Narcan is a commonly known name for naloxone, which is a medication that can be used to quickly reverse an opioid overdose by displacing the opioids from the receptors. It has no effect on overdoses of non-opioid agents. Examples of opioids include heroin, fentanyl, oxycodone, hydrocodone, codeine, and morphine. Naloxone comes in multiple formulations, including two different injectables and two different nasal sprays. Naloxone should be given to any person who shows signs of an overdose or is suspected to have overdosed. Although it usually causes withdrawal sympotms if the person is dependent on opioids, you cannot overdose on naloxone. It is also non-addictive and has no potential for abuse. Some formulations of naloxone are now over-the-counter and available to anyone. A few groups that may want to carry it are those who use opioids, family and friends of those who use opioids, and those who work with the public such as police officers, social workers, and more.

Who is at risk for overdose?

Some risk factors for opioid overdose include those who have opioid use disorder, those who use injectable opioids, those taking prescription opioids without medical supervision, patients taking more than 100 mg of morphine or the equivalent daily, and those who are combining opioids with alcohol or other substances that can decrease respiratory function. Another group to consider is those who resumed opioid use after a period of abstinence, such as someone who recently left rehab. Someone like this may take the higher dose that they had previously used, but then experience an overdose since their body is no longer used to that high amount.

Signs of overdose:

• Unconsciousness
• Very small (“pinpoint”) pupils
• Slow or shallow breathing
• Vomiting
• Inability to speak
• Faint heartbeat
• Limp arms and legs
• Pale skin
• Purple lips and fingernails

What to do if you witness an overdose:

If you see someone who is overdosing, call 911 and administer naloxone. If there is minimal to no response, another dose can be given in 2-3 minutes. Stay with the victim until help arrives. It is important to note that naloxone will not harm the person if they are not actually experiencing an overdose.

How to use the various formulations

• Intramuscular injection
  • Open cap of vial
  • Remove cap of needle and insert into vial
  • Flip vial upside down and pull back plunger, drawing up 1 mL of naloxone (may be single dose or may have multiple doses in the vial, depending on the product)
  • Inject naloxone into the muscle of the upper arm

• Auto-injector
  • Remove the auto-injector from the outer case
  • Pull off the red safety guard
  • Put the black end of the device against the outer thigh, through clothing
  • Press firmly until you hear a click and a hiss, and then hold for 5 seconds

• Multi-step intranasal atomizer
  • Remove the yellow caps from ends of the applicator
  • Twist the nasal adapter on the tip of the applicator until tight
  • Take the purple cap off the prefilled vial, insert it into the applicator, and twist until tight
  • Push half of the dose (1 mL) into each nostril; this is one full dose

• Single-step intranasal spray
  • Peel back the tab with the circle to open
  • Insert tip into either nostril and administer the full dose
  • Entire dose is administered with one spray
  • Each package should have 2 devices in case a second dose is needed in the other nostril
  • *Available OTC*

Written by: Cassady Reno, PharmD

Additional resources:

• https://nida.nih.gov/publications/drugfacts/naloxone
• https://www.who.int/news-room/fact-sheets/detail/opioid-overdose
• https://www.ncdhhs.gov/naloxone-faq-final-approved/download#:~:text=Symptoms%20of%20withdrawal%20include%20confusion,No
• https://www.mass.gov/doc/naloxone-pamphlet-0/download#:~:text=The%20naloxone%20vial%20contains%202mL,half%20in%20the%20other%20nostril.&text=Single%2Dstep%20nasal%20spray%3A%20Peel,is%20administered%20with%20one%20spray.
• https://www.walgreens.com/topic/pharmacy/naloxone.jsp#:~:text=Naloxone%20(NARCAN%C2%AE%20Nasal%20Spray,and%20lasts%2030%2D90%20minutes.
• https://naloxoneautoinjector.com/instructions/#:~:text=Firmly%20pull%20the%20auto%2Dinjector%20from%20the%20outer%20case.&text=Pull%20off%20the%20red%20safety%20guard.&text=Place%20the%20black%20end%20of,in%20place%20for%205%20seconds.

Additional articles you may be interested in: https://corumpharmacy.com/over-the-counter-otc-medication-safety/