Narcan (Naloxone)

According to a study published in 2017, 46% of Americans have friends or family addicted to drugs. Addiction poses an increased risk of death from overdose.

As many as 60% of overdose deaths are directly related to opioid addiction including heroin and prescription pain-killers.

What would you do if you found someone you love overdosing on opioids?

In recent years the United States government has declared opiate addiction a public health emergency, and have taken measures to curb the increasing death rate of this addictive class of drugs.

One such measure was making a life-saving medication known as Narcan (brand name Naloxone) available to the public. It’s designed to be used in an emergency to reverse opiate overdose.

With only basic training, Narcan can mean the difference between life and death in an overdose situation.

Recently, pop singer Demi Lovato was rushed to hospital after overdosing on a common prescription opiate known as Oxycontin.

Her friends were able to save her life by giving her a timely dose of Narcan before paramedics arrived on the scene.

What is Narcan? How is it used, and who has access to it?

We’ll go over the following topics:

  • What Narcan is and how it’s used
  • How to identify an opiate overdose
  • What to do while waiting for emergency services to arrive after giving the Narcan

If you know someone who may be at risk of an opiate overdose, you need to read this article — so let’s get started.

What is Narcan™ (Naloxone)?

If opioids had a nemesis, it would be Narcan.

Narcan (Naloxone) is a non-addictive drug used to treat opiate overdoses. It was developed as a way for first responders to give life-saving support before emergency medical professionals arrive on the scene.

In order to make it as simple to administer as possible, it’s made in the form of a nasal spray. All that’s needed is a quick spray into one of the nostrils of the overdose victim.

Naloxone works by binding to the opioid receptors like opiate drugs do, but don’t exert any effect on them. They push any existing opiates off the receptors, thus reversing their effects.

Narcan gives concerned bystanders the opportunity to do something. It’s used to provide emergency care and buys extra time so that emergency services have a better chance of saving the life of people going through an opiate overdose.

After Narcan is given, the overdose victim will need to be monitored, and additional medical support may be necessary until paramedics arrive. We’ll get into what this involves in more detail later on.

A Primer on Opiate Drugs and Overdose

Drug overdose-related deaths are on a steady rise in the United States.

In 2017, there were an estimated 72,000 deaths due to drug overdoses. That’s about 200 people per day in the United States alone and more than 8,000 more cases than the record highs of the year before.

More than half of those incidents involved opiates like fentanyl, heroin, and prescription painkillers. It’s a problem growing at a steady rate and in need of a solution.

What are Opiates?

Opiates are a class of chemicals originating from the opium poppy (Papaver somniferum).

From a chemical perspective, they’re considered alkaloids — which are notorious for their potent pharmacological effects on humans.

Some Examples of Alkaloids Include:

Name of Alkaloid Effect Source
Morphine Central Nervous System Depressant Opium Poppy
Caffeine Central Nervous System Stimulant Coffee, Tea, Yerba Maté, Kola Nut
Nicotine Central Nervous System Stimulant Tobacco
Cocaine Central Nervous System Stimulant Coca Plant
Scopolamine Anticholinergic Belladonna
Harmaline MAO Inhibitor Ayahuasca Vine
Yohimbine Central Nervous System Depressant Yohimbe plant

The opium poppy (Papaver somniferum) produces a thick resin in its seed pods, which is high in a variety of different opioid alkaloids.

The raw form that was popular throughout much of last three centuries was called opium. It contains a variety of naturally occurring opioids.

Most opiates these days, however, are made synthetically in labs.

What Do Opiates Do?

In a hospital setting, opiates are actually very useful.

They have some of the strongest pain-inhibiting effects in the world compared to other pain-management options. Doctors use them to help people recovering from traumatic injuries like broken bones, sprained muscles, and after surgery.

They’re also used to help hyperactive and anxious individuals relax due to their ability to “turn down” the central nervous system.

The problem is that they’re both highly addictive, and potentially lethal.

What Are the Different Types of Opiates?

There are many types of opiates, from raw opium derived from the opium poppy to the synthetic and extremely potent form of fentanyl.

Some opiates are legal, others are illegal.

Although opiates can vary a lot in their potency and effects, they generally have the same effects on the body. The difference comes down to what else is mixed in with them, and how potent they are. 

Examples of Common Opiates and Their Effects Include:

Drug

Features

What It’s Used For

Heroin Very similar in structure to morphine. Illicit drug use
Percocet® Combination of oxycodone and acetaminophen Moderate to severe pain
Vicodin® Combination of hydrocodone and acetaminophen Moderate to severe pain
Methadone Has a long duration of effects Opiate addiction
Fentanyl Very strong and short lasting Severe or chronic pain
Buprenorphine Comes as a topical patch Opiate addiction
Morphine The original opiate found in the poppy plant Moderate to severe pain
Meperidine Not commonly used Moderate to severe pain
Codeine Also works as a cough suppressant. Moderate pain and coughing
Norco Combination of hydrocodone and acetaminophen Moderate to severe pain

How Opiates Work

Since opiates are used to treat pain, what makes them so dangerous? How do opiates work?

Let me explain.

