Naloxone is effective for reversing opioid overdose, but optimal strategies for out-of-hospital use are uncertain.

To synthesize evidence on 1) the effects of naloxone route of administration and dosing for suspected opioid overdose in out-of-hospital settings on mortality, reversal of overdose, and harms, and 2) the need for transport to a health care facility after reversal of overdose with naloxone.

Ovid MEDLINE (1946 through September 2017), PsycINFO, Cochrane Central Register of Controlled Trials, CINAHL, U.S. Food and Drug Administration (FDA) materials, and reference lists.

English-language cohort studies and randomized trials that compared different doses of naloxone, administration routes, or transport versus nontransport after reversal of overdose with naloxone. Main outcomes were mortality, reversal of overdose, recurrence of overdose, and harms.

Dual extraction and quality assessment of individual studies; consensus assessment of overall strength of evidence (SOE).

Of 13 eligible studies, 3 randomized controlled trials and 4 cohort studies compared different administration routes. At the same dose (2 mg), 1 trial found similar efficacy between higher-concentration intranasal naloxone (2 mg/mL) and intramuscular naloxone, and 1 trial found that lower-concentration intranasal naloxone (2 mg/5 mL) was less effective than intramuscular naloxone but was associated with decreased risk for agitation (low SOE). Evidence was insufficient to evaluate other comparisons of route of administration. Six uncontrolled studies reported low rates of death and serious adverse events (0% to 1.25%) in nontransported patients after successful naloxone treatment.

There were few studies, all had methodological limitations, and none evaluated FDA-approved autoinjectors or highly concentrated intranasal formulations.

Higher-concentration intranasal naloxone (2 mg/mL) seems to have efficacy similar to that of intramuscular naloxone for reversal of opioid overdose, with no difference in adverse events. Nontransport after reversal of overdose with naloxone seems to be associated with a low rate of serious harms, but no study evaluated risks of transport versus nontransport.

Agency for Healthcare Research and Quality. (PROSPERO: CRD42016053891)

纳洛酮可有效逆转阿片类药物过量，但院外使用的最佳策略尚不确定。

综合以下方面的证据：1) 在院外环境中怀疑阿片类药物过量服用纳洛酮的途径和剂量对死亡率、过量服用的逆转和危害的影响，以及 2) 逆转后需要运送到医疗保健机构的必要性纳洛酮过量。

Ovid MEDLINE（1946 年至 2017 年 9 月）、PsycINFO、Cochrane 对照试验中央登记册、CINAHL、美国食品药品监督管理局 (FDA) 材料和参考清单。

英语队列研究和随机试验，比较了纳洛酮过量逆转后不同剂量的纳洛酮、给药途径或转运与非转运。主要结局是死亡率、过量服用的逆转、过量服用的复发和危害。

单个研究的双重提取和质量评估；对整体证据强度 (SOE) 的共识评估。

在 13 项符合条件的研究中，3 项随机对照试验和 4 项队列研究比较了不同的给药途径。在相同剂量（2 mg）下，1 项试验发现高浓度鼻内纳洛酮（2 mg/mL）和肌内纳洛酮的疗效相似，1 项试验发现低浓度鼻内纳洛酮（2 mg/5 mL）效果较差与肌肉注射纳洛酮相比，但与躁动风险降低有关（低 SOE）。证据不足以评估给药途径的其他比较。六项非对照研究报告称，在纳洛酮治疗成功后，非转运患者的死亡率和严重不良事件发生率较低（0% 至 1.25%）。

很少有研究，都存在方法学限制，也没有评估 FDA 批准的自动注射器或高浓度鼻内制剂。

较高浓度的鼻内纳洛酮（2 mg/mL）似乎与肌注纳洛酮在逆转阿片类药物过量方面的疗效相似，在不良事件方面没有差异。逆转纳洛酮过量后的非转运似乎与低严重危害发生率相关，但没有研究评估转运与非转运的风险。

医疗保健研究和质量机构。(PROSPERO: CRD42016053891)