All rescue medications are needed in fentanyl era

Abstract

Stories of overdose deaths greatly outnumber stories of withdrawal precipitated by the use of rescue medications such as naloxone. In fact, the illicit fentanyl supply is so strong that the standard dose of intranasal naloxone — 4 milligrams — is no longer enough in most cases, unless there is oxygen supplementation (see FDA urges higher naloxone doses in fentanyl era, CPU March 2024; https://onlinelibrary.wiley.com/doi/full/10.1002/cpu30843). Most reversals of overdose require at least two doses and waiting in between those doses can be fatal. Brain damage from oxygen loss can also occur. Yet the harm reduction community continues to fret about naloxone and other rescue medications causing precipitated withdrawal.