Add naloxone to in-flight medical supplies

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