Naloxone is an opioid antagonist. That means it prevents the effects of opioids by blocking receptors in the brain. It is used to reverse an opioid overdose. A person who has stopped breathing because of an opioid overdose can usually talk and walk within minutes of receiving naloxone.
Opioids are drugs that relieve pain and cause relaxation. Morphine, oxycodone and other opioids are usually prescribed to treat severe pain after surgery, during cancer treatment or during end-of-life care. Sometimes the drugs are prescribed to treat mild or moderate pain. These prescription drugs are considered safe when used as prescribed for a few days or a week.
However, individuals can misuse prescription opioids or an illegal opioid called heroin to get high. When abused, opioids overwhelm parts of the brain that cause happiness and relaxation. They also affect parts of the brain that control breathing. Overdosing on an opioid can make a person stop breathing.
In high enough doses, naloxone and other opioid antagonists can reverse the effects of any opioid. Some opioids, such as fentanyl and carfentanil, are so potent that several naloxone sprays or shots are required to reverse the effects. Drugs that naloxone can reverse include:
Countless lives have been saved in the past decade because of increased availability of naloxone. A 2015 survey by the Harm Reduction Coalition found that 152,283 laypersons in 136 organizations received naloxone kits between 1996 and June 2014. These organizations received reports of 26,463 overdose reversals during the timeframe.
The Food and Drug Administration approved naloxone in 1971, but the medication wasn’t accessible outside of health care settings for decades. In recent years, states have passed laws regulating the availability of the opioid antidote to first responders and the public.
“Naloxone is a completely benign drug,” Lexi Reed Holtum told DrugRehab.com. “It has zero abuse potential. It’s super safe.”
Holtum is the executive director of the Steve Rummler Hope Network, an organization dedicated to raising awareness about opioid addiction and safe treatments for chronic pain. Holtum and other members of the Steve Rummler Hope Network have conducted hundreds of naloxone trainings.
“As far as side effects go, our doctors tell us that there’s a very small chance that you’re going to be allergic to naloxone,” Holtum said. “The reality is, if you overdose on an opioid, you have to have this antidote or you die.”
Contrary to misconceptions about the medication, naloxone is considered safe for most people. It is not a controlled substance. It doesn’t harm individuals who don’t have opioids in their system.
The medication kicks opioids off of receptors in the brain, so individuals who are dependent on or addicted to opioids may go into withdrawal after receiving naloxone. Opioid withdrawal causes unpleasant symptoms, but it’s rarely life threatening.
Pharmaceutical companies have developed new ways to administer naloxone to make the medication easier for laypeople to use. The FDA approved a device called Evzio in April 2014. Evzio is a user-friendly device that contains audio instructions for administering a naloxone injection.
The FDA approved another form of naloxone called Narcan in November 2015. Narcan is a nasal spray that contains naloxone. It was the first form of naloxone that didn’t have to be injected.
Narcan was also the brand name of the first naloxone injection, which was approved in 1971. However, the injection form of Narcan is no longer available. The nasal spray version is the only Narcan product that you can buy today.
Some people use the term “Narcan” to refer to all forms of naloxone. However, Narcan is a brand name for specific forms of naloxone. Evzio and generic naloxone injections contain the same active ingredient as Narcan.
It can be difficult to determine if someone is overdosing on opioids because some people who use opioids to get high desire the experience of so-called “nodding” before they fall asleep. People who get high on heroin and fall asleep should respond if you try to wake them.
If they don’t respond, they may be unconscious. Being unconscious is different from being asleep. Loss of consciousness is one of the warning signs of an opioid overdose. Other warning signs of an opioid overdose include:
If you suspect an overdose but the person is still awake, ask them if they took an opioid and when and how they consumed it. You can use the information to determine how to respond if they pass out. If they pass out or you find them unresponsive, you should take steps to save their life.
“Naloxone isn’t the first thing you do if someone overdoses,” Holtum told DrugRehab.com. “The first thing you do is call 911. Then give rescue breaths. Then give naloxone.”
Call 911 as soon as possible once you realize a person has overdosed. Provide the 911 dispatcher with as much information as possible, including the type of opioid used, the time of use and how it was used. If the person isn’t breathing, perform rescue breathing before administering naloxone.
To perform rescue breathing:
The person’s chest should inflate with each breath. After providing two or three rescue breaths, administer naloxone.
How to administer a naloxone injection:
How to administer Narcan:
How to administer Evzio:
If the person isn’t breathing, continue to perform rescue breathing for two to three minutes or until first responders arrive. If the person doesn’t wake up after two or three minutes, administer another dose of naloxone.
Stay with the person until emergency responders arrive. Once first responders arrive, provide them with as much information as possible.
After reviving someone with naloxone, encourage them to seek medical care. It is possible for a person to overdose a second time once the naloxone wears off. In one study, IV administration of naloxone lasted 45 minutes. Many opioids last for several hours.
