Naloxone, commonly known as Narcan, is a medication designed to rapidly reverse the effects of an opioid overdose. Alcohol overdose, or alcohol poisoning, occurs when a person consumes enough alcohol to impair basic bodily functions. Narcan cannot treat alcohol poisoning because the two substances affect the body through completely different biological pathways.
How Naloxone Works to Reverse Opioid Effects
Naloxone functions as an opioid antagonist. Opioids exert their effects by binding to specific proteins on nerve cells, known as opioid receptors, found primarily in the brain, spinal cord, and gastrointestinal tract. When opioids occupy these receptors, they slow down breathing, which is the main cause of death in an overdose.
Naloxone has a stronger affinity for the mu-opioid receptor than most opioids. When administered, it quickly competes with and displaces the opioids attached to these receptors. This action effectively reverses the severe central nervous system and respiratory depression caused by the drug, often restoring normal breathing within minutes. Because naloxone only targets opioid receptors, it has no effect if a person does not have opioids in their system.
The Dangers and Mechanism of Alcohol Overdose
Alcohol overdose occurs when the blood alcohol concentration (BAC) becomes so high that it begins to shut down the brain regions controlling basic life support functions. Ethanol, the intoxicating agent in alcoholic beverages, is a central nervous system depressant that acts on neurotransmitter systems. Specifically, alcohol enhances the activity of gamma-aminobutyric acid (GABA), the brain’s main inhibitory neurotransmitter.
This increased GABA signaling slows down brain activity, leading to symptoms like confusion, loss of coordination, and severe respiratory depression. Alcohol also inhibits the function of glutamate, the main excitatory neurotransmitter, which further contributes to sedation. Dangers include seizures, hypothermia, and a loss of the gag reflex. A compromised gag reflex, combined with stomach irritation, puts a person at high risk of aspirating vomit into their lungs, which can be fatal.
Why Naloxone Cannot Treat Alcohol Poisoning
Naloxone is ineffective against alcohol poisoning because alcohol does not interact with the mu-opioid receptors that the drug is designed to target. The mechanism of alcohol toxicity is centered on the GABA and glutamate neurotransmitter systems, which are completely separate from the opioid pathways. Consequently, administering naloxone during an alcohol overdose will not reverse the effects of the alcohol, restore consciousness, or improve breathing.
The medical community recommends administering naloxone in any ambiguous overdose situation where the cause is unknown. This practice stems from the widespread issue of polydrug use, as alcohol is often consumed alongside other substances, including opioids. If a person is suffering from both alcohol poisoning and an opioid overdose, naloxone will only reverse the life-threatening respiratory depression caused by the opioid. It provides no benefit against alcohol toxicity, but it may buy time for emergency medical services to arrive and address the alcohol poisoning.
What to Do During an Alcohol Overdose Emergency
An alcohol overdose is a medical emergency. Call 911 or your local emergency number immediately. Do not attempt to let the person “sleep it off” or assume they will recover on their own, as their condition can rapidly worsen.
While waiting for emergency services, stay with the person and try to keep them awake and responsive. If they are unconscious, position them in the recovery position by gently rolling them onto their side. This helps prevent them from choking on their own vomit, a common cause of death in alcohol poisoning cases. Monitor their breathing and level of consciousness until medical personnel arrive.