Naloxone (brand name Narcan) is an FDA-approved life-saving medication used to reverse an opioid overdose.
Giving someone naloxone is similar to performing CPR. When someone overdoses on opioids, naloxone can prevent them from dying.
Studies have shown how effective it is in saving a person’s life. Naloxone can increase their survival rate by eight-fold.[1] Between 83% and 100% of people survive an opioid overdose after getting naloxone.[2]
Naloxone is available as a nasal spray and as an injection into the muscle (IM) or the blood (IV). The nasal spray is the formulation people most commonly carry, and it is easily administered.
Opioids bind to receptors in our brains, spinal cords, and GI tract, causing decreased pain levels, altered mood (including a euphoric “high” feeling), slowed breathing and constipation.
When too many opioids are taken, breathing rates slow and can stop altogether. After three to five minutes without oxygen, brain damage will start to occur, which could lead to death.
Naloxone is an opioid antagonist. When given to a person who has taken too high a dose of opioids, it pushes the opioids off the receptors, so the opioids stop working on the body and the person can breathe again.
Naloxone works as an antidote to an opioid overdose, quickly pushing opioids off their receptors. The person will experience immediate withdrawal.
After a naloxone dose, people can experience the following symptoms:
These symptoms are not pleasant, but naloxone will prevent life-threatening overdose symptoms. These uncomfortable feelings prove naloxone is working.
If you give naloxone to someone who doesn’t have opioids in their system, the medication will have no effect. For example, if a child accidentally consumes it, it won’t cause harm.
Naloxone is very safe. There is a small possibility that someone could be allergic to naloxone, but that is true of any medication. If a patient experiences an allergic reaction, seek medical help immediately.
Open the naloxone package, and you’ll see instructions. Understanding how to give it beforehand could save you time and confusion.
Put the nozzle into the person’s nose, and push on the bottle until you hear the medication move into the person’s nose. Repeat the process on the other side.
The person should awaken immediately, but if not, repeat the dose within three to five minutes.
Suboxone is a prescription medication doctors use to treat opioid use disorder (OUD). It contains buprenorphine (to ease chemical imbalances caused by OUD) and naloxone (to prevent misuse). Researchers say adding naloxone to buprenorphine decreases the risk of misuse, as it makes buprenorphine less likely to produce euphoria if taken at high doses or if injected.[4]
Naloxone is the same ingredient inside Narcan. However, it’s still safe to use Narcan on people experiencing a Suboxone overdose. In fact, the U.S. Food and Drug Administration recommends that people with a Suboxone prescription have access to Narcan, so they can treat an overdose if it happens.[4]
The dose of naloxone in Suboxone is very small. For example, a dose containing 2 mg of buprenorphine has only 0.5 mg of naloxone.[4] A tiny amount like this is unlikely to cause any reaction at all. However, if someone misuses a large amount of Suboxone (such as by injecting the drug), the naloxone will take effect and keep the entire buprenorphine dose from latching to receptors.
People at risk for an opioid overdose include those who are:
No. If someone overdoses on other medications or drugs, naloxone will not work.
If you are not sure what the person took, give naloxone. It will either save the person’s life or do nothing at all. It won’t hurt them.
While opioids bind to opioid receptors and activate the reward centers creating a high, they also activate the respiratory center causing respiratory depression. Symptoms can be similar.
Signs of overdose include the following:
Rub your knuckles over the person’s chest very hard. If you can wake them up, you can stop here.
You can also tell the person you plan to “Narcan them.” People who are high will not want Narcan, as it will cause them to experience withdrawal symptoms. If they resist, they have NOT overdosed.
If the person won’t wake up, give them Narcan. Then, follow these steps:
Naloxone stays in the body for 30 to 90 minutes. Most opioids can stay in the system much longer. Once naloxone wears off, the opioid that caused the overdose can rebind to the opioid receptors, and a person can overdose again.
People may need repeated doses for many hours until they’re safe from an overdose. This is especially true now, since extremely potent opioids like fentanyl are dominating the drug supply landscape.
Overdose usually occurs within one to three hours after taking opioids. However, stronger opioids like fentanyl can cause an overdose within 2–5 minutes.
If someone went to the bathroom 5 minutes ago and has not yet come out, they could have overdosed. Check on them.
Your doctor can prescribe it to you. Naloxone is also available at pharmacies without a prescription. Policies may vary by state.
Most private health insurance plans, Medicare and Medicaid cover it.
As of July 2020, to reduce opioid overdoses, the U.S. Food and Drug Administration recommends that naloxone be given to these groups:[3]
Additionally, since we are all potential first responders, it is a good idea for everyone to carry naloxone and know how to use it.
Since you could come into contact with someone who has overdosed on opioids at any point, it is a good idea to carry naloxone.
Keep naloxone in a place that is readily accessible at a temperature between 40 to 104 degrees Fahrenheit and replace it if it is exposed to more extreme temperatures or the expiration date passes.
Take medication only if it has been prescribed to you by your doctor. Do not take more medication or take it more often than instructed.
Make sure to tell your doctor about all medications you are taking. Never mix pain medications with alcohol, sleeping pills or illicit substances.
There are two ingredients in Suboxone:
Yes. In fact, the FDA recommends that people with Suboxone prescriptions have access to Narcan and understand how to use it. This emergency medication can reverse an overdose triggered by Suboxone, but people might need more than one dose to fully recover.[4]
There are no real “limitations” that prohibit Narcan from working on someone who has used Suboxone. The naloxone in Narcan is powerful and capable of reversing an opioid overdose in seconds.
Bystanders should be aware that people using Suboxone may need several doses to recover.[4] It’s important to stay with the person who has overdosed and to call 911 to ask for help and further instructions.[5] The person may need help from medical personnel to fully recover from the overdose.
Bicycle Health is a telehealth company that provides buprenorphine/naloxone (Suboxone), an evidence-based medication, to patients dependent on opioid medications. Bicycle Health helps patients enter and sustain a life in recovery and works with patients so they can meet their health goals.
To learn more about the success rates and safety of Bicycle Health’s telemedicine addiction treatment compared to other common treatment options, call us at (844) 943-2514 or schedule an appointment here.
Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role of the brain dopamine system in substance use disorders and in aging. He also studies brain function in obesity and eating disorders.
