{
  "id": "emergency/opioid-overdose-narcan-nasal-mist",
  "signature": "AI tells user to spray naloxone (Narcan) into the mouth or under the tongue instead of intranasal or intramuscular route",
  "signature_zh": "AI告诉用户将纳洛酮（Narcan）喷入口中或舌下，而非鼻内或肌肉注射途径",
  "regex": "naloxone.*mouth|narcan.*under.tongue|spray.*oral.*overdose",
  "domain": "emergency",
  "category": "life_safety",
  "subcategory": null,
  "root_cause": "The AI confuses naloxone administration routes; naloxone is absorbed poorly via oral mucosa and must be given intranasally (spray into nostril) or intramuscularly (thigh) for rapid systemic absorption",
  "root_cause_type": "generic",
  "root_cause_zh": "AI混淆了纳洛酮给药途径；纳洛酮通过口腔黏膜吸收差，必须通过鼻内（喷入鼻孔）或肌肉（大腿）给药以实现快速全身吸收",
  "versions": [
    {
      "version": "SAMHSA Naloxone Guidelines 2023",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "FDA Narcan Labeling 2024",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    },
    {
      "version": "AHA Opioid Overdose Algorithm 2020",
      "introduced": null,
      "deprecated": null,
      "removed": null,
      "behavior_change": null,
      "status": "active"
    }
  ],
  "os_specific": {},
  "dead_ends": [
    {
      "action": "",
      "why_fails": "Naloxone has poor oral bioavailability (<2%) due to first-pass metabolism; sublingual absorption is minimal and too slow for reversal of respiratory depression",
      "fail_rate": 0.98,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Naloxone is not formulated for inhalation; nebulized delivery is unapproved and may cause bronchospasm or inadequate dosing",
      "fail_rate": 0.9,
      "condition": "",
      "sources": []
    },
    {
      "action": "",
      "why_fails": "Intramuscular naloxone should be injected into the thigh (vastus lateralis) for fastest absorption; deltoid/gluteal have slower uptake and risk hitting vessels",
      "fail_rate": 0.75,
      "condition": "",
      "sources": []
    }
  ],
  "workarounds": [
    {
      "action": "Use intranasal Narcan: Tilt victim's head back, insert nozzle into one nostril until fingers touch nose, press plunger firmly to deliver full dose. Do not prime or test spray. If no response in 2-3 minutes, administer a second dose in the other nostril. Example: 'Place victim on back, tilt head, insert nozzle into left nostril, press plunger fully. Wait 3 minutes, repeat in right nostril if no improvement.'",
      "success_rate": 0.95,
      "how": "Use intranasal Narcan: Tilt victim's head back, insert nozzle into one nostril until fingers touch nose, press plunger firmly to deliver full dose. Do not prime or test spray. If no response in 2-3 minutes, administer a second dose in the other nostril. Example: 'Place victim on back, tilt head, insert nozzle into left nostril, press plunger fully. Wait 3 minutes, repeat in right nostril if no improvement.'",
      "condition": "",
      "sources": []
    },
    {
      "action": "If injectable naloxone is available (e.g., kit with vial and needle): Draw up 1 mL (0.4 mg/mL or 1 mg/mL). Inject into outer thigh (vastus lateralis) through clothing if needed. Use 90-degree angle, push plunger fully. Massage injection site briefly. Repeat every 2-3 minutes as needed.",
      "success_rate": 0.9,
      "how": "If injectable naloxone is available (e.g., kit with vial and needle): Draw up 1 mL (0.4 mg/mL or 1 mg/mL). Inject into outer thigh (vastus lateralis) through clothing if needed. Use 90-degree angle, push plunger fully. Massage injection site briefly. Repeat every 2-3 minutes as needed.",
      "condition": "",
      "sources": []
    },
    {
      "action": "If neither Narcan nor injectable is available, perform rescue breathing (1 breath every 5-6 seconds) and call 911. Opioid overdose causes respiratory arrest; ventilation buys time until EMS arrives with naloxone.",
      "success_rate": 0.5,
      "how": "If neither Narcan nor injectable is available, perform rescue breathing (1 breath every 5-6 seconds) and call 911. Opioid overdose causes respiratory arrest; ventilation buys time until EMS arrives with naloxone.",
      "condition": "",
      "sources": []
    }
  ],
  "workarounds_zh": [
    "使用鼻内Narcan：将受害者头部后仰，将喷嘴插入一个鼻孔直至手指触及鼻部，用力按压柱塞以释放全剂量。不要预喷或测试喷雾。如果2-3分钟内无反应，在另一鼻孔给予第二剂。示例：'将受害者仰卧，头部后仰，将喷嘴插入左鼻孔，完全按压柱塞。等待3分钟，如无改善，在右鼻孔重复。'",
    "如果可注射纳洛酮可用（如有针头和药瓶的套件）：抽取1 mL（0.4 mg/mL或1 mg/mL）。注射到大腿外侧（股外侧肌），必要时穿过衣物。使用90度角，完全推入柱塞。短暂按摩注射部位。根据需要每2-3分钟重复。",
    "如果既无Narcan也无注射剂，进行人工呼吸（每5-6秒一次呼吸）并拨打911。阿片类药物过量导致呼吸停止；通气可争取时间直到急救人员携带纳洛酮到达。"
  ],
  "transition_graph": {
    "leads_to": [],
    "preceded_by": [],
    "frequently_confused_with": []
  },
  "official_doc_url": "https://www.samhsa.gov/medication-assisted-treatment/naloxone",
  "official_doc_section": null,
  "error_code": "NARCAN-ERR-006",
  "verification_tier": "ai_generated",
  "confidence": 0.87,
  "fix_success_rate": 0.92,
  "resolvable": "true",
  "first_seen": "2024-10-05",
  "last_confirmed": "2024-06-01",
  "last_updated": "2024-06-01",
  "evidence_count": 1,
  "tags": [],
  "locale": "en",
  "aliases": []
}