been established as a key intervention for reversing opioid overdoses and saving lives. However, there remains a critical need to optimize naloxone dosing strategies. This article examines the challenges of both under-dosing and over-antagonism in naloxone administration, emphasizing the importance of a tailored approach to overdose management. A 'just the right dose' approach is essential for minimizing the risks of over-antagonism while still reversing opioid overdose. This involves starting with a modest naloxone dose and carefully titrating it based on the patient's response, considering factors such as opioid type, overdose severity, and opioid tolerance. A tailored approach to naloxone dosing may present challenges for non-medically trained responders but it can ensure that as many people as possible receive the right dose of naloxone when they need it. Training programs should also emphasize the importance of first aid and supportive care, including airway management and alerting emergency services, as well as careful monitoring of the patient's response. [Author's abstract]

Affiliation :

National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK

Lien : https://doi.org/10.1111/add.70060

Cote : Abonnement électronique

Naloxone dosing in the era of synthetic opioids: Applying the Goldilocks principle [Addiction opinion and debate] (2025)

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