Naloxone is a medication that can reverse the effects of an opioid overdose by blocking opioid receptors in the brain. This helps restore normal breathing when it has slowed or stopped. It is a safe medication that only works if opioids are present in a person’s system and will not cause harm if opioids are absent. Naloxone is available without a prescription, making it an important tool in emergency situations.
Recognizing an Opioid Overdose
Identifying an opioid overdose allows for timely naloxone intervention. Key indicators include very small, constricted “pinpoint” pupils that do not react to light. Breathing can become very slow, shallow, or even stop entirely, and the person may be unresponsive, unable to wake up even when shaken or shouted at.
Other signs include cold and clammy skin, and discolored lips or fingertips, which may appear blue, purple, or gray. The person might make choking sounds or a gurgling, snoring noise, sometimes referred to as a “death rattle.” Their body may become very limp, and their pulse might be slow, erratic, or absent. If there is any doubt, assume an overdose is occurring and act.
Administering Naloxone and Repeat Dosing
Naloxone can be administered as nasal sprays or auto-injectors, both designed for use by individuals without medical training. For a nasal spray, such as Narcan, the device is pre-filled with a single dose and should not be primed or tested. To administer, tilt the person’s head back, gently insert the nozzle into one nostril until fingers are against the bottom of the nose, then firmly press the plunger to release the dose. Some products may deliver 10 milligrams (mg) per spray, while others deliver 4 mg.
When using an auto-injector, such as the EVZIO device, pull it from its outer case and remove the red safety guard. Place the black end firmly against the middle of the outer thigh, which can be done through clothing if necessary, and hold for 5 seconds until a click and hiss confirms injection. Each auto-injector contains a single dose and cannot be reused. After the initial dose, if the person does not respond within 2 to 3 minutes, another dose should be given. This repeat dosing can be done every 2 to 3 minutes, alternating nostrils for nasal sprays if applicable, until the person responds or emergency medical assistance arrives. Stronger opioids, like fentanyl, may require multiple doses.
Immediate Steps After Naloxone Administration
After administering naloxone, immediately call emergency services, such as 911 or your local equivalent. Naloxone’s effects are temporary, typically lasting 30 to 90 minutes, while many opioids remain in the body longer. This difference means the person could experience re-sedation or go back into an overdose once the naloxone wears off.
While waiting for medical help, remain with the person and monitor their breathing and responsiveness. If breathing but unresponsive, place them in the recovery position by rolling them onto their side. This position helps prevent choking if they vomit. Be prepared to administer additional doses of naloxone if they relapse into respiratory depression before emergency personnel arrive. Inform responders that naloxone has been given upon their arrival.