Naloxone
What is naloxone?
Naloxone (pronounced na-LOX-own) is a fast-acting medication used to temporarily reverse the effects of opioid overdoses.
How does naloxone work?
Naloxone is an opioid antagonist, which can restore breathing within 2 to 5 minutes. When you take an opioid, it attaches to and affects certain receptors in your brain. Naloxone works by kicking opioids off of the opioid receptors in your brain and temporarily binding to those receptors instead. This blocks the effects of opioids on your body, reversing overdose symptoms and restoring breathing. Naloxone works for about 20-90 minutes.
Naloxone only works if you have opioids in your system, such as:
fentanyl
heroin
morphine
codeine
Signs of an opioid overdose:
Will not respond to stimulation (“heavy nod”)
Deep snoring, gurgling (“death rattle”), choking or wheezing
Breathing is very slow, irregular, or has stopped
Clammy skin, “drained” or pale face, person looks “wrong” or not alive
Nails, lips, or fingertips have blue undertones (on light skin) or grey/ashen undertones (dark skin)
Pinpoint pupils and sclera (white part of eye) is pale or red (not vibrant white)
May be shaking and/or sweating, confused, dizzy, and unable to stay awake
5-step opioid overdose response:
Check for responsiveness and vital signs
Call 911 if the person is unresponsive
Administer Naloxone (instructions below)
Start CPR
Assess: Is it Working? If NO improvements in 2-3 minutes, repeat steps 3 & 4
If at any point you need to leave the person alone, place them in the recovery position
Administering Naloxone
Nasal Spray Naloxone (Narcan)
Give one nasal spray in one nostril
Lay the person on their back
Peel back the tab to open the spray packaging. Do not prime or test the device
Tilt the person's head back and provide support under their neck with your hand
Gently insert the tip of the nozzle into one nostril until your fingers on either side of the nozzle are against the bottom of the person's nose. Press the plunger firmly to give the entire dose of naloxone
Put the nasal spray down next to their head on the side you gave the dose, so that you remember how many doses you’ve given and on what side
Take a deep breath and make note of the time. If it does not work, you will give another dose of naloxone in the other nostril in 2-3 minutes
Injectable (IM) Naloxone
Inject one ampoule (1mL) into upper arm or thigh
You may want to put on the gloves in your kit
Shake the ampoule so all the liquid is in the bottom
Snap off the tip of the ampoule with a plastic snap cap or an alcohol swab to protect your fingers. Open it away from you
Insert a new syringe into the ampoule and steadily draw up all of the naloxone into the syringe
The needle can puncture through jeans/sweaters & light jackets. Do not attempt to remove clothing - simply pull down and away from the injection site
You may swab the injection site to clean it
Plunge the needle into the upper arm muscle or the thigh muscle at a 90-degree angle
If you hit bone, pull back a little bit before injecting
Depress plunger all the way
If the syringe does not automatically retract, place the needle sheath over the needle to prevent injuries. Place the syringe by the person’s head to keep track of the number of doses
Take a deep breath and make note of the time. If it does not work, you will give another dose of naloxone in 2-3 minutes
Why does Naloxone only work temporarily?
While naloxone is only active in the body for 20 to 90 minutes, the effects of most opioids last longer. This means that the effects of naloxone are likely to wear off before the opioids are gone from the body, which causes breathing to stop again.
Naloxone may need to be used again, depending on the amount or type of opioid taken, or how the opioids were taken (i.e. oral or injection). This is why seeking medical help after administering naloxone is important (Government of Canada, 2019).
How safe is naloxone?
Naloxone is very safe
If someone has not used opioids, naloxone will have no effect. It does not produce a high and does not reverse other types of overdoses (i.e. stimulants, alcohol, etc.)
Naloxone may be administered to pregnant women
A very small percentage of people may have hypersensitivity (allergic reaction)
In people who are opioid-dependent, naloxone administration may cause opioid withdrawal. People experiencing opioid withdrawal may be extremely sensitive to touch, be aggravated, feel unwell, vomit, and/or have diarrhea. Withdrawal symptoms are temporary and are not life-threatening
Where to get Naloxone and Overdose Response Training
You can get FREE naloxone kits and training at most pharmacies and some community organizations. Call in advance to check if they're in stock.