What Is Naloxone (NARCAN) and How Does it Work?
Naloxone (commonly referred to by its brand name NARCAN) has established itself as the number one tool for reversing the consequences of a potentially life-threatening opioid overdose. It can be administered by emergency services personnel and bystanders alike.
The current opioid crisis facing the U.S. makes understanding how naloxone works crucial both for the most vulnerable and individuals looking to help. Overdoses become dangerous very quickly. Rapid and decisive action is required to identify and respond to these potentially devastating emergencies in time.
How Does Naloxone Work to Block Opioid Overdose Effects?
Naloxone works to block the potentially life-threatening effects of an opioid overdose by acting as an opioid antagonist. The drug binds to opioid receptors in the brain, which blocks these drugs’ effects. This in turn reverses the dangerous respiratory depression that can result from an overdose. Naloxone is effective against illicit opioids like fentanyl and heroin as well as prescription opioid medications.
Naloxone is safe and easy to administer, even for bystanders with no formal medical experience. The easiest and least invasive way to give naloxone to somebody suffering an opioid overdose is using the FDA-approved NARCAN® Nasal Spray. Naloxone also comes as an injectable, which can be administered into the outer thigh or any other major muscle.
Can Bystanders Administer Naloxone?
Bystanders can confidently administer naloxone as its benefits far outweigh any negative effects. Naloxone works immediately, doesn't lead to addiction, and won’t cause any ill effects if administered to an individual who hasn't taken opioids. This is especially important to know as a casualty likely won't be able to tell you what they've taken.
How Effective Is Naloxone?
Naloxone is extremely effective at blocking the effects of a suspected overdose when it's administered quickly and correctly. A real-world study of naloxone administration for opioid overdose reversal among bystanders found that 95% of overdose events were successfully reversed using NARCAN Nasal Spray.
The key to successful overdose reversal is reaching the required plasma concentration. This makes quick access to the most effective tools critical to achieving a positive outcome. For this reason, bystanders are advised to carry two 4mg NARCAN Nasal Sprays to ensure the patient receives effective treatment. Carrying two is also useful in the case of multiple overdose casualties.
Which Opioids Does Naloxone Counter?
Naloxone counters the effects of highly potent opioids like fentanyl and heroin. It's also effective in reversing accidental overdoses caused by the consumption of other opioids such as:
- Oxycodone (including OxyContin®)
- Hydrocodone (including Vicodin®)
- Codeine
- Buprenorphine
- Methadone
- Opium
Fentanyl is a particularly dangerous drug as it's increasingly mixed with other illicit drugs to boost their potency. These drugs are often made to look like legitimate prescription opioids or other types of illicit drugs. This means the consumer is unlikely to know that the drug they’re consuming contains a potentially lethal dose.
The lack of awareness surrounding what goes into illegal drugs is part of what makes them so dangerous and why it’s so critical for more people to carry naloxone.
Who Should Carry Naloxone?
Anyone who knows somebody at increased risk of drug abuse or an opioid overdose should carry naloxone. Family, friends, or neighbors of anyone suffering from opioid use disorder or anyone at risk of inadvertently consuming a lethal dose of fentanyl are recommended to keep a naloxone kit on hand and be ready to administer it at any moment.
Encourage Vulnerable Individuals to Carry Naloxone
It's important to remember that an individual experiencing an overdose won't be able to use injectable naloxone or NARCAN Nasal Spray themselves. However, individuals at risk of an opioid overdose should be encouraged to carry naloxone at all times so a bystander can help them.
Unfortunately, the official response to the growing opioid crisis often isn't enough to protect those at risk. According to the Centers for Disease Control and Prevention, primary care physicians wrote just 1.5 naloxone prescriptions for every 100 high-dose opioid prescriptions. This means that individuals have an important role to play in reducing the toll of this crisis.
Prescription Opioid Users and Narcan
Having NARCAN Nasal Spray on hand is potentially life-saving for people who take high-dose prescription opioids. This includes individuals who recognize they’re suffering from an addiction to prescription opioids or who use their prescription in conjunction with other drugs.
The following groups of people should keep naloxone on hand:
- Patients who take physician-prescribed high-dose opioid medications (50 morphine milligram equivalents or more per day)
- Anyone who takes opioids and benzodiazepines together
These people should let their family, friends, and other people around them know they have Narcan so they can be helped if they suffer an accidental opioid overdose.
Common Signs of an Opioid Overdose
Look for telltale signs that an individual is suffering from an overdose, as this is key to a successful intervention. The most common signs of an overdose are:
- Slow or weak breathing: These could be signs that the patient’s respiratory drive is depressed as a result of opioids, and they may not be getting enough oxygen.
- Constricted pupils: Significantly reduced pupil size may indicate an overdose.
- The casualty is choking or making gurgling sounds.
- The patient may be falling asleep or has lost consciousness.
- Discolored skin. This is especially evident around the lips and nails.
- Cold and/or clammy skin
- Limp body
Protect Yourself When Offering Life-Saving Treatment
It’s important to protect yourself when offering medical treatment. An overdose responder kit provides the tools you need to save a life in an emergency while protecting yourself from bloodborne pathogens.
Nitrile gloves will help you offer treatment safely both for you and the casualty while a CPR barrier shield offers invaluable protection if the patient stops breathing and you need to give rescue breaths.
How to Respond Effectively to an Opioid Overdose
Act with assuredness when you witness a suspected opioid overdose. Remember that naloxone won’t harm the patient if they’re not going through an overdose and your intervention could save their life if they are.
Take the following action if you suspect an opioid overdose:
- Call 9-1-1 immediately.
- Administer a dose of naloxone using NARCAN Nasal Spray or an injectable. Wait for 2-3 minutes to see if the casualty responds. If you don’t see any response to the first dose, administer another.
- Speak to the casualty to keep them awake, alert, and breathing.
- Lay the individual on their side in the emergency position. This will prevent dangerous choking episodes.
- Stay with the person and keep them warm and calm until emergency responders arrive on the scene.
How Long Does Naloxone Last?
Various factors impact how long naloxone lasts. The dose the patient receives, how the drug is administered, and the severity of the overdose will all affect naloxone’s efficacy. Keep in mind that the main goal when giving naloxone is to restore breathing; it’s not necessary for the patient to fully wake up or even appear alert.
As the first responder, you must be aware that individuals with opioid addiction may start to suffer from withdrawal symptoms after coming around. Symptoms of opioid withdrawal include shaking, sweating, nausea, or rage. These are normal but unpleasant reactions for the casualty. Stay with the individual and try to comfort them until the emergency services arrive; your presence will make the ordeal much more tolerable.
Naloxone Nasal Spray Saves Lives
Naloxone and especially the NARCAN Nasal Spray offers a glimmer of hope in the opioid crisis facing the United States. Its ability to quickly and effectively reverse the potentially devastating effects of an opioid overdose makes it a crucial tool in treating the most vulnerable in society and reducing the effects of this epidemic.
Understanding how to use naloxone and having it on hand empowers bystanders to offer life-saving treatment. Having the confidence, knowledge, and tools to intervene could make all the difference in an emergency situation.
