From the Guidelines
Placing ice on the groin of someone experiencing a heroin overdose is not recommended and could be harmful. Instead, the appropriate response to a heroin overdose is to call emergency services (911) immediately and administer naloxone (Narcan) if available, as recommended by the 2024 American Heart Association and American Red Cross guidelines for first aid 1. Naloxone comes as a nasal spray (4mg per nostril) or injectable form and works by blocking opioid receptors to reverse the overdose effects. While waiting for help, place the person in the recovery position (on their side) to prevent choking if they vomit, and perform rescue breathing if they're not breathing adequately.
The misconception about using ice on the groin likely stems from outdated practices or myths. This approach wastes critical time, may cause tissue damage from the extreme cold, and does nothing to address the life-threatening respiratory depression caused by opioid overdose. The femoral vein in the groin area does not provide a pathway to rapidly cool the body or eliminate the drug from the system. Every minute counts during an overdose, so focusing on evidence-based interventions like naloxone administration and professional medical care is essential for saving lives, as emphasized by the 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1.
Key steps to take in case of a heroin overdose include:
- Calling emergency services immediately
- Administering naloxone if available
- Placing the person in the recovery position
- Performing rescue breathing if necessary
- Avoiding the use of ice or other unproven methods
It is crucial to prioritize evidence-based interventions and seek professional medical help promptly to improve outcomes in cases of heroin overdose, as highlighted by the 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care 1.
From the Research
Heroin Overdose Treatment
- The provided studies do not mention applying ice to the groin area in the case of heroin (opioid) overdose 2, 3, 4, 5, 6.
- The studies focus on the use of naloxone as a treatment for heroin overdose, including its administration via intranasal routes 3, distribution and training programs for injection drug users 4, and observation periods in emergency departments 5, 6.
- There is no evidence in the provided studies to support the application of ice to the groin area as a treatment for heroin overdose.
Naloxone Administration
- Naloxone is a well-established essential medicine for the treatment of life-threatening heroin/opioid overdose 2.
- The intranasal administration of naloxone has been introduced as a first-line treatment in some jurisdictions, but further research is required to confirm its clinical effectiveness and safety 3.
- Training programs for injection drug users to administer naloxone and perform cardiopulmonary resuscitation (CPR) have been shown to be effective in preventing heroin overdose deaths 4.
Observation Periods
- The optimal observation period for patients who have received naloxone for heroin overdose is not universally agreed upon 5, 6.
- A 2-hour observation period has been suggested, but some studies recommend a longer observation period, especially for patients with polysubstance use or preexisting cardiopulmonary conditions 5.
- A 1-hour observation period after naloxone administration may be adequate for recurrent heroin toxicity in patients transported to an emergency department 6.