Everybody has a set of receptors throughout the spinal cord and brain called the opiate receptors.

These receptors are used to control the amount of pain that enters the brain. We naturally produce our own opioids to control this system — known as endorphins.

When we experience a painful event — such as a broken bone — large amounts of pain signals are sent to the brain to warn it. The pain can be unbearable, and after a while, is no longer helpful to the body. It makes us feel panicked and depressed, so the body releases endorphins to dull the pain response by activating the opiate receptors.

We use endorphins to balance our pain levels. We want to feel enough pain to know when something is wrong, but not so much pain that we become anxious or depressed for too long.

Opiate medications are similar to our endorphins and bind to the same receptors. They override the system and forcibly “turn off” the transmission of pain.

The Opioid Receptors & Addiction

Deep within the brain lies another region affected by opioids known as the ventral tegmental area” — we’ll call it the VTA.

This region is full of neurons that produce dopamine, which is heavily involved in our reward center.

When we do something good, dopamine is released to give us a brief hit of euphoria. The idea behind this is that it’s used to create habits in humans. It makes us want to repeat activities that are good for us — such as eating, resting, having sex, or exercising.

Neurons in the VTA are always on. They constantly release dopamine.

Instead of turning these neurons off, we have another set of neurons that act as the brake pedal — limiting the release of dopamine by only letting off the brake when we need a dose.

We’ll call these the inhibitory neurons.

Their job is to control the amount of dopamine released by the VTA by keeping their foot on the brake pedal.

These inhibitory neurons also have opioid receptors and are thus affected by both endorphins and opioids. When we take opioid medications, it stops the inhibitory neurons from holding back dopamine.

They take their foot off the brake pedal, allowing dopamine release to go out of control.

Too much dopamine makes us feel euphoric and high. This is what strong opiates like heroin or fentanyl do.

The body doesn’t like releasing that much dopamine, so in an attempt to stop it, the inhibitory neurons will work harder and harder to limit the release of dopamine from the VTA.

As time goes on, we become forced to take higher and higher doses of opiates in order to get the same euphoric and pain-killing effects.

This is tolerance — we’re effectively tolerating the effects of the drug as the body tries to get back to normal so we need to take much more. 

If we stop taking the drug, dopamine release stops completely and pain signals surge to the brain — making us feel as though we need the drug to feel happy and pain-free.

Eventually, we reach a point when not taking the drug is excruciating. We’re depressed, unmotivated, and in pain.

This is addiction.

What Happens During an Opiate Overdose?

Opioid receptors are found in other regions of the brain too — such as the medulla — which is also where our breathing rate is controlled.

This is important because changes in our respiratory rate is the most dangerous part of an opiate overdose.

Our breathing is regulated automatically. We can control it if we want (try taking a deep breath) but most of the time it’s regulated automatically — without having to think about it.

High doses of opiates hijack the respiratory center, causing our breathing rate to slow to dangerous levels.

Without breathing effectively, our brain starts to starve for oxygen. We become sleepy and will eventually fall unconscious.

We enter a coma for a brief period of time before dying from heart failure or brain death.

What Causes Opiate Overdose?

Most people that take opiates in the short-term are not in danger of overdosing, especially enrolled in as a patient in a nearby drug rehab.

When taking opioids of any kind over longer periods, tolerance causes us to take larger and larger doses for the drug to have the desired effect.

Eventually, the dose becomes so high it can cause an overdose.

This is what was reported to have happened recently to Demi Lovato. She was taking the prescription painkiller Oxycontin, which she developed tolerance to over several years.

What are the Signs of an Opiate Overdose?

  • Extreme drowsiness
  • Slowed breathing
  • Slowed heart rate
  • Pinpoint pupils
  • Confusion
  • Loss of consciousness

Doctors and emergency services will immediately measure things like breath rate, heart rate, body temperature, and something called pulse oximetry.

Pulse oximetry is a measurement of the amount of oxygen saturated in the blood. Anything less than 90% is considered serious and in need of immediate medical attention.

How Does Naloxone Work?

Narcan works by binding to the specific opioid receptors found in the medulla that cause breath rate to slow down. These are known as the Mu– opioid receptors.

Narcan will bind to the opioid receptors to block opiates. In fact, Narcan is so strong, it will actually kick any existing opiates off the receptors, thus reversing the effects of the overdose.

Signs of Improvement After Taking Narcan

Narcan will take about 2-3 minutes before anything changes. It’s important to understand what the improvements should look like. If no improvement is noticed after about 3 minutes, another dose of Narcan should be given.

Signs of improvement include:

  • Breath rate increases (ideal is 12-20 per minute)
  • Heart rate increases (ideal is 60-100 per minute)
  • Consciousness may or may not be regained
  • Pupils will begin to dilate

What’s the Dose of Narcan (Naloxone)?

Narcan is powerful and only needs small doses to be effective.

Most of the Narcan available to the public comes in the form of a nasal spray to make dosing as simple as possible. The dose these spray applicators deliver is standardized to around 4 mg of Naloxone.

One pump or spray from the nasal applicator is equal to one dose. 

A single spray applicator will deliver two full doses each.

