Expert Statement Regarding High-Dose Naloxone and Long-Acting Opioid Overdose Reversal Formulations in North Carolina

<strong>Scientific petition signed by 54 North Carolina-based experts in overdose reversal.</strong> We make the following statement regarding new high-dose naloxone (e.g., &ldquo;Kloxxado&rdquo; 8 mg, &ldquo;Zimhi&rdquo; 5 mg, &ldquo;Rezenopy&rdquo; 10 mg) or long-acting nalmefene (e.g., &ldquo;Opvee&rdquo; 2.7 mg, &ldquo;Zurnai&rdquo; 1.5 mg) formulations for the treatment of a suspected opioid overdose. As clinicians, researchers, advocates, and frontline providers working to curb overdose, we are broadly supportive of compassionate, person-centered innovations to prevent overdose deaths. At this time, and in alignment with other experts from across the US we do not recommend the use of any high-dose or long-acting overdose reversal agents in North Carolina by community groups, treatment providers, EMS and other first responders, or bystanders with access to naloxone. We also support the Call to Action emerging from the national <a href="https://www.healthmanagement.com/insights/briefs-reports/compassionate-overdose-response-summit-highlights-and-key-takeaways/">Compassionate Overdose Response Summit</a>. <strong>Key Points</strong> Over 17 years, successful overdose reversals with naloxone have needed on average only 1.6 doses. Severe withdrawal from high doses of naloxone leads to more immediate re-dosing of opioids and using alone. Risk of subsequent overdose increases. Nalmefene nasal spray has never been tested in the current North Carolina drug supply or on people using opioids. Its real-world effectiveness is unknown. There is no urgency to switch to pharmaceuticals that are untested. Overdose rates in North Carolina are stabilizing with continued distribution of standard forms of naloxone.