The Naloxone Guide

What Is Naloxone?

Naloxone is an opioid antagonist. Being an antagonist means it protects against the impacts of opioids by blocking receptors in the brain. It is used to reverse an opioid overdose. During an opioid overdose, a person has stopped breathing. However, within minutes of receiving naloxone, they can walk and talk like normal.

Opioids are drugs that soothe discomfort and create relaxation. Morphine, oxycodone and other opioids are generally prescribed to deal with severe discomfort after surgical procedure, during cancer therapy or during end-of-life treatment. Often the medications are recommended to treat light or modest discomfort. These prescription drugs are considered risk-free when used as recommended for a couple of days or a week.

On the other hand, people can abuse prescription opioids or use the illegal narcotic opioid called heroin to obtain a euphoric high. Opioids cause a rush of endorphins like dopamine throughout the brain causing happiness and relaxation. Too much can be fatal because overdosing on an opioid causes respiratory suppression meaning breathing stops. 

In high enough doses, naloxone and various other opioid antagonists can reverse the effects of any kind of opioid. Some opioids, such as fentanyl and carfentanil, are so powerful that several naloxone sprays or shots are required to reverse the effects.

Drugs that naloxone can reverse consist of:

  • Buprenorphine
  • Hydromorphone
  • Codeine
  • Demerol
  • Hydrocodone
  • Heroin
  • Morphine
  • Oxycodone
  • Oxymorphone
  • Methadone

In the previous decade, due to the increased availability of naloxone, countless lives have been saved. A 2015 study by the Harm Reduction Coalition found that 152,283 laypersons in 136 organizations obtained naloxone kits between 1996 and June 2014. These organizations obtained records of 26,463 overdose reversals throughout the duration.

Is Naloxone Safe?

The Food and Drug Administration accepted naloxone in 1971. Despite being FDA approved, the medication was only available inside hospitals. Recently, states have actually passed regulations providing accessibility to the opioid remedy to first-responders and the general public.

Naloxone is a totally benign medication. There’s zero possibility of abuse and it is very safe.

Lexi Reed Holtum, executive director of the Steve Rummler Hope Network who has conducted hundreds of naloxone trainings says, “As far as side effects go, our doctors tell us that there’s a very small chance that you’re going to be allergic to naloxone. The reality is, if you overdose on an opioid, you have to have this antidote or you die.” To put it plainly, the benefits of Naloxone far outweigh any disadvantages.

Apart from misconceptions about the drug, naloxone is safe for the majority of the population. It is not a controlled substance. You do not obtain a high and it does not damage people who don’t have opioids in their system.

Naloxone prevents the reception of opioids in the brain. For this reason, people dependent on opioids may go into withdrawal after receiving naloxone. Opioid withdrawal creates unpleasant symptoms, but it’s seldom life-threatening.

What Are Evzio and Narcan?

Pharmaceutical businesses have developed brand-new ways to administer naloxone making the medicine easier for the common person use. The FDA approved a device called Evzio in April 2014. Evzio is a user-friendly tool that contains audio directions for administering a naloxone injection.

The FDA accepted another form of naloxone called Narcan in November 2015. Narcan is a nasal spray which contains naloxone. It was the first form of naloxone that doesn’t have to be injected.

Narcan was initially the brand of the naloxone injection, which was accepted in 1971. The injection type of Narcan is no longer available. Therefore, the nasal spray variation is the only Narcan product that you can buy today.

Some people utilize the term “Narcan” to describe all kinds of naloxone. Nevertheless, Narcan is a brand name for a specific form of naloxone. Evzio and generic naloxone injections contain the exact same active ingredient as Narcan.

