Naloxone, more commonly known by the brand name Narcan, is a medicine used to reverse an opioid overdose by countering the effect an opioid has on your brain. Just as someone with allergies might carry an EpiPen (epinephrine injection device), or someone with diabetes may carry glucagon, naloxone is for emergency use and can save a person’s life. Studies show there are bystanders present during one out of three opioid overdose deaths.1 If more people carried naloxone for emergencies, many lives could be saved. Emergency medical services (EMS) data from Massachusetts found that 93.5% of people given naloxone survived their overdose.2
There are several types of naloxone delivery systems:
In this article, we will explain how to use Narcan, a brand of naloxone administered as a nasal spray. This is the type of naloxone that HSS dispenses as a certified distributor for the New York State Opioid Overdose Program.
Naloxone is an opiate antagonist – a medicine used to reverse opioid overdose by blocking opioids from binding to receptors in the brain.3 When naloxone is given by nasal spray or by an injection, the medicine knocks opioids out of receptors in the brain for a short time, giving the person a chance to breathe again.4 The family of opioid drugs on which naloxone works includes prescription pain medications such as oxycodone (OxyContin), fentanyl, hydrocodone (Vicodin), hydromorphone (Dilaudid), morphine, methadone, and illegal street drugs like heroin.
People at high risk of opioid overdose include those who:
It is important to know that it is possible to accidentally take more opioids than you realize, especially when taking illicit substances that might have fentanyl mixed with them. Fentanyl is a synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine.5 It is a major contributor to overdoses in the United States, many of which are fatal. Fentanyl, especially illegally made fentanyl, is often mixed into illicit drugs to make them cheaper but more powerful. Because fentanyl is so potent, it also makes these drugs far more addictive and dangerous.
Fentanyl can come in powder, liquid, or tablet form. It is frequently mixed with drugs like heroin, cocaine, and methamphetamine, or made into pills that look like prescription opioids. In a liquid form, it can be taken with nasal spray, eye drops, or put onto paper or candies.
Many people selling or using drugs are not aware that their drugs are laced with fentanyl, or how much fentanyl is mixed into the drugs. It is possible for both first-time and long-term drug users to accidentally overdose. Any type of opioid overdose, whether prescription or illicit opioids, can lead to death. It should be noted that naloxone will not reverse the effects of non-opioid drugs with which fentanyl or any other opioid may be mixed (including cocaine and methamphetamines). It will only work on the opioids themselves.
Naloxone should be administered to anyone you suspect may be having an opioid overdose. Naloxone works on opioids, including heroin, fentanyl, and prescribed opioid medicines. It does not work on non-opioid drugs such as benzodiazepines, cocaine, methamphetamines or alcohol. However, naloxone will not hurt someone who is not having an opioid overdose, so you can still administer naloxone if you are not sure what is causing the overdose.
Signs of an opioid overdose include:
If you believe someone is having an opioid overdose, call 911 right away, then administer naloxone.
You can watch our naloxone (Narcan) training video6, or read the instructions below:
Important note: There is only one dose in every applicator, so do not test it first!
Move the person onto their back, then follow the three Ps: Peel, Place and Press.
Naloxone has little to no effects in most people who do not have opioids in their system, which is why it is often better to be safe than sorry. If you are not sure whether a person is overdosing from opioids, it usually best to administer naloxone anyway. Be sure to also call 911 right away.
For people who do have opioids in their system, naloxone may cause side effects such as:
Naloxone may also block natural endorphins created by the body that reduce pain. Other rare side effects may include:
Naloxone can also cause other adverse events, including:
Naloxone should be used with caution in people who:
Naloxone is an emergency treatment that can reverse opioid overdose, and it can often be acquired over the counter without a prescription. Naltrexone is not an emergency medicine – it is a substance use treatment prescribed by a doctor.9 Naltrexone is taken either as pills or an injection, and it blocks opioids and alcohol from providing the “high” feeling that people get from using these substances. However, it doesn’t actually stop you from being intoxicated, even if you don’t feel drunk or high. Do not drive or do anything that requires you to be mentally alert.
In most states, you don’t need a prescription to get naloxone from a pharmacy. Ask your doctor or pharmacist about getting naloxone.
In New York state, you may be eligible for the Naloxone Co-payment Assistance Program (N-CAP), which can help reduce the cost of naloxone.10 Other states also have naloxone awareness programs, so check to see what programs exist in your state.
If you are having surgery at HSS, you can ask about getting a naloxone (Narcan) kit for free from HSS. HSS is a certified distributor for the NYS Opioid Overdose Program. The chronic pain service has naloxone kits available for patients in the hospital.