In hospitals, the dose is different:

The typical adult dose of Narcan given in hospitals is 0.4 to 2 mg/dose or 0.005 mg/kg IV followed by a maintenance dose of 0.0025 mg/kg/hr.

(Image Source: Delphi Health Group)

Who Can buy Narcan?

Opiate addiction and overdose was declared a state of public emergency as the rate of deaths increase substantially each year.

As part of the United States governments attempt to curb this growth, drugs like Narcan were made available to anybody in the United States without the need for a prescription. 

The American Medical Association recently endorsed the American public to use Narcan as a way to cut the rate of opiate overdoses.

Additionally, Gil Kerlikowske — the director of the Office of National Drug Policy — recently condoned the sale of Narcan to the public as a way to reduce the overdose epidemic currently sweeping the country.

Where to Buy Narcan

You can buy Narcan from local or online pharmacies without a prescription as part of recent harm reduction laws put into place by the federal government.

Most Narcan available from your local pharmacy or online will come in the form of a multi-dose nasal spray.

Anybody who believes they need more than two doses will need to speak with their pharmacist before purchase.

Guide to Using Naloxone During an Overdose

If someone is overdosing on opiates, it’s important to give them a dose right away. Waiting too long can mean the difference between life and death. 

It’s important to follow these four steps when administering Narcan to someone going through overdose:

Step 1. Confirm Opiate Overdose

This is important because Narcan will not do anything to help if the victim is overdosing on anything but opioids.

It won’t work on alcohol, benzodiazepines, cocaine, or methamphetamines — only opiates.

Luckily, this is very simple to do.

Key signs of opiate overdose:

  • They are unconscious
  • They are breathing very slowly or not at all
  • They have pinpoint pupils

First, try to wake the person up by shaking them or pinching their shoulders. If they don’t respond, listen to their breath for a few moments and look at their chest to see if it’s moving.

Someone going through opiate overdose will be breathing very slowly (less than 4 breaths per minute). In many cases, they won’t be breathing at all. 

Next, open their eyelids to look at their pupils. Someone overdosing on opiates will have very small, pinpoint pupils — it’s the hallmark for opiate overdose.

These key findings will give you enough indication that they’re overdosing on opioids to warrant using Narcan.

Step 2. Administer Narcan

Tear open the Narcan packaging, and insert the round plunger side into one of the overdose victims nostrils — then squeeze.

A dose of Narcan will be sprayed into the nose, and quickly absorbed by the tiny blood vessels in the area.

After about 2 or 3 minutes, you should start to see some improvement in their condition, but it’s important to keep a close eye on them.

Take note of the time you gave them a dose, and continue to watch their breathing.

Make sure someone has called emergency help.

Step 3. Support the Patient Until Help Arrives

Narcan takes about two minutes before it produces any effects, and will last between 45 minutes and 90 minutes.

It’s important to make sure the victim’s condition is stable until help arrives.

If they aren’t breathing, you or another bystander may need to perform resuscitation to breathe for them until the Narcan starts to take effect.

Check their pulse, and count their breaths by watching their chest rise and fall.

If they are breathing, you can roll them into the recovery position and wait for help. Keep watching them and look for signs of improvement or worsening.

If nothing happens after about 3 minutes, another dose of Narcan can be given.  

Frequently Asked Questions About Narcan (Naloxone)

How Long Does Narcan (Naloxone) Take to Work?

The effects of the Narcan will take about 2-3 minutes to take effect.

The compound needs to first absorb through the microcapillaries in their nose, into their bloodstream, and then make their way into the brain where they can start to reverse the effects of the opioids.

Injectable Narcan is slightly faster, taking between 30 seconds and 1 minute to start to work.

How Long Do the Effects of Naloxone Last?

Naloxone works well for about 30 minutes before tapering off. By the 90 minute mark, most of the effects of naloxone are gone.

In most cases, this is enough time for help to arrive. By the time the Naloxone wears off, the patient has had a chance to process the opiates, lowering the concentrations in the blood to safe levels.

With severe overdoses, there may still be enough opiates in the bloodstream to cause them to overdose again as the naloxone wears off. This is especially the case if the overdose is the result of long-lasting opioids like Oxycontin or methadone.

This is why it’s important to always go to the hospital for observation after overdosing, even if the Narcan eliminates the effects of the overdose.

Can Naloxone Get You High?

No.

If someone who has not taken opioids takes naloxone, nothing will happen. In some cases, Narcan will cause side effects, however. 

Is Narcan Dangerous?

In most cases, no.

Narcan works by forcing opiates off the opioid receptors. If it’s given to someone who isn’t having an overdose, nothing will happen.

If someone who is an opiate user is given Narcan, it may push them into a state of withdrawal. This is not life-threatening but can be extremely uncomfortable.

Some users who are pushed into a state of withdrawal too quickly after overdose will awake in a fit of rage and discomfort.

This is why it’s important to always give only one spray of the Narcan at a time.

What are the Side Effects of Narcan?

Side effects are not common, but will usually be the result of a mild to moderate withdrawal from the opioids. This will only happen with people who are regular users of the drug.

Side effects of Narcan may include:

