The Opioid epidemic is ravaging the United States and there seems to be no end in sight. Where opioid addiction and overdose was once an exclusively urban problem, it has now spread to all corners of the nation. The health crisis is fueled by opioid pharmaceuticals such as Oxycodone and other seemingly legitimate prescription medications.
The problem devastates families and their communities, and it also exacts an economic toll. Under President Obama, the Council of Economic Advisors determined that the financial cost of opioid fatalities was between $221.6 and 549.8 billion dollars in 2015. Unfortunately, regulating the industry is not as easy as discovering the cost in dollars or lives. However, until significant regulatory measures are enacted, there are overdose reversal drugs available to help reduce overdose fatalities.
What is it?
Naloxone, also known as the brand names Narcan and Evzio, is a medication that is known as an opioid antagonist. That term means what it might seem to imply: Naloxone is the enemy of opioids and thus seeks to ensure that they don't work. The drug works by blocking the opioid receptors in the user's brain. Opioid receptors are special nerve cells that are shaped in such a way that opioid molecules fit them much as a key fits its lock.
Opioid antagonists have an almost exact molecular structure to that of their nemeses. When introduced to the body, they remove opioid molecules from receptors and take residence on the opioid receptor sites themselves, blocking drugs such as Oxycodone and heroin from actively affecting the brain. Thus, when Naloxone is active in the body, it removes the opioids causing the negative reaction and neither prescription nor illicit opioids will be effective for a period of time. In this way, it can put an immediate halt to any opioid effects, including (and especially) overdose.
Where do you get it?
Naloxone is a prescription drug that can be obtained without a doctor's approval in most states. It is most commonly found with Emergency Medical Technicians, law enforcement officers, and Emergency Room professionals. They keep the drug in stock for when they encounter a victim of opioid overdose. Since the drug is easily administered via nasal spray and other methods, even untrained people can have the opportunity to provide help when the need arises. Naloxone also has very few side effects that stem specifically from its use and not the use of opioids. For this reason, it is recommended that those who use prescription or illicit opioids also have Naloxone available.
Injection & Auto-injection vs. Nasal Spray
There are three ways to deliver Naloxone to the body: injection, auto-injection, and as a nasal spray. To administer Naloxone via injection, the administering agent needs to have professional training. Thus, this delivery method is primarily used by doctors and nurses in Emergency Rooms and EMTs on crisis calls. Please keep in mind that Naloxone is commonly known by its brand name, Narcan.
Auto-injection is a method that enables laypeople to easily administer the drug to themselves or to someone in the throes of overdose. This delivery system involves a single-use device that can be easily uncapped and pressed to the overdose victim's outer thigh, whereupon a small needle will inject the life-saving drug. These devices also usually have an audio instruction recording that plays when you remove it from its case, allowing those unused to the application of an auto-injector the best possible chance of administering the medication correctly.
Intra-nasal Naloxone is perhaps the easiest method of all. When a person is overdosing, all their friend or loved one needs to do is squirt Naloxone into their nose, much like any nasal spray. This method, along with auto-injection, has become quite popular among harm reduction advocates. These nasal sprays also only have a single dose in each spray bottle. If the administering party believes that another dose is needed, they must have another nasal spray applicator on hand.
While intra-nasal and auto-injection Naloxone are easily administered by medical professionals and laypeople alike, the difficulty is that these methods may not always deliver a dose adequate for halting an overdose in its tracks. However, each intra-nasal and auto-injection kits come with two doses. This helps to ensure that an overdose is stopped at least long enough to ensure that the victim receives medical attention, including a professionally administered injection. Extra doses should not be given right away or at the same application site. Most applicators suggest waiting 3-5 minutes for signs of revival and, if there is none, administering the next does in an alternate injection site, the opposite thigh for auto-injectors, or the alternate nostril for the nasal spray.
How to Use it
Injection
Injected Narcan or Naloxone is perhaps the most effective. The doses can be specially tailored to suit the specific needs of an individual based on their body size and the amount of opioids they may have ingested. However, this method requires a medical professional for the procedure. The overdose victim must be held steady while the syringe is filled, the skin cleared with a swab, and then the dose injected. Additionally, only medical professionals have access to the bottles of naloxone used for this injection.
Auto-injection
Auto-injection is a relatively safe and easy way for most anyone to deliver Naloxone to an overdose victim. The kit only requires that one remove a cap and press the auto-injection device to the outer thigh of their overdosing friend or loved one (making sure there is nothing in their pockets that may interfere with the dose, such as keys or a phone). Sometimes a single dose from an auto-injection kit is not adequate to fully stop an overdose, or the first dose may wear off before an ambulance arrives. Thus, these kits commonly come with two doses.