Testimonials

Coalition Recovery
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Wonderful! Coalition is the best of the best! The staff are not only professional, educated, and welcoming, but extremely passionate about loving and treating people who battle the disease of addiction. What makes Coaltion stand out from the rest is their aftercare program, where you'll be supported and counseled by the same staff who worked with you while you were inpatient. A "coalition" is an alliance for combined action, but this treatment facility is more than that: it's a family.
Donaven
Donaven
18:27 05 Nov 18
Coalition provides amazing treatment and aftercare for those struggling with addictions. The staff and executives are top notch and focus on client care first before anything else. Their approach to addiction treatment and the Renaissance program are unlike any I’ve seen. They are not solely concerned on the client remaining substance free, but also with having a high quality of living and living life to their fullest potential.
Stefanie Crain
Stefanie Crain
14:21 15 Jun 18
Coalition Recovery in Tampa is an excellent addiction treatment center. I love their admissions team & clinical staff. They use evidence-based methods and create custom individualized treatment plans to provide the best care for their clients. I have referred clients here many times and they all talk about the excellent care they received by the staff at Coalition Recovery. Great work!
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Lara Frazier
20:40 11 Dec 18
If you’re looking for a treatment facility for either you or a loved one- Coalition Recovery is hands down the best choice. I have never met a staff more dedicated to actual PATIENT CARE than this facility. Truly, this staff is committed to not only caring for patients in fragile physical and/or mental states but also assisting in the process of sobriety beyond the inpatient level. This is not ‘just’ a treatment center; it is the first step in a new beginning.
Carly Svetec
Carly Svetec
21:07 22 Jun 18
The opportunity to go to Coalition recovery is the best gift my mother has ever given me. From the moment I walked in the front door I felt a huge weight lift and I knew that if I put in the work my life was about to improve exponentially. Every staff member that works there has a huge heart and I felt more than comfortable sharing my inner most secrets with them and asking for help and advice. They have helped me overcome extreme anxiety and depression issues, have helped grow my feeling of self worth, they have led me in the right direction to have a fulfilling life and have made me truly excited for my future. I took advantage of every opportunity they gave me. They even have a program that will get you on track to pursue a degree! I was fearful that I would never be able to succeed in college and I am thrilled to tell them about all of my successes! Dr. Val is my personal therapist and I can not say enough nice things about how she has helped me. I truly value her opinions and how she challenges me. I do not know where I would be or how I would be doing without her. If you are truly ready to change your life and willing to do the work and stay open minded Coalition will be the place that turns your life around. Every clinitian and staff member is completely dedicated and invested in my well being and I am excited to stay in contact and be one (of their many) success stories! Thank you Coalition Recovery!
Amanda Cilento
Amanda Cilento
19:55 18 Jan 19
I would be proud to recommend Coalition Recovery to close friends and family. They truly take the time to understand you specifically. They don’t force any particular program on you, so you can just use what works best for you. Thank you Coalition Recovery, I hope the best for you guys
Mary Carlton Romanski
Mary Carlton Romanski
15:20 15 Jun 18
Top-notch treatment center! A friend of mine went to treatment here for help with his drinking problem. He tells me all the time that Coalition Recovery saved his life! It's great seeing my buddy back to his old self. Glad he found exactly what he needed at CR.
Patrick Sneed
Patrick Sneed
22:00 21 Jan 19
Coalition Recovery is a top notch drug & alcohol rehab facility! Their staff does a great job and genuinely cares for their patients. I highly recommend them to anyone struggling with substance abuse problems.
Thomas Jenkins
Thomas Jenkins
20:13 12 Feb 19
The leadership, and the members of the organization as a whole, are all true professionals. This attentive and caring staff won’t just put a band-aid on. Their approach will treat underlying causes and create positive outcomes for everyone. If you’re in the Tampa Bay Area, this is the only place to go for treatment.
Ryan Matheson
Ryan Matheson
13:24 29 Jun 18

How Do You Administer Naloxone?

It can be difficult to determine if somebody is overdosing on opioids. It is common for people to fall asleep after using, but they should respond if you try to wake them. They may be unconscious if they do not respond. This loss of consciousness is one of the indications of an opioid overdose.

Various other warning signs of an opioid overdose include:

  • Vomiting
  • Pale or blue skin, lips or nails
  • Limp body
  • Slow breathing or no breathing
  • Sluggish heart price

If you believe someone else is going through an overdose but they are still awake, find out what and how much they have used. In the event they do pass out, you can utilize the information to identify just how to respond. When they pass out or you discover them less competent, you need to take steps to save their life.

Above all else, The first thing you should do if someone overdoses is to call 911. After calling 911, administer Naloxone if available. 

When calling 911, Supply the dispatcher with as much detail as possible, including the type of opioid used, the time of use and just how it was administered. Next, carry out rescue breathing before administering naloxone if the individual isn’t breathing.

How to Perform Rescue Breathing:

  1. Lay the person on their back.
  2. Tilt their head back.
  3. Clear their mouth of vomit or foreign fragments.
  4. Squeeze their nose.
  5. Open their mouth.
  6. Take a breath one breath into their mouth every five seconds.

The person’s upper body needs to raise with each breath. After giving 2 or three rescue breaths, carry out naloxone.

How to Provide a Naloxone Injection:

  1. Clean the skin with alcohol if possible.
  2. Get rid of the cap from the vial of naloxone.
  3. Put the syringe right into the vial.
  4. Attract all of the naloxone into the syringe.
  5. Insert the needle of the syringe right into the individual’s arm, upper thigh or butt.
  6. Press the plunger up until every one of the naloxone is injected.

How to Provide Narcan:

  1. Remove the Narcan from the package.
  2. Place one finger on each side of the nozzle.
  3. Place the thumb on the plunger, however do not push the plunger.
  4. Insert the tip of the nozzle into a nostril up until your fingers touch the individual’s nose.
  5. Press the plunger securely with your thumb.

How to Administer Evzio:

  1. Remove Evzio from the external case. Prevent touching the black base.
  2. Remove the red safety and security guard from the device.
  3. Press the black base against the middle of the external thigh and hold for five secs.

If the person isn’t breathing, continue to do rescue breathing for two to three minutes or until initial-responders show up. If the individual does not awaken after 2 or three minutes, provide an additional dose of naloxone.

It is important to stay with the individual up until emergency situation-responders arrive. As soon as first-responders show up, provide them with as much information as possible.

What to Do After Reviving Someone with Naloxone

After restoring a person with naloxone, encourage them to seek medical treatment. Because IV naloxone lasts around 45 minutes whereas opioids can last for several hours it is possible for a person to overdose a second time once the naloxone wears off.

Individuals who overdose on long-acting opioids, such as methadone or extended-release tablets are at an increased risk for experiencing a second overdose. Naloxone does not get rid of the opioids from the body – it briefly stops them from affecting the brain.

Referring Patients to Rehab

Individuals that are addicted to opioids normally go into withdrawal after receiving naloxone. This happens becuase their brain craves opioids, and naloxone prevents opioids from easing those cravings. Treatment from a health center can help people mitigate and cope with these withdrawal symptoms.

In addition to alleviating withdrawals and mitigating a second overdose, health care providers can counsel clients about the threats of misusing opioids. In doing this, they can likewise link them with drug rehabilitation centers and various other healing solutions to help them find detox and treatment and live without the dependency towards opioids.

If individuals reject addiction treatment, some medical facilities might offer naloxone sets. These kits generally include a dosage of naloxone, details regarding the dangers of using opioids, locations that distribute naloxone, psychological health hotlines and details regarding local rehabilitation centers.

Where Can You Find Naloxone?

Naloxone is more readily available today than ever before. Numerous big drug stores, consisting of CVS and Walgreens have actually boosted accessibility to naloxone. As of July 1, 2017,  according to the Prescription Drug Abuse Policy System, pharmacists in 49 states and the District of Columbia can sell naloxone without a prescription from an additional health supplier.

In some areas, medical facilities, health and wellness divisions and crisis facilities are licensed to administer and dispense naloxone. In addition to these facilities, some drug treatment centers and prevention groups are licensed to dispense naloxone in some states. Social workers and other advocates might likewise be able to provide the drug, depending on neighborhood laws.

Lots of people first learn about naloxone and how to use it at naloxone understanding or training events. These events are typically organized by advocates in the neighborhood who are dedicated to preventing deaths from opioid overdose.

The Rising Price

The expense and availability of the medication vary by state. For instance, in some states, health departments and not-for-profit companies, funded by federal grants, help boost accessibility to naloxone. These organizations supply naloxone at no charge to people taking opioids or to people who know someone that uses opioids frequently.

Many insurance coverage plans cover naloxone when it is carried out in a medical setting, such as an emergency room. A select variety of insurance policy plans repay individuals who acquire the medication with a prescription or over-the-counter. Repayment differs relying on the state and type of insurance strategy.

According to a 2016 research released in the New England Journal of Medicine, the price of naloxone has actually increased over the last few years. The price of a single dosage of naloxone normally varies between $20 and $150. The rate of a two-pack of Evzio auto-injectors can cost as much as $4,500.

Price of Amphastar’s 1-mg-per-milliliter Naloxone Vial

Amphastar's Naloxone vial price change

Price of Hospira’s 0.4 mg-per-milliliter Naloxone Vial

Price of Hospira's 0.4 mg-per-milliliter Naloxone Vial

Price of Kaleo’s Evzio Device

Price of Kaleo's Evzio Device

 

 

 

Naloxone in Addiction Treatment

The main purpose of Naloxone is to reverse opioid overdoses. However, there are other functions for the drug such as in utilizing it as a tool for recovery.

In fact, Naloxone is used in one of the most widely used medications used for opiate addictions – Suboxone. Most people have heard of Suboxone, but they may not be aware that Naloxone is a part of this drug. Naloxone and Buprenorphine combine together to make Suboxone.

Buprenorphine’s purpose in Suboxone is to alleviate the cravings and withdrawals associated with long-term opioid use. The proven benefits of Medication Assisted Treatment has been shown to improve retention rates in substance abuse rehabilitation. Studies have also shown the longer a person remains in treatment, the greater their chances of success.

The only problem with buprenorphine is its susceptibility for abuse. Here is where Naloxone comes in. Naloxone blocks opioid receptors – which may sound counterintuitive when combined with buprenorphine – but Naloxone only works when injected intravenously. The only way to administer Suboxone is sublingually (by mouth). Therefore if someone attempts to abuse suboxone by injecting it, they will not feel any high.

Thanks to Naloxone, addiction psychiatrists can now prescribe medication to people with opioid use disorders without the possibility of patients abusing it. This has made medication-assisted therapy for opioid use disorder a no-brainer.

Naloxone Training Events

What Do You Learn at Naloxone Training Events?

Many naloxone training events are open to the general public. However, you might need to sign up ahead of time. The program for each and every event varies, but naloxone trainings typically start with a short summary of opioid addiction. Event hosts might likewise speak about healthcare resources and neighborhood opioid trends.

After this intro, a presenter shows how to administer naloxone. From here, participants typically practice administering naloxone on a dummy or volunteer. The practice devices do not have needles or drugs.

For instance, at a June 2017 naloxone training event in Jacksonville, Florida, volunteers from Drug-Free Duval trained clinical trainees, registered nurses, community supporters and college professors to teach others how to use naloxone.

“The event was about training people in the neighborhood to be instructors in [naloxone management] so we are able to canvass the neighborhood in a larger duty,” Melanie Bright, young people director at Drug Free Duval.

Education events like the ones held by Drug Free Duval and occur each week in communities across the United States. For this reason, events can help highlight that Naloxone isn’t a medication used to treat opioid dependency. It’s a medicine that saves lives.

When more individuals have accessibility to naloxone and know exactly how to make use of the drug, more lives can be saved. As a result, more individuals have a chance to think of the influence of opioids in our society. Additionally, more people have the opportunity to seek the abundance of resources for addiction recovery.

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