What Is Narcan®? And How Can It Save Lives?
The widespread availability of opiate painkillers is a leading cause for the alarming rise in US drug overdose-related deaths. Misuse and abuse of opioids, whether from the pharmacy (e.g., Vicodin, Oxycontin, Percocet, etc.) or from the street (e.g., Heroin), heavily impacts the lives of those who become dependent or addicted to them. It also leads to heavy burdens placed upon the families and friends of those who use opioids.
Fortunately, support services have improved vastly over the years. Identifying the epidemic of opioid-related overdoses has resulted in effective emergency treatment drugs and programs. The first US Naloxone distribution program began in 1996. By June 2014, there were 644 programs across the US, and over 26,000 overdoses were reversed. Supportive "Naloxone laws" are now in effect in 30 states.
Coming from a similar background of alcohol abuse, I have dedicated my new, sober life to assisting others in need of support for abuse-related crises.
In this article, you will find a complete guide to help someone who has overdosed on an opiate drug.
Understanding Narcan® (naloxone).
What does and opioid overdose look like?
Are there different forms of Narcan® (naloxone) available?
What to do after Narcan® (naloxone) treatment?
Help Share This Information.
Whether it was street-supplied heroin or commercially prepared painkillers – and will teach you how to use Narcan® (Naloxone) to help save a life.
Part 1: Understanding Narcan™ (naloxone).
Learning how to use Narcan® (naloxone) requires some background knowledge about what it is, how it works, and what product containing Naloxone to use. The following bullets will break this information down into bite-size pieces:
What is Narcan® (naloxone)?
Narcan® is the marketed name of a prescription medicine containing the drug naloxone, which can reverse an overdose by blocking the effects of opioids on the brain. It will not have any effect on someone who has not taken an opioid, and it is not possible to get "high" from it. There are other products that contain naloxone, but Narcan® is the first formulation intended for use in community settings by laypeople, like police and firefighters, and also people like you and I.
What is it used for?
Any opioid overdose can be reversed by Narcan® (naloxone). This includes street-marketed drugs like heroin and heroin/fentanyl blends, as well as prescription opioids.
Common prescription opioid painkillers include hydrocodone (e.g. Vicodin, Lortab), oxycodone (e.g. OxyContin, Percocet), fentanyl (e.g. Duragesic, Fentora), hydromorphone (e.g. Dilaudid, Exalgo), oxymorphone (Opana ER), and buprenorphine (Subutex, Suboxone), morphine, codeine, and methadone.
What is its mechanism of action?
Narcan® (naloxone) blocks the opiate receptors in the brain so the opioid becomes unrecognizable to the body.
How can it save someone from overdose?
When someone overdoses on an opioid, their breathing and heartbeat may slow or stop. A lack of oxygen to the brain can result in brain damage within only a few minutes.
By calling 911 and administering Narcan® (naloxone) immediately, the person may revive and respond to rescue breathing by breathing normally, buying time until emergency services arrive.
Who can administer it?
First responders and healthcare providers, as well as friends, family members, or caregivers can administer Narcan® (naloxone).
Part 2: What Does an Opioid Overdose Look Like?
For anyone whose life revolves around a user of heroin or prescription painkillers, recognizing the symptoms of a person overdosing from an opioid is critical. The most important signs include finding the victim:
- limp or unresponsive
- Unable to speak, but is awake.
- Blue or gray skin, notable around the lips and fingernails.
- Choking, gurgling, or making slow, heavy snoring sounds.
- Breathing slowly, erratically, or is not breathing at all.
- No palpable pulse, or it is slow and/or erratic.
What Should You Do If You Suspect and Overdose?
Call 911 immediately! If someone has overdosed on an opioid, you may not be able to wake them. Their breathing may become very slow or even stop. Without immediate medical assistance, an overdose can quickly lead to death.
If the victim is not breathing, perform "Rescue Breathing." Move the victim onto his/her back. Tilt his/her head back, lift the chin, and give the victim two regular breaths. Wait five seconds and give one breath. Wait five seconds and give another breath. Repeat "rescue breathing" until the victim begins breathing alone, or medical help arrives.
