Zimhi Injectable Naloxone Is High Dosage but Less Popular Than Inhalers

As more and more highly potent and lethal batches of opioids hit the streets, it’s becoming abundantly clear that the need for high-dosage naloxone is at a critical high. Zimhi is one such form of naloxone, designed specifically for intramuscular (IM) administration in emergency situations, and providing the equivalent of 12.5 vials of traditional 0.4mg naloxone in a single dose. And yet, even with its high dosage, it continues to be less popular than traditional forms of naloxone such as nasal spray.

What is Zimhi Injectable Naloxone?

Zimhi is a brand name for high-dosage injectable naloxone. It’s manufactured by Adamis Pharmaceuticals Corporation and was approved by the FDA in 2021. It comes in a pre-filled syringe containing 5mg of naloxone per only 0.5mL, which is equivalent to 12.5 vials of traditional 0.4mg naloxone!

IM vs IV Medications

While the word “injectable” might seem a bit scary, it’s important to know that this medication is intramuscular (IM) and not intravenous (IV).  IM medications are injected into the muscle, where they are absorbed and distributed throughout the body. This is different from IV medications, which are injected directly into the bloodstream.

For opioid users and bystanders who might be wary of needles, it’s important to know that IM injections are typically less invasive and less intimidating than IV injections. Zimhi itself is designed to be easily held with one hand, providing a sturdy grip while injecting it into the outer thigh.

Why is Zimhi Important?

In the midst of an opioid epidemic, having access to high-dosage naloxone like Zimhi can mean the difference between life and death. In Adamis Pharmaceutical’s press release on its FDA approval, Dr. Jeffrey Galinkin, an anesthesiologist and former member of the FDA Advisory Committee for Anesthetics, Analgesics and Addiction Products, said, “I am pleased to see this much needed high dose naloxone product will become part of the treatment tool kit as a countermeasure to the continued surge in fentanyl related deaths. The higher intramuscular doses of naloxone in ZIMHI should result in more rapid and higher levels of naloxone in the systemic circulation, which in turn, should result in more successful resuscitations.”

Encouraging Use and Battling Stigma

So, we know that Zimhi is an important tool in the fight against opioid overdose deaths. It’s also highly effective and also readily available, since it’s low cost and can be found in places like harm reduction centers and emergency departments. But unfortunately, there is still a lot of stigma surrounding opioid addiction, naloxone use, and injectables alone.

In a study examining the poor implementation of naloxone some of the many reasons people listed as not wanting to use injectable naloxone medication included:

  • Fear of needles and bloodborne pathogens
  • Perceived as endorsing or encouraging drug use, especially caregivers
  • Stigmatizing to people who use drugs
  • Fear of being stopped by police
  • Bulky case that’s indiscreet
  • Fear of immediate withdrawals

Breaking Down Myths

Some of these fears are rightfully founded. For instance, it’s true that Zimhi’s extremely high dose of naloxone can cause immediate withdrawals in someone who is highly dependent on opioids. However, these effects are temporary and do not outweigh the benefits of potentially saving someone’s life.

As for concerns about stigma or being stopped by police, it’s important to remember that during medical emergencies, the priority is on saving lives and ensuring the safety of those involved. Naloxone, including injectable naloxone like Zimhi, use should not be seen as endorsing drug use, but rather as a harm reduction tool that can prevent fatal overdoses and offer a second chance at recovery.

Promoting Education and Access

To combat these stigmas and encourage more widespread use of Zimhi, it’s a good idea to educate yourself on its use and encourage others on how to properly administer the medication. It’s fairly easy.

To administer Zimhi, you can follow these simple steps:

  1. Remove the red injector from its packaging.
  2. Remove the safety needle cap by twisting it off.
  3. Place the red injector against the outer thigh (through clothing if necessary).
  4. Push the plunger down and hold it for 2 seconds until you hear a click.
  5. The medication is fully given when the plunger is all the way down, you might still see some of the medication in the plunger.
  6. Pull the needle out and pull the safety cover over the needle with one hand.
  7. Seek emergency medical attention immediately after administering the medication.

Effective and Safe

Despite people’s reluctance to use naloxone due to fear or stigma, it’s important to remember that injectable naloxone is a safe and effective medication that has been used for decades. It has no potential for abuse, doesn’t harm people that aren’t using opioids, and can be easily administered by anyone with proper training or instructions. If you or a loved one only currently have access to Zimhi or other injectable naloxone, it’s important to educate yourself on its use and have it readily available in case of an emergency.