Nasal Spray
Intra-nasal Naloxone is a favorite among harm reduction advocates who have been known to advocate for free and open distribution of this method. That is because this overdose cessation method is perhaps the easiest to administer. When an overdose victim is in the middle of their overdose, a friend or loved one only needs to spray the drug into their nose to see instant revival. However, the doses are not always enough. For that reason, each intra-nasal Naloxone kit comes with two doses. Thus, a person might be able to administer a second dose to a friend in need or help two people if a non-opioid has been spiked with Fentanyl, for instance, which is becoming much more common.
Naloxone can reverse the effects of:
Naloxone primarily works as an antagonist for any and all opioid drugs. Thus, it is effective against drugs such as:
- Oxycodone
- Lortab
- Fentanyl
- Oxycontin
- Heroin
- Vicodin
- Morphine
What it Can’t Do
Naloxone, known by brand-name Narcan, seems like a wonder drug. In fact, the fact that it works with immediacy against opioid overdose is wonderful. However, it does not work against other overdoses or with any other class of drugs whatsoever. The receptors that Naloxone clears and protects are only those that accept opioid molecules. Thus, if a person is overdosing as a result of multiple drugs, including an opioid such as prescription Oxycontin, a dose of Naloxone will only inhibit the opioids in a patient's system. If their overdose is mainly created by the non-opioid in their system, naloxone will be ineffective at reviving them. This is part of why it is imperative that you always, always call for emergency medical personnel if you believe someone may have overdosed. Do not rely on Naloxone to be the only miracle they need.
Naloxone does NOT work with the following drugs:
- Alcohol
- Cocaine
- Valium
- Xanax
- Klonopin
- Any and all benzodiazepines
- Amphetamines
- Adderall
- Ritalin
- Methamphetamine
Why Carry It Anyway
Any illicit drug use is fraught with danger, and that danger has dramatically increased with the introduction of Fentanyl to street drugs. Once considered a last resort painkiller, the drug has been unleashed onto the illicit drug market. In powder form, pure Fentanyl can induce overdose with only a few grains. Thus, when it is used to augment a supply of heroin or even amphetamines, it is extremely dangerous. For an illustration of its potency, the National Institute on Drug Abuse states that Fentanyl has 50 to 100 times the potency of morphine. Its clinical use is generally reserved for chronic pain patients who have developed a high tolerance to other opioid painkillers.
Drug dealers often mix Fentanyl with their other opioids in order to create a more potent product. Users are likely to deepen their opioid dependence if they survive a dose laced with Fentanyl. It is also mixed into amphetamine, cocaine, or other uppers as a way to distinguish a dealer's product in the market.
Whether a user anticipates finding Fentanyl in their amphetamines or other illicitly obtained drugs, it is wise to carry Naloxone. If they happen to come across a bad batch of cocaine, for instance, the Naloxone may be the only thing between living and death by overdose.
Side Effects
One of the great things about Naloxone is that the only effect it has is to block the activity of opioid drugs on the nervous system. For that reason, most states allow access to Naloxone by non-professionals, opioid users, and those with opioid users in their lives. Various states have enacted Naloxone access laws that expand access far beyond medical professionals.
It should be noted that although Naloxone only acts to antagonize the activity of opioids, there may be unpleasant after effects. That is, since the drug stops opioid activity, the user might immediately go into withdrawal. The user might seek to immediately ingest more opioids that they have on their person, or seek to find more. Opioid addicts have also been known to react very negatively upon regaining consciousness following overdose cessation. For instance, one addict was so upset to have lost the effect of his drug that he punched the doctor who had just then injected him with Naloxone.
Thus, while there is no true danger inherent to the use of Naloxone, it is not without after effects for both the user and their caregivers. As with any medications or powerful substances, it is wise to be fully informed prior to use.
Sources:
- https://www.whitehouse.gov/sites/whitehouse.gov/files/images/The%20Underestimated%20Cost%20of%20the%20Opioid%20Crisis.pdf
- https://www.owenmumford.com/us/healthcare-professionals/injection-pens-and-needles/
- https://www.drugabuse.gov/related-topics/opioid-overdose-reversal-naloxone-narcan-evzio
- Additional Resources for Counselors
The article The Overdose Reversal Drug Narcan and Counselors was originally published on Addiction-Counselor – Career and Degree Finder