Roll the victim on his/her side into the "recovery position" if you must leave the victim for any reason, e.g., to get the naloxone emergency kit. This will prevent the victim from choking if he/she vomits.
Part 3: Are There Different Forms of Narcan® (naloxone) Available?
There is only one commercially available form of Narcan® (naloxone) available and that is the 4mg nasal spray. As mentioned previously, there are other products containing naloxone, but it is my opinion that they will be phased out because of the ease of use and effectiveness of Narcan® (naloxone).
One other product is the commonly distributed naloxone emergency overdose kit with a syringe and nasal atomizer, which must be assembled before using.
Prior to Narcan®, naloxone was FDA-approved only in injectable forms, most commonly delivered by syringe or auto-injector. An atomizer has been utilized as a nasal spray adaptor, by fitting it onto the syringe.
Because of concerns about risky needle use, most emergency providers have preferred the nasal atomizer method. Although not FDA-approved, the success of the emergency kits received positive legislative support, leading to widespread use and further success in saving lives.
The good news of a new, FDA-approved, ready-to-use naloxone nasal spray (Narcan®) is very encouraging. Without needing to assemble anything in such a desperate moment, perhaps this new convenient method will lead even more successful outcomes.
The following section provides necessary information you need for how to use both naloxone emergency kits with syringe with nasal atomizer and Narcan® Nasal Spray. Because of the prevalence of naloxone emergency kits with the syringe and nasal atomizer, I will cover the information for this product first. This includes specific step-by-step instructions for administering it.
After, the new FDA-approved ready-to-use Narcan® Nasal Spray will be explained in similar detail.
1. Naloxone emergency kit with Syringe and Nasal Atomizer (Assembly Required)
Typically distributed in a kit, the contents should include two doses of naloxone, needle-less syringe, nasal atomizer adaptor, a pair of gloves, a CPR mask, and instructions.
Comes with a 2mL naloxone needle-less luer-lock syringe. It also includes the following: a mucosal atomization device, CPR mask, safety gloves, and instructions.
Patented in 1961 by Sankyo, naloxone was approved as an injection therapy for opioid overdose in 1971 by the FDA. Considered one of the most important medicines in a national health system, Narcan (naloxone) is included in the World Health Organization's (WHO) List of Essential Medicines.
Available as a generic medication, its wholesale price ranges between $0.50 to $5.30 per dose. Naloxone rescue kits, like the one shown above, are widely available across the US, e.g., at most Walgreens in Massachusetts for $8 each. They are available without a prescription and contain 2 doses of Naloxone, 2 nasal atomizers, and instructions.
Naloxone can be legally prescribed by any trained and certified pharmacist, who will then provide training for the one requesting it. Primary care providers may also prescribe it. Substance abuse treatment programs provide training and access through emergency kit distribution or prescriptions. There is also an online National Naloxone Provider Locator.
Naloxone should be stored safely. Keep it away from sunlight, and keep it at room temperature. Never put it in the refrigerator.
Step-by-Step Instructions for Using Naloxone Emergency Kit with Syringe & Atomizer.
Provided by Harm Reduction Coalition, the following image and instructions provide a step-by-step guide to teach you how to use Naloxone emergency kit with Syringe and Atomizer:
Step 1: Call 911!
Step 2: If the victim is not breathing, perform rescue breathing for a few quick breaths.
Step 3: Attach the nasal atomizer adaptor to the front end of the needle-less syringe.
Step 4: Attach the glass cartridge of nasal Narcan to the back-end of the syringe.
Step 5: Tilt the victim's head back. Spray half (1cc) of the naloxone into one nostril, and the other half (1cc) into the other nostril.
It can take time for the naloxone to take effect. If the victim is not breathing or breathing is very shallow, continue performing rescue breathing. If you don't see a change within 3-5 minutes, you should give the victim another dose of naloxone and continue performing rescue breathing.
Continue reading, below, for important information regarding the post-treatment period.
2. Newly FDA Approved Syringe-Free Ready-To-Use Narcan® Nasal Spray:
Requiring no assembly or priming before using, NARCAN® Nasal Spray is a ready-to-use, syringe-free, needle-free device. It delivers a 4mg dose of Narcan® (naloxone) in an individual 0.1ml nasal spray.
