Add naloxone to in-flight medical supplies
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* Launette M. Rieb

The recently published *CMAJ* article on the management of in-flight emergencies is timely.1 In 25 years of practice, I have responded to half a dozen calls of “Is there a doctor on board?”

Several years ago, one such case occurred when a passenger travelling to a funeral ingested a large amount of alcohol on top of his usual dose of a prescription opioid before the flight and became markedly impaired. I monitored him throughout the flight and wondered if naloxone (an opioid antagonist) was on board. The flight attendant I asked did not think so. Recently, I was on a different flight when another passenger required medical assistance. In this case, I reviewed the medical kit and found that there was again no naloxone in the emergency supplies, as the article by Kodama and colleagues confirmed.

As a family physician certified in addiction medicine, I am aware of the ability of naloxone to save the life of someone in opioid-induced respiratory arrest. Given the rise in the number of travellers, as outlined by Kodama and colleagues, coupled with the rising rates of opioid overdose in British Columbia2 and across North America, I believe it would be wise for airlines to add naloxone to their medical kits. People using potent opioids sometimes require three to four doses of naloxone for resuscitation.3

Naloxone nasal spray is effective and may be the simplest to use for flight attendants, especially during turbulence.4 Otherwise, naloxone for injection would be appropriate to stock.5

## Footnotes

*   **Competing interests:** None declared.

## References

1.  Kodama D, Yanagawa B, Chung J, et al. “Is there a doctor on board?”: Practical recommendations for managing in-flight medical emergencies. CMAJ 2018;190:E217–22.
    
    [FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czoxMDoiMTkwLzgvRTIxNyI7czo0OiJhdG9tIjtzOjIyOiIvY21hai8xOTAvMjUvRTc3NC5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 

2.  Baldwin N, Gray R, Goel A, et al. Fentanyl and heroin contained in seized illicit drugs and overdose-related deaths in British Columbia, Canada: an observational analysis. Drug Alcohol Depend 2018; 185:322–7.
    
    

3.  Kassen D, Buxton J. Overdose recognition and response in the BC Take Home Naloxone Program: review of data up to July 2016. Vancouver: BC Centre for Disease Control; 2016. Available: [www.bccdc.ca/resource-gallery/Documents/Educational%20Materials/Epid/Other/THN%20report%20Aug\_final.pdf](http://www.bccdc.ca/resource-gallery/Documents/Educational%20Materials/Epid/Other/THN%20report%20Aug_final.pdf) (accessed 2018 Mar. 1).
    
    

4.  Authorized Canadian naloxone nasal spray (NARCAN) coming to market. Ottawa: Health Canada; 2017 June 30. Available: [http://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2017/63784a-eng.php](http://healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2017/63784a-eng.php) (accessed 2018 Mar. 1).
    
    

5.  Boyer EW. Management of opioid analgesic overdose. N Engl J Med 2012;367:146–55.
    
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