Mass Opioid Exposure Enhancing Medical Countermeasure Preparedness
Article Sidebar
Main Article Content
Abstract
The feasibility of using opioids to intentionally cause mass casualties has been demonstrated to horrific effect in the past 25 years, and the current wide availability of high-potency synthetic opioids in the United States raises the risk of their use as a weapon of mass effect on the civilian population. These facts highlight the pressing need to prepare for future events with easily and quickly administered, fast onset, durable medical countermeasures. The recently FDA-approved intranasal nalmefene was developed to those requirements. Intranasal nalmefene can increase availability, access, and treatment capacity for emergency response to a mass exposure to synthetic opioids and expand first responders’ ability to treat certain opioid overdose patients. Emergency responders and local supplies of naloxone and nalmefene serve as the first line of defense against a mass opioids incident, with government stock of nasal nalmefene spray available for resupply to prevent depletion of opioid receptor antagonist products in the community.
Article Details
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Publishing in IJOP allows authors to keep their copyright while giving IJOP unrestricted copyright permissions. Articles published in IJOP use Creative Common Attribution 4.0 International (CC BY-ND 4.0) licensing. This license requires that re-users give credit to the creator. It allows re-users to copy and distribute the material in any medium or format in unadapted form only, even for commercial purposes. Additional terms apply and can be accessed here.
Publishing in IJOP also allows authors to have contracts for non-exclusive distribution of the Journal's published version of the article, such as posting to an institutional repository or publication in a book, on the condition that the original publication in the original layout format in IJOP is retained and acknowledged.
We permit and encourage authors to post the articles they published in IJOP on their affiliated websites. This helps share the information, encourages citation in other works, and promotes scholarly discourse in the spirit of open access.
References
BBC News. (2002, October 27). Gas “killed Moscow hostages.” BBC News World Edition. http://news.bbc.co.uk/2/hi/europe/2365383.stm
Biomedical Advanced Research and Development Authority [BARDA]. (2024, August 26). BARDA procures emergency opioid overdose treatment OPVEE nasal nalmefene spray from Indivior Inc. under Project BioShield contract. U.S. Department of Health & Human Services, Administration for Strategic Preparedness and Response. https://www.medicalcountermeasures.gov/newsroom/2024
Centers for Disease Control and Prevention [CDC]. (2024, October 2). Potential public health risk among individuals ordering counterfeit prescription medications from online pharmacies. https://www.cdc.gov/media/releases/2024/s1002-counterfit-prescription-online-pharmacies.html
Chemical and Biological Weapons Nonproliferation Program. (2002, November 4). The Moscow theater hostage crisis: Incapacitants and chemical warfare. Middlebury Institute of International Studies at Monterey, James Martin Center for Nonproliferation Studies. https://nonproliferation.org/the-moscow-theater-hostage-crisis-incapacitants-and-chemical-warfare
Crystal, R., Ellison, M., Purdon, C., & Skolnick, P. (2023). Pharmacokinetic properties of an FDA-approved intranasal nalmefene formulation for the treatment of opioid overdose. Clinical Pharmacology in Drug Development, 13(1). https://doi.org/10.1002/cpdd.1312
Desai, I. (2024, February 12). 3 men, 1 woman found dead at South Lake Tahoe home are identified. Authorities suspect fentanyl. Sacramento Bee. https://www.sacbee.com/news/local/article285399977.html
Ellison, M., Hutton, E., Webster, L., & Skolnick, P. (2024). Reversal of opioid‐induced respiratory depression in healthy volunteers: comparison of intranasal nalmefene and intranasal naloxone. Journal of Clinical Pharmacology, 64(7). https://doi.org/10.1002/jcph.2421
Gold, M.S., Milas, B., Cutchins, C., Walsh, S.L., Piotrowski, J., & Boyer, E.W. (2025). Overdose reversal challenges and priorities in the era of synthetic opioids: Insights from the respire expert forum. Current Addiction Reports, 12(39), 12:39. https://doi.org/10.1007/s40429-025-00648-5
KOAA News (2025, June 10). Organizers shut down Southern Colorado arts festival due to fentanyl-laced substances. KOAA News 5. http://www.koaa.com/news/covering-colorado/organizers-shut-down-southern-colorado-arts-festival-due-to-fentanyl-laced-substances
Laffont, C.M., Purohit, P., Delcamp, N., Gonzalez-Garcia, I., & Skolnick, P. (2024). Comparison of intranasal naloxone and intranasal nalmefene in a translational model assessing the impact of synthetic opioid overdose on respiratory depression and cardiac arrest. Frontiers in Psychiatry, 15. https://doi.org/10.3389/fpsyt.2024.1399803
Morell, M.J. (2017, September 3). The opioid crisis becomes a national security threat. The Cipher Brief. https://www.thecipherbrief.com/column_article/opioid-crisis-becomes-national-security-threat
Moreno-Paz , B., & Nguyen, T. (2024, May 2). Officials say opioid “outbreak” in Austin, Texas, linked to 9 deaths and 75 overdoses. USA Today. https://www.usatoday.com/story/news/nation/2024/05/02/austin-texas-opioid-overdose-outbreak/73548183007
Opiant Pharmaceuticals. (2023). OPVEE (nalmefene) nasal spray [label]. U.S. Food and Drug Administration. https://www.accessdata.fda.gov/drugsatfda_docs/label/2023/217470Orig1s000.pdf
Riches, J.R., Read, R.W., Black, R.M., Cooper, N.J., & Timperley, C.M. (2012). Analysis of clothing and urine from Moscow theatre siege casualties reveals carfentanil and remifentanil use. Journal of Analytical Toxicology, 36(9), 647–656. https://doi.org/10.1093/jat/bks078
Stolbach, A.I., Mazer-Amirshahi, M., Nelson, L.S., & Cole, J.B. (2023, September 28). ACMT & AACT joint position statement on nalmefene should not replace naloxone as the primary opioid antidote at this time. American College of Medical Toxicology. https://www.acmt.net/news/acmt-aact-joint-position-statement-on-nalmefene-should-not-replace-naloxone-as-the-primary-opioid-antidote-at-this-time
Tanz, L.J., Dinwiddie, A.T., Mattson, C.L., O’Donnell, J., & Davis, N.L. (2022). Drug overdose deaths among persons aged 10-19 years—United States, July 2019-December 2021. Morbidity and Mortality Weekly Report, 71(50). https://doi.org/10.15585/mmwr.mm7150a2
U.S. Attorney's Office, Southern District of New York. (2024, September 30). U.S. Attorney announces charges against 18 defendants in scheme to manufacture and distribute millions of deadly counterfeit pharmaceuticals through fake online pharmacies. https://www.justice.gov/usao-sdny/pr/us-attorney-announces-charges-against-18-defendants-scheme-manufacture-and-distribute
U.S. Food and Drug Administration [FDA]. (2023, May 22). FDA approves prescription nasal spray to reverse opioid overdose. https://www.fda.gov/news-events/press-announcements/fda-approves-prescription-nasal-spray-reverse-opioid-overdose
Vo, K.T., van Wijk, X.M.R., Lynch, K.L., Wu, A.H.B., & Smollin, C.G. (2016). Counterfeit norco poisoning outbreak—San Francisco Bay Area, California, March 25-April 5, 2016. Morbidity and Mortality Weekly Report, 65(16), 420–423. https://doi.org/10.15585/mmwr.mm6516e1