When used as directed, the Narcan® nasal spray delivers a measured dose with a consistent flow. Easily administered by anyone, this convenient prescription spray requires no medical training.
It can be used on adults and children, and can be repeated as necessary. However, it's not a substitute for medical services. Seek prompt medical care for the victim by calling 911 immediately.
An innovative small business located in Radnor, PA, Adapt Pharma focuses on "developing cutting-edge treatments for patients with special medical conditions." After Fast Track Designation and Priority Review, the FDA approved Adapt Pharma's NARCAN® (naloxone HCl) Nasal Spray for commercial use in the US.
It became commercially available in early 2016, and is packaged with two separate NARCAN® Nasal Spray units containing a single 4mg dose in each. Adapt Pharma reports that individuals with health insurance coverage are expected to find "broad coverage and affordable co-pays."
Once launched, qualifying group purchasers will source the new Narcan® devices directly from wholesalers and distributors. It will also be widely available at retail pharmacies.
Step-by-Step Instructions for Using Narcan® Ready-to-Use Spray:
Step 1: Call 911!
Step 2: Place the victim on his/her back.
Step 3: Make certain the device nozzle is inserted in either nostril of the victim, with support provided to the back of the neck allowing the head to tilt back.
Step 4: Do not prime or test the device prior to use.
Step 5: Administer the dose by pressing firmly on the device plunger.
Step 6: Remove the device nozzle from the nostril after use.
Step 7: Turn victim on his/her side to prevent choking and make sure that 911 was called.
The victim may need an additional dose if he/she revives and then relapses before the emergency team (EMS) arrives. Or, after waiting 2-3 minutes with no response, administer another dose in the opposite nostril. Additional doses may be provided every 2-3 minutes until EMS arrives.
Part 4: What to do after the Narcan® Nasal Spray or Naloxone Emergency Kit with Syringe & Nasal Atomizer Treatment
If the Victim Does Not Revive:
If no change occurs after the second dose, there are a few possible reasons. There may be no opioids in the victim's system, or they may be unusually strong (e.g., an overdose with Fentanyl or Heroin/Fentanyl) and requires more naloxone, or the victim's heart may have stopped.
IMPORTANT! CALL 9-1-1 If Not Already Done.
If the victim is not breathing after treatment, does not respond to stimulation, and has no pulse, then he/she needs cardiopulmonary resuscitation (CPR) by a trained bystander or EMS.
If the Victim Revives:
If the victim cannot walk and/or talk properly after reviving, he/she needs to go to the hospital. It is critical to stay with the victim for several hours to make sure they are fully recovered. Additional important points include:
Naloxone only lasts between 30 – 90 minutes -- But the effect of an opioid may last longer. It's possible that the Naloxone could wear off before the opioid. In this case, the overdose will recur, requiring more doses of Naloxone. Never leave a victim before ensuring his/her complete recovery.
Naloxone can initiate opioid withdrawal -- When a person is addicted to an opioid, removing it from his/her body can bring on withdrawal syndrome. Symptoms include weakness, body aches, increased blood pressure, increased heart rate, sweating, fever, chills, shivering, trembling, abdominal cramps, nausea, vomiting, diarrhea, runny nose, sneezing, nervousness, restlessness, or irritability.
Upon reviving, victims often do not recognize what happened. They just revive and feel sick and uncomfortable. These withdrawal symptoms may make the victim want to use again to stop the discomfort.
However, this could easily result in another overdose. No relief will come because the immediate effect of the opioid will be blocked until the Naloxone wears off. HarmReduction.org advises caregivers to try explaining to the victim what happened and encourage the victim to not use again.
Part 5: Please Help Share This Information & Help Save Lives
Opioid overdose-related deaths in the US are growing and claimed almost 24,500 lives in 2013. This represents an average of one life every 21 minutes. The majority of these deaths happened in the victim's home and involved prescription opioids.
I hope you found this guide helpful. Now it's your turn. Please get involved -- help save lives by sharing this vital information.
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