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IM naloxone better than IN for overdose

Prehospital outcomes associated with an initial strategy of intranasal vs. intramuscular naloxone administration by EMS clinicians: a nationwide cohort study
Prehospital Emergency Care · Added 18 May 2026

Nationwide cohort study compared prehospital outcomes for initial intranasal versus intramuscular naloxone administration in suspected opioid overdose.

Study type

Cohort

Design

Retrospective nationwide EMS cohort with multilevel regression

Participants

16,550 adults given EMS naloxone across 1,481 agencies

Main finding

IM vs IN: lower odds of repeat naloxone (aOR 0.39 [0.35–0.44]), lower transport odds (aOR 0.82 [0.71–0.95]), higher odds GCS >12 (aOR 1.15 [1.01–1.30]); no difference in arrest, hypoxia, agitation or nausea/vomiting treatment

Caveat

Retrospective database study; US setting and possible confounding by indication

Bottom line

Hypothesis-generating

Learning goal

Weigh the route of initial naloxone administration against patient outcomes and response in opioid overdose care.

More

• Topic: Toxicology
• Daily scan: 18 May 2026

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