“If you get a dose of Narcan to wake you up, that doesn’t mean you don’t go to the hospital,” Dr. Chris Johnson, an emergency room physician, told DrugRehab.com. “Narcan doesn’t last forever and some opiates last longer than Narcan.”
Individuals who overdose on long-acting opioids, such as methadone or extended-release pills, are at an increased risk for experiencing a second overdose. Naloxone doesn’t remove the opioids from the body. It temporarily prevents them from affecting the brain.
“Narcan binds to the opiate receptor better than the opiates do,” Johnson said. “It kicks the opiate molecule off the receptor. But when the Narcan gets broken down, the opiate molecules can bind back on the opiate receptor again. If you go to a hospital and you need another dose of Narcan, you get it. Whether you get a paramedic to give you Narcan or you take Narcan yourself, you must go to the hospital.”
Individuals who are addicted to opioids usually go into withdrawal after receiving naloxone. Their brain craves opioids, and naloxone prevents the opioids from relieving those cravings. Medical care from a hospital may help individuals who are addicted to opioids cope with symptoms of opioid withdrawal.
Health care providers can counsel patients about the risks of misusing opioids. They can also connect them with drug rehab centers and other recovery services to help them detox and learn to live without drugs.
If individuals refuse addiction treatment, some hospitals will provide them with naloxone kits. The kits usually include a dose of naloxone, information about the risks of using opioids, locations that distribute naloxone, mental health hotlines and information about local rehab facilities.
Naloxone is more widely available today than ever before. Several large pharmacy groups, including Walgreens and CVS, have increased access to naloxone. As of July 1, 2017, pharmacists in 49 states and the District of Columbia can sell naloxone without a prescription from another health provider, according to the Prescription Drug Abuse Policy System.
In some communities, hospitals, health departments and crisis centers are authorized to dispense naloxone. Drug prevention and intervention groups are authorized to dispense naloxone in some states. Social workers and other advocates may also be able to provide the medication, depending on local laws.
Many people first learn about naloxone at naloxone awareness or training events. These events are usually hosted by advocates in the community who are dedicated to preventing deaths from opioid overdose.
“We need every single individual who is in a position to reverse an opioid overdose to have the tool, naloxone, in their hands and to know what to do,” said Holtum, who has hosted numerous naloxone training events. “If we can get to someone when they’ve stopped breathing but their heart is still beating, then naloxone will save their life.”
The cost and availability of the medication varies by state. Some health departments and nonprofit organizations are funded by federal grants designed to increase access to naloxone. The organizations provide naloxone at no cost to individuals taking opioids or to individuals who know someone who uses opioids regularly.
Most insurance plans cover naloxone that’s administered in a health care setting, such as an emergency room. A limited number of insurance plans reimburse individuals who purchase the drug with a prescription or over the counter. Reimbursement varies depending on the state and type of insurance plan.
The price of naloxone has gone up in recent years, according to a 2016 study published in the New England Journal of Medicine. The price of a single dose of naloxone usually ranges between $20 and $150. The price of a two-pack of Evzio auto-injectors can cost as much as $4,500.
Most naloxone training events are open to the public, but you may have to register with the host organization ahead of time. The agenda for each event varies, but naloxone trainings usually begin with a brief description of opioid addiction. Event hosts may also talk about local opioid trends and health care resources.
After this introduction, a presenter demonstrates how to administer naloxone. Attendees are usually allowed to practice administering naloxone on a dummy or volunteer. The practice devices do not contain needles or medication.
At a June 2017 naloxone training event in Jacksonville, Florida, volunteers from Drug Free Duval trained medical students, nurses, community advocates and college professors to teach others to use naloxone.
“The event was about training people in the community to be trainers in [naloxone administration] so we are able to canvass the community in a larger role,” Melanie Bright, youth director at Drug Free Duval, told DrugRehab.com.
Naloxone training events can also serve as conduits for community engagement and planning. Bright said the event helped create a group of community trainers who can teach others about naloxone administration, safe prescription drug storage and how to recognize warning signs for substance use disorders.
“[The event] brought us together to talk about the issues and to figure out how we’re going to approach the general community who might not work in the field,” Bright said. “They, too, need knowledge about opioids, and they need to know how to use naloxone if they have a loved one that’s overdosing.”
Training events like the ones held by Drug Free Duval and the Steve Rummler Hope Network occur every week in communities across the United States. Naloxone isn’t a medication used to treat opioid addiction. It’s a medication that saves lives and opens the door to conversations about recovery.
“Naloxone training in the community is important because when someone overdoses, seconds and minutes matter,” Holtum said. “Naloxone can save their life.”
When more people have access to naloxone and know how to use the medication, more lives can be saved. More people have a chance to think about the impact of opioid use. And more people have the opportunity to seek recovery resources.
Dr. Christopher Johnson is an expert speaker on the opioid crisis. To contact him, visit his website.
Trey Dyer contributed to this guide. Trey has received naloxone training from Drug Free Duval, a community coalition in Jacksonville, Florida.