Research Brief: Why Rescue Breathing is Still Important for Opioid Overdose Response

By Sharon Stancliff, MD, Medical Director, Harm Reduction Coalition


The American Heart Association now promotes “hands only CPR” for sudden cardiac arrest, leading to some confusion about how best to administer first aid in opioid overdose situations. Some studies have found that in sudden cardiac arrest, chest compressions alone are equal to or perhaps better than compressions combined with rescue breathing.

A new research brief by the Harm Reduction Coalition finds that this advice does not apply to cases of asphyxiation such as opioid overdose or drowning. A couple studies actually find worse outcomes when “hands only CPR” is used in these settings.

The take-home message? Rescue breathing remains vital in opioid overdose situations. By the time the victim is unconscious, the oxygen in the blood has been depleted, which means that replenishing oxygen is key.

For more information see the Harm Reduction Coalition alert.

Please circulate this alert widely!

Please share your comments and ideas on how to get the word out.

Let's Panic About Bath Salts!

by Matt Curtis


This week the U.S. Centers for Disease Control and Prevention (CDC) reported that in the first 4 months of 2011, emergency department visits associated with stimulant drugs sold as “bath salts,” “plant food” or other outwardly innocuous household products have already surpassed the number logged in 2010.  Although testing of such drugs appears to be limited, police labs have detected methylenedioxypyrovalerone (MDPV) and mephedrone, both fairly potent stimulants similar in effect to amphetamines (MDPV is a norepinephrine-dopamine reuptake inhibitor and mephedrone is related to methcathinone). The drugs have been sold under a variety of names including White Rush, Cloud Nine, Ivory Wave, Ocean Snow, Scarface, and Hurricane Charlie, all labeled as "not intended for human consumption."  

News: Wales to Expand Naloxone Distribution

The United Kingdom was one of the first countries to take up naloxone distribution as a strategy for reducing overdose deaths, with Scotland leading the way.  


The BBC reports that now, after the pilot "Take Home Naloxone" project that began in 2009, Wales plans to step up its naloxone efforts. Wales is estimated to be home to roughly 20,000 "problem drug users" - presumably injectors. Six hundred eighty four naloxone kits were distributed in the initial project, with 51 overdose reversals reported.

Pubmed May 2011 Update

[This PubMed update will be a regular post to keep abreast of the latest research. The articles are selected from an automated PubMed search for “heroin overdose”.

Today’s post describes two articles pertaining to prescription opioids (or “opioid analgesics”), of growing interest particularly in developed countries with high rates of opioid prescription for pain management.

1) Pharmaceutical opioid analgesic and heroin dependence: How do treatment-seeking clients differ in Australia?

Nielsen S, Bruno R, Lintzeris N, Fischer J, Carruthers S, Stoové M.

Drug Alcohol Rev. 2011 May;30(3):291-299.

Comments: This review of individuals seeking treatment in Australia found that, compared to heroin users, prescription opioid users were roughly 10% less likely to report a history of overdose and over twice as likely to report initial use for pain control. Demographics, overall health, and history of injection drug use (IDU) were similar for the two groups. The authors admit that the treatment system is oriented toward IDUs which might explain the similarity of these two groups and limits generalizability. Notably, this to determine the relative risk of overdose among prescription opioid users compared to heroin users.

2) The prescription drug epidemic in the United States: A perfect storm.

Maxwell JC.

Drug Alcohol Rev. 2011 May;30(3):264-70.

Comments: This appears to be a thorough and thoughtful review for anyone interested in the issues around prescription opioid abuse in the United States (I can’t access the full article at this time). Data sources include patient surveys, emergency department visits, and mortality and toxicology. Clinical and policy responses are also discussed, including clinician training, risk assessments, treatment agreements, prescription drug monitoring programs, and options for disposal of leftover medication. The author notes the concern that responses could raise many barriers to appropriate pain treatment and yet fail to decrease abuse.