Update on: ‘Treating the unexpected: the opiate overdose patient’

Dear Editor, I am writing in response to the article ‘Treating the unexpected: the opiate overdose patient’ (Willis, 2010) which I found very interesting as it highlighted a number of aspects in appropriate and ethically sound treatment of the opiate overdose patient and also the difficulties that ambulance clinicians face in delivering such care.

I was intrigued about the discussion regarding the use of Naloxone Hydrochloride (Narcan). The author stated: ‘Those patients who are physically dependent on narcotic drugs are at risk of violent withdrawal symptoms and so the IV route is preferred under these circumstances in order to keep the patient in a groggy state’ (Willis, 2010).

I agree with this theory but in my experience, intravenous cannulation in the field of a known opiate user has many additional risks which need to be considered. The intravenous user may be at a greater risk of contracting blood borne diseases such as hepatitis and HIV through the sharing of syringes. This creates an additional risk to the paramedic who decides that IV cannulation is appropriate.