What is Naloxone/Narcan?
Naloxone/Narcan is a medicine that rapidly reverses an opioid overdose. It is an opioid antagonist. This means that it attaches to opioid receptors and reverses and blocks the effects of other opioids. Naloxone/Narcan can quickly restore normal breathing to a person if their breathing has slowed or stopped because of an opioid overdose. But, Naloxone/Narcan has no effect on someone who does not have opioids in their system, and it is not a treatment for opioid use disorder. Examples of opioids include heroin, fentanyl, oxycodone (OxyContin®), hydrocodone (Vicodin®), codeine, and morphine.
How is Naloxone/Narcan given?
Naloxone/Narcan should be given to any person who shows signs of an opioid overdose or when an overdose is suspected. Naloxone/Narcan can be given as a nasal spray or it can be injected into the muscle, under the skin, or into the veins. Steps for responding to an opioid overdose can be found in the Substance Abuse and Mental Health Administration’s (SAMHSA) Opioid Overdose Prevention Toolkit.
Resource on Naloxone/Narcan Use For First Responders During COVID
First Responders Can Safely Administer Naloxone/Narcan during the COVID-19 Pandemic (HHS)
What are the different Naloxone/Narcan delivery systems?
Naloxone/Narcan comes in two FDA-approved forms: injectable and prepackaged nasal spray. No matter what dosage form you use, it is important to receive training on how and when to use Naloxone/Narcan. You should also read the product instructions and check the expiration date.
Injectable brands of Naloxone/Narcan are offered by different companies listed in the FDA Orange Book under “Naloxone/Narcan” (look for “injectable”). Typically, the proper dose must be drawn up from a vial. Usually, it is injected with a needle into the muscle, although it also may be administered into a vein or under the skin. The FDA recently approved Zimhi, a single-dose, prefilled syringe that can be injected into the muscle or under the skin.
Prepackaged Nasal Spray (generic Naloxone/Narcan, Narcan®, Kloxxado®), developed as a result of NIDA-funded research, is an FDA-approved prefilled, needle-free device that requires no assembly and is sprayed into one nostril while the person lays on their back. This device can also be easier for loved ones and bystanders without formal training to use.
Is Narcan® The Same As Naloxone?
When Naloxone was first approved to reverse opioid overdoses, its brand name was “Narcan.” There are now other formulations and brand names for Naloxone, but many people continue to call all of these products “Narcan.” However, the proper generic name is “Naloxone.”
Can I Give Naloxone/Narcan To Someone Who Has Overdosed?
Yes. Families with loved ones who struggle with opioid addiction should have Naloxone/Narcan nearby; ask their family member to carry it; and let friends know where it is. People should still call 911 immediately in the event of an overdose.
Naloxone/Narcan is used more by police officers, emergency medical technicians, and non-emergency first responders than before. In most states, people at risk or know someone at risk for an opioid overdose can be trained on how to give Naloxone/Narcan. Families can ask their pharmacists or healthcare provider how to use the devices.
What Precautions Are Needed When Giving Naloxone/Narcan?
Naloxone/Narcan works to reverse an opioid overdose in the body for only 30 to 90 minutes. But many opioids remain in the body longer than that. Because of this, it is possible for a person to experience the effects of an overdose still after a dose of Naloxone/Narcan wears off. Also, some opioids are stronger and might require multiple doses of Naloxone/Narcan. Therefore, one of the most important steps to take is to call 911 so the individual can receive immediate medical attention. NIDA is supporting research for stronger formulations for use with potent opioids like fentanyl.
People who are given Naloxone/Narcan should be observed constantly until emergency care arrives. They should be monitored for another 2 hours after the last dose of Naloxone/Narcan is given to make sure breathing does not slow or stop.
Tolerance vs. Dependence vs. Addiction
Long-term use of prescription opioids, even as prescribed by a doctor, can cause some people to develop a tolerance, which means that they need higher and/or more frequent doses of the drug to get the desired effects.
Drug dependence occurs with repeated use, causing the neurons to adapt so they only function normally in the presence of the drug. The absence of the drug causes several physiological reactions, ranging from mild in the case of caffeine, to potentially life-threatening, such as with heroin. Some chronic pain patients are dependent on opioids and require medical support to stop taking the drug.
Drug addiction is a chronic disease characterized by compulsive, or uncontrollable, drug seeking and use despite harmful consequences and long-lasting changes in the brain. The changes can result in harmful behaviors by those who misuse drugs, whether prescription or illicit drugs.
People with physical dependence on opioids may have withdrawal symptoms within minutes after they are given Naloxone/Narcan. Withdrawal symptoms might include headaches, changes in blood pressure, rapid heart rate, sweating, nausea, vomiting, and tremors. While this is uncomfortable, it is usually not life-threatening. The risk of death for someone overdosing on opioids is worse than the risk of having a bad reaction to Naloxone/Narcan. Clinicians in emergency room settings are being trained to offer patients immediate relief and referral to treatment for opioid use disorder with effective medications after an opioid overdose is reversed. NIDA offers tools for emergency clinicians here.
Side effects from Naloxone/Narcan are rare, but people might have allergic reactions to the medicine. Overall, Naloxone/Narcan is a safe medicine. But it only reverses an overdose in people with opioids in their systems and will not reverse overdoses from other drugs like cocaine or methamphetamine.
How Much Does Naloxone/Narcan Cost?
The cost varies depending on where you get the Naloxone/Narcan, how you get it, and what type you get. Patients with insurance should check with their insurance company to see if this medicine is covered. Patients without insurance can check the retail costs at their local pharmacies. Some drug companies have cost assistance programs for patients unable to pay for it. However, at Cape Family Medical Clinic we always offer Narcan to anyone in the community at no cost – we will never charge for this life-saving medication.
Where Can I Get Naloxone/Narcan?
Many pharmacies carry Naloxone/Narcan. In some states, you can get Naloxone/Narcan from a pharmacist even if your doctor did not write you a prescription for it. You can also come into our clinic whenever we are open and just ask for Narcan – we will give you a discreet kit that contains
- Black Drawstring Bag
- CPR Mask
- Information Cards On How To Use
Co-Prescribing Naloxone/Narcan With Prescription Opioids
Research indicates that clinicians prescribing Naloxone/Narcan along with prescription opioids may reduce the risk of opioid-related emergency room visits and prescription opioid-involved overdose deaths. The U.S. Centers for Disease Control and Prevention recommends co-prescription of Naloxone/Narcan for some patients who take opioids. This recommendation was first outlined in the 2016 CDC Guideline for Prescribing Opioids for Chronic Pain and is still present in the updated 2022 CDC Clinical Practice Guideline for Prescribing Opioids for Pain.
