Knowing how naloxone works and having it on hand are the best ways to counter the effects of a potentially life-threatening opioid overdose. In the face of the current opioid crisis, naloxone (commonly known by its brand name Narcan) has emerged as the number one tool for reversing these critical situations.
Understanding the mechanism of naloxone is crucial for both those at risk and those seeking to help. Opioid emergencies have a narrow window for treatment, so it’s essential to recognize the symptoms and respond swiftly.
Naloxone’s Opioid-Blocking Effects Explained
Narcan (the brand name for the generic medication naloxone) is an opioid antagonist used to reverse the effects of an overdose of drugs like heroin, fentanyl, and prescription opioid medications. The drug works by binding to opioid receptors in the brain. This blocks the effects of these drugs and reverses the respiratory depression that can result from an overdose.
It’s important to be aware that the effects of naloxone may wear off before the effects of the drugs the person took. Some patients may need multiple doses. It’s essential to call the emergency medical services or send someone to make the call while administering the first dose of naloxone to the patient.
Naloxone is safe and easy to administer even by bystanders with no previous medical experience. The easiest and least invasive way to administer naloxone is using the FDA-approved Narcan nasal spray device, which is available online and over the counter. Alternatives include injecting naloxone into the outer thigh or any other major muscle.
Naloxone works immediately, isn’t addictive, and has few negative effects. Furthermore, administering Narcan won’t cause any ill effects if opioid drugs aren’t present in a person’s system. This makes the medication the best solution for a suspected overdose and a safe way to offer potentially life-saving care if the casualty isn’t in a position to tell you what they’ve taken.
How Effective Is the Narcan Brand of Naloxone?
Narcan is highly effective at blocking the effects of an opioid overdose when administered quickly. Research funded by the National Institute on Drug Abuse (NIDA) into its effectiveness confirms that the FDA-approved Narcan 4-mg dose nasal spray was shown to produce a higher plasma concentration of naloxone than naloxone administered using improvised devices.
Which Opioids Does Naloxone Block?
Naloxone blocks potent opioids like heroin and fentanyl. Naloxone is also effective in reversing overdoses caused by:
- Buprenorphine
- Codeine
- Hydrocodone
- Methadone
- Opium
- Oxycodone
Who Should Carry Naloxone?
Carrying naloxone nasal spray is highly recommended for anyone who knows somebody at risk of drug abuse or an opioid overdose. Friends or family of anyone with opioid use disorder (OUD) should keep a naloxone kit on hand and be prepared to administer it at any moment.
Having Narcan readily available is also potentially life-saving for individuals who regularly take high-dose prescription opioids or people who recognize they’re suffering from an opioid addiction. This includes:
- Individuals who take high-dose opioid medications (50 morphine milligram equivalents or more per day) as prescribed by a doctor
- People who take opioids and benzodiazepines together
- People who use illegal drugs
Individuals experiencing an overdose cannot use injectable naloxone or Narcan nasal spray on themselves. It’s important for vulnerable people to let friends, family, and others they interact with regularly know they have it in case they experience an opioid overdose.
Protect Yourself When Offering Life-Saving Treatment
It’s important to protect yourself as the first responder when offering medical treatment of any kind. An overdose responder kit offers the tools you need to intervene in an emergency while protecting yourself from blood-borne pathogens that could impact your own health.
Brian Graddon, ex-firefighter paramedic and SWAT medic, and current CEO of True Rescue explains: “When responding to an opioid overdose, we recommend having nitrile gloves, a CPR mask (if performing rescue breaths), & biohazard bag at your disposal.”
Good Samaritan Laws Protect First Responders
All 50 states and Washington DC have some form of Good Samaritan law that protects first responders who act in good faith during emergency situations like an opioid overdose. These laws protect individuals giving emergency medical care at the scene, including administering naloxone. Non-medically trained bystanders who witness a potential opioid overdose can therefore act decisively to save lives without fear of liability.
Is It a Good Idea to Carry Naloxone?
Carrying naloxone is absolutely a good idea as it provides potentially life-saving care for those at high risk of overdose. Though professional first responders will typically carry naloxone, they won’t usually arrive until at least seven minutes after the call, and potentially longer in rural areas. Naloxone/Narcan is most effective when administered immediately.
Remember: Administering naloxone isn’t dangerous to the casualty even if you misdiagnose an opioid overdose. If in doubt, always administer naloxone.
Common Signs of an Opioid Overdose
Recognizing the most common signs of an overdose is critical to saving a life. They include:
- Constricted pupils: Significantly smaller pupil size can indicate an overdose.
- Blue, purple, or gray skin: Look especially at the lips and nails for signs of an overdose.
- Slow, weak, or no breathing: The patient may be struggling to breathe.
- The patient is making choking or gurgling sounds.
- Falling asleep or losing consciousness
- Limp body
- Cold and/or clammy skin
How to Respond Effectively to an Opioid Overdose
It can be hard to know for sure if someone is experiencing an opioid overdose. When in doubt, treat it as you would treat an overdose; you could save a life doing so. Be aware that fentanyl is particularly potent and overdoses may need to be treated with two or more doses of naloxone.
- Call 9-1-1 immediately and administer naloxone. If the individual overdosing fails to respond within 2-3 minutes after administering a dose of naloxone, administer a second dose (page 2 of the PDF).
- Keep the person awake, alert, and breathing.
- Lay the person down on their side to prevent possible choking episodes.
- Stay with the person until first responders arrive on the scene.
How Long Do the Effects of Naloxone Last?
The duration of the effects of naloxone depends on the dose, how you administer the medication, and the severity of the overdose. Monitor the person after you administer naloxone; the main goal should be to restore breathing. It’s not necessary for the person to be completely awake or alert.
Be aware that people with a physical dependence on opioid drugs could start to suffer from withdrawal symptoms after coming around. These symptoms include shaking, sweating, nausea, or feelings of anger. This is a normal yet unpleasant reaction for the person. Comfort them and stay with them until professional assistance arrives to make the ordeal as manageable as possible.
Be Prepared to Save a Life
Naloxone’s ability to rapidly reverse overdoses is a testament to its crucial role in mitigating the devastating impact of the opioid crisis. Understanding the medication’s mechanism of action—plus having the tools on hand to offer effective treatment—empowers individuals to act decisively in emergencies.
Naloxone is not a solution to the underlying addiction but it does serve as a vital lifeline. Intervening with the right treatment can save the lives of people suffering amid this epidemic and give them the second chance they need.