Fentanyl is a powerful synthetic opioid, 50 to 100 times stronger than morphine. While it has legitimate medical uses, its high potency and presence in illicit drug supplies pose a significant risk for accidental overdose. A specific medication can reverse these life-threatening effects.
Understanding the Reversal Agent
Naloxone is the primary medication used to reverse a fentanyl overdose. As an opioid antagonist, it rapidly binds to opioid receptors in the brain, blocking or reversing the effects of opioids by displacing them from these sites. This action is particularly important because opioids can depress the central nervous system, leading to slowed or stopped breathing. By displacing opioids, naloxone quickly restores normal breathing and consciousness, with effects often observed within minutes. Naloxone is available in various forms, most commonly as a pre-filled nasal spray or an injectable auto-injector.
However, naloxone remains active in the body for a limited time, typically between 30 to 90 minutes. This temporary action is important to remember because many opioids, especially potent ones like fentanyl, can stay in the body longer, potentially leading to a return of overdose symptoms once the naloxone wears off.
Recognizing an Overdose and Responding
Identifying an opioid overdose swiftly is important for a timely response. Observable signs often include severely constricted pupils, sometimes referred to as “pinpoint” pupils. The person’s breathing may become very slow, shallow, irregular, or even stop completely. They may be unresponsive, unable to be woken up even with sternal rubs or loud verbal commands.
Other indicators can include a limp body, pale or clammy skin, and blue or grayish lips and fingernails due to lack of oxygen. Choking sounds or a snore-like gurgling noise, sometimes called the “death rattle,” may also be present. If an opioid overdose is suspected, immediately call emergency services (e.g., 911). Prompt action can save a life.
Administering and What to Expect
Once emergency services have been contacted, administering naloxone is the next step if available. For a nasal spray, remove the device from its packaging and avoid priming or testing it, as each device contains a single dose. Gently tilt the person’s head back and support their neck, then insert the tip of the nozzle into one nostril until your fingers are against the bottom of their nose, and firmly press the plunger to deliver the entire dose. If using an auto-injector, pull it from its outer case and follow any voice instructions it may provide. Place the black end of the auto-injector against the outer thigh, which can be done through clothing, and press firmly until you hear a click and hiss, holding it in place for several seconds.
After administering the naloxone, stay with the person and monitor them closely. They may not wake up immediately or might become agitated as the naloxone takes effect. If the person does not respond within two to three minutes, administer a second dose using a new device, alternating nostrils if using a nasal spray. Continue to provide rescue breaths if the person is not breathing or their breathing is very shallow, and roll them onto their side into the recovery position to prevent choking if they vomit. Medical professionals should evaluate the person even after naloxone administration, as the effects are temporary and overdose symptoms can return.
Importance of Accessibility and Training
Widespread accessibility to naloxone is important for public health, particularly in the context of the ongoing opioid crisis. The U.S. Food and Drug Administration approved naloxone nasal spray for over-the-counter sale, making it widely available without a prescription. This increases ease of access to this life-saving medication.
Individuals who know someone at risk of opioid overdose or who are in a position to respond to an emergency are encouraged to carry naloxone. Many communities offer training programs that teach people how to recognize an overdose and properly administer naloxone. Equipping more people with this knowledge and the medication itself empowers bystanders to intervene during an overdose, potentially saving lives before emergency medical services arrive.