In recent years, the opioid crisis has become a significant public health concern, affecting millions of people worldwide. According to the Centers for Disease Control and Prevention, nearly 50,000 people died from an opioid-involved overdose in 2019.
Naloxone, commonly known by the brand name Narcan, is a life-saving medication that has emerged to combat opioid overdoses. When administered promptly and correctly, naloxone can revive individuals experiencing an opioid overdose, providing them with a chance to receive further medical assistance.
Understanding how to administer naloxone can mean the difference between life and death in emergencies. In this guide, we’ll discuss how to administer naloxone effectively, ensuring that you’re prepared to respond to an opioid overdose emergency.
What is naloxone?
Naloxone is an opioid antagonist that works by blocking the effects of opioids in the brain. It rapidly restores normal breathing to a person whose breathing has slowed or stopped due to an opioid overdose. This includes overdose due to heroin, fentanyl, and prescription opioid medications.
Naloxone has no effect on a person who does not have opioids in their system, so it is safe to use even if you don’t know for certain what drug the person is overdosing on. It is not a treatment for opioid use disorder (although it is present in Suboxone (buprenorphine/naloxone)).
Naloxone is available in a few different forms. The nasal spray (which is the form Narcan comes in) is most common and is very accessible to various emergency responders and bystanders. It also comes as an injectable solution and in auto-injector devices.
Narcan is available without a prescription, and is also often available from community health organizations and harm reduction organizations, like Empower Treatment.
Identifying signs of opioid overdose
Before administering naloxone, it’s important to recognize the signs of opioid overdose. Common symptoms include:
- Slow, shallow, or no breathing
- Unresponsiveness or inability to speak
- Very small ‘pinpoint’ pupils
- Vomiting
- Choking or gurgling sounds
- Bluish or purplish lips or fingernails
- Faint heartbeat
- Pale skin
- Limp arms and legs
- Unconsciousness or inability to awaken
If you see someone having or showing any of these symptoms, act quickly and administer naloxone as soon as possible.
How to administer naloxone
Administering naloxone requires swift action, but it’s important to follow proper procedures to ensure effectiveness and safety. Here’s a step-by-step guide on how to do it effectively:
- Call for assistance: Before administering naloxone, ensure your safety and the safety of others at the scene. Call 911 emergency services immediately if you suspect an opioid overdose.
- Check for responsiveness: Gently shake the person and shout their name to know if they are conscious or responsive. You can also firmly rub your knuckles against their sternum, which is quite uncomfortable and will usually elicit a response if the person is able to respond.
- Position the person: Lay the person on their back on a flat surface, ensuring their airway is clear and unobstructed. Tilt their head back slightly to open the airway.
- Prepare the naloxone: Get out the naloxone medication and any accompanying instructions or supplies. If using a naloxone nasal spray (like Narcan), remove the device from its packaging and assemble it according to the manufacturer’s instructions. If using an injectable formulation, prepare the syringe and needle as instructed.
- Administer the naloxone:
- Nasal spray (Narcan): This is the most common and accessible form of naloxone. If using a nasal spray, follow the instructions provided with the product. Typically, you’ll insert the nozzle into one nostril and press the plunger firmly to release the medication while supporting the person’s head. Repeat the process in the other nostril if necessary.
- Injectable solution: If using an injectable solution (which is mostly used by health professionals), assemble the syringe and needle according to the instructions. Inject the naloxone into a large muscle, such as the thigh or upper arm.
- Auto-injector device: If using an auto-injector device (it looks like a box and is mostly used by military and first responders), remove the device from its packaging and follow its instructions. Place the device against the person’s outer thigh and press firmly to administer the naloxone.
- Close monitoring: After administering naloxone, closely monitor the person’s breathing and consciousness and be prepared to administer additional doses if necessary. You should monitor for another 2 hours after the last dose of naloxone to make sure breathing does not slow or stop. If you didn’t call 911 before, do so now. Naloxone is likely to induce precipitated withdrawal, so the person may come to with uncomfortable withdrawal symptoms, including headache, agitation, nausea, vomiting, tremor, and increase in heart rate. These symptoms indicate that the medication is working.
Post-administration care
After administering naloxone, providing supportive care to the individual is essential. This includes:
- Keeping the person lying on their side to prevent choking in case of vomiting
- Monitoring their vital signs until emergency medical help arrives.
- Providing reassurance and comfort to the person and those around them.
Even after administering naloxone and reversing the overdose, it’s essential to seek medical attention for the person as soon as possible. Opioid overdoses can have long-term health consequences, and professional medical care is necessary to address underlying issues and prevent future overdoses.
Training and education
To ensure you’re prepared to administer naloxone effectively, consider undergoing training and education on opioid overdose response. Many harm reduction organizations offer free naloxone training programs that cover overdose recognition, naloxone administration, and post-administration care.
Conclusion
Administering naloxone can save lives and prevent irreversible harm in the event of an opioid overdose. By familiarizing yourself with the signs of overdose and learning how to administer naloxone properly, you can help prevent opioid-related deaths. Remember to act fast when faced with an opioid overdose situation.
