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NALOXONE CHALLENGE TEST

  • Nov 28, 2020
  • 2 min read

Updated: Dec 16, 2020

INTRODUCTION:


Naloxone is an opioid antagonist that is used for the reversal of opioid toxicity as it binds to the same opioid receptors but instead of activating it, it blocks the activation and produces a reverse effect. Naloxone challenge test is used for the assessment of opioid dependence (Resources, February 20, 2020).


One of the three routes can administer naloxone: Intravenous, Subcutaneous, or Intramuscular. When a patient reports an adequate period of abstinence also has a negative report of a urine test for morphine, methadone, buprenorphine, and oxycodone then this test is performed to confirm the abstinence (Wermeling, 2015).

In a 20 to 30-minute time period, if the patient does not suffer from withdrawal effects, that means the report is negative. Once negative does not give the guarantee that the patient will not experience withdrawal effects when tested with naltrexone (SAMHSA, 2018).

The symptoms to be monitored are sneeze, cough, yawn, lacrimation, shivering, restlessness, sweating, vomiting, gooseflesh (Judson, Himmelberger, & Goldstein, 1980).


INTRAVENOUS ADMINISTRATION:


1. 0.8 mg of naloxone is drawn into a sterile syringe then injected 0.2 of it intravenously.

2. Wait for 30 seconds for the symptoms to appear, if they do appear stop injecting and treat the signs or symptoms.

3. If no symptoms occur, inject the remaining 0.6 mg and wait for 20 minutes. Vitals should be checked regularly in between and monitor for withdrawal symptoms.

4. If withdrawal occurs, stop naloxone challenge and treat symptomatically and repeat the test in 24 hours or otherwise start the opioid agonist treatment.

5. If there are no withdrawal symptoms, naltrexone should be started at a 25 mg dose for two consecutive days followed by 50 mg daily.

6. Instruct the patient for the risk of overdose and death if they tend to use the opioids again.


SUBCUTANEOUS ADMINISTRATION:


1. First, inject the naloxone at 0.8 mg dose subcutaneously

2. Wait for 20 minutes, check all the vitals in between, and observe the symptoms of withdrawal.

3. If they appear, stop the test and treat symptomatically, the test can be repeated in 24 hours.

4. If there are no withdrawal symptoms, naloxone is injected at 25 mg dose for the first two days and then 50 mg afterward daily.


Immediate response on overdose patients:


The patient can face unconsciousness, hypoxic, and can be unable to attend in case of overdose or discontinuation of medicine. The quick care for the first responder suspecting an opioid overdose patient are as follows:


1. Sense opioid overdose: check for sub consciousness, pale color, slow breathing

2. Call EMS (emergency medical service) to get the medical attention

3. Administer Naloxone

4. Do passive breathing in case the patient could hardly breath

5. Repeat the dose after 5 min until the EMS arrives in case the situation isn’t under control


Naloxone is currently only available is injection form which is proving to be a hindrance in its expansion. There are certain risks implied by injection administration e.g. needlestick injury, HIV infection. Thus, it raises concerns with the application via medical providers, or at home family member or even by first responders. Medical directors to choose a needle free way of administration e.g. nasal spray are investigating alternative routes. However, all the alternatives must have a safe way to go about and be effective.

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About Dr. Viveck Baluja and KneeTie Vascular Neurology

Dr. Viveck Baluja, MD, is a board-certified vascular neurologist (American Board of Psychiatry and Neurology — Vascular Neurology) practicing telemedicine across California, Michigan, and Colorado, with additional consultation services available to international families, particularly in India.

KneeTie offers three focused services: emergency stroke second opinions delivered within 24 hours, traumatic brain injury (TBI) consultations for survivors and caregivers, and same-day adult ADHD evaluations for residents of CA, MI, and CO.

Stroke Second Opinion

After a stroke, families often have minutes to make decisions. Dr. Baluja provides a second set of expert eyes from a board-certified vascular neurologist — reviewing imaging, hospital records, and current treatment — typically within 24 hours of request. Common questions include: Was tPA appropriate? Should we pursue thrombectomy? What is the recovery outlook? What rehabilitation makes sense?

TBI Consultation

Traumatic brain injury recovery is rarely linear. Dr. Baluja helps patients and families understand recovery timelines, treatment options, post-concussion syndrome, and red flags that warrant emergency evaluation. Consultations typically last 50 minutes and are scheduled within the same week.

Same-Day Adult ADHD Evaluation

A real evaluation by a board-certified neurologist — not a 7-minute screening. Dr. Baluja's ADHD evaluations include comprehensive history, sleep and lifestyle assessment, and behavioral strategy alongside any medication discussion. Available same-day for residents of California, Michigan, and Colorado.

Why a Vascular Neurologist?

Vascular neurology is a subspecialty focused on stroke, cerebrovascular disease, and brain blood flow — among the rarest neurology subspecialties in the U.S. Most online telehealth services use general practitioners or nurse practitioners. KneeTie is led by a board-certified vascular neurologist with full state licensure and HIPAA-compliant telehealth infrastructure.

Schedule a consultation: Use the booking calendar above to choose a service and reserve a time. For active stroke or post-tPA emergencies, email gorungo@kneetie.com directly with "URGENT" in the subject line.

© 2020 KneeTie, Jagannatha Health LLC 

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