High Dose Naloxone & Nalmefene

At NEXT Distro we oppose the distribution of high dose naloxone and nalmefene… here’s why!

High Dose Naloxone

Brand names include Kloxxado (8mg nasal spray), Zimhi (5mg auto-injector), and Rezenopy (10mg nasal spray).

For context, the standard dosage for naloxone is 3-4mg for nasal spray and 0.4mg for intramuscular injection. These high dose alternatives have been developed by pharmaceutical companies who believe that higher dosage is always better when it comes to overdose reversal – we disagree with this approach.

If you use opioids you are more likely to experience precipitated withdrawal symptoms, including a high fever and vomiting, after a higher dose of naloxone.

“Naloxone is incredibly effective, and a standard dose of 4mg is enough to reverse most overdoses. When administered, naloxone will do its job to efficiently remove opioids from the body’s receptors. More naloxone does not allow it to work any faster, because we have only so many opioid receptors in the body. Furthermore, higher dose and long-acting products tend to make withdrawal more severe, leading to vomiting, nausea, flu-like symptoms and anxiety. Physician experts have compared a standard dose product with a higher dose 8mg product and found no difference in survival, but more than double the risk of withdrawal.”

Quote from Vital Strategies 2024 Compassionate Overdose Response Summit

Nalmefene

Nalmefene, brand name Opvee, is an opioid overdose reversal medication distinct from naloxone (Narcan nasal spray is a common brand of naloxone, for example).

When Opvee first came on the market in 2023 it was met with immediate resistance from harm reduction advocates, medical professionals, and public health officials due to the long-lasting effects of nalmefene in comparison to naloxone. When nalmefene is used to reverse an overdose for a person who uses opioids it instantly puts that person into precipitated withdrawal which can cause agonizing symptoms that can last for up to 12 hours, in many cases leading to hospitalization.

What DO we recommend for responding to an overdose?

Rescue breaths and good old standard dosage naloxone!

In the event of an opioid overdose, oxygen is not reaching the person’s brain, so you ALWAYS want to pair rescue breathing along with a dose of naloxone.
This can be mouth-to-mouth (with or without a face shield!) or an oxygen canister.
Making sure the person is getting oxygen is highly effective for overdose reversal, so be sure to help them breathe before reaching for additional doses of naloxone!

We also HIGHLY SUPPORT low-dose 3mg naloxone nasal spray, the newest compassionate overdose response tool, RiVive made by Harm Reduction Therapeutics.

Check out our training video:
nextdistro.org/resources-collection/narcan-training-video-next-distro