Fentanyl, a powerful synthetic opioid, is more potent than morphine or heroin. Its presence in the illicit drug supply increases the risk of accidental overdose, which can rapidly lead to life-threatening respiratory depression. A reversal agent’s swift action is crucial in these situations, restoring breathing and preventing fatal outcomes.
Understanding Naloxone and Its Action
Naloxone, commonly known by brand names like Narcan or Kloxxado, is an opioid antagonist. It works by binding to the same opioid receptors in the brain that opioids like fentanyl occupy, blocking or reversing their effects. When administered, naloxone rapidly displaces opioids from these receptors, counteracting respiratory depression and restoring normal breathing.
Naloxone’s onset of action is fast: within 1 to 2 minutes intravenously, 2 to 5 minutes for intramuscular or subcutaneous injections, and 2 to 3 minutes for nasal spray. It only works if opioids are present and will not cause harm if administered to someone who has not taken opioids. However, because naloxone’s effects can wear off in 30 to 90 minutes while fentanyl’s effects may last longer, multiple doses may be necessary.
Recognizing an Opioid Overdose
Recognizing the signs of an opioid overdose quickly is important. A person experiencing an overdose may exhibit very small, constricted pupils, often described as “pinpoint.” Their breathing may become slow, shallow, or even stop entirely, sometimes accompanied by gurgling or choking sounds.
The individual might be unresponsive to attempts to wake them, such as shaking or shouting their name, and their body may appear limp. Another indicator is discolored skin, particularly blue or grayish lips and fingertips, which signals a lack of oxygen.
Administering Naloxone and Post-Administration Care
Administering naloxone requires prompt action, and the specific steps vary slightly depending on the form. For a nasal spray, remove it from the box, peel back the tab to open, and hold it with your thumb on the plunger and fingers on either side of the nozzle. Do not prime or test the spray. Tilt the person’s head back, support their neck, and gently insert the nozzle tip into one nostril until your fingers are against the bottom of their nose, then firmly press the plunger to deliver the entire dose.
If using an injectable form, remove the colored cap from the vial and insert the needle through the rubber stopper, drawing all the fluid into the syringe. Inject the needle straight into a large muscle, such as the shoulder or front of the thigh, pushing the plunger all the way down. It is acceptable to inject through clothing.
Regardless of the administration method, call emergency services immediately (e.g., 911 in the U.S.). If the person does not respond within 2 to 3 minutes, administer a second dose of naloxone in the other nostril (for nasal spray) or use a new syringe for injection. After administering, place the person in the recovery position by rolling them onto their side to prevent choking if they vomit. Stay with them and monitor their breathing until medical help arrives, as the naloxone’s effects can wear off, and the overdose may return.
Accessing and Safely Using Naloxone
Naloxone is increasingly accessible, often available without an individual prescription through “standing orders” in many pharmacies. Individuals can simply request it at the pharmacy counter and use their insurance, or in some cases, obtain it for free through community programs or harm reduction centers. This expanded access aims to ensure more people have this life-saving medication on hand.
Naloxone is safe, non-addictive, and has minimal side effects, especially if no opioids are present in a person’s system. It should be stored at room temperature, between 15°C and 30°C (59°F to 77°F), and protected from direct light. While naloxone has an expiration date of 18 to 36 months, studies suggest it can remain effective for several years beyond this date, even if exposed to temperature extremes. Carrying naloxone is a practical measure for anyone at risk of opioid exposure or witnessing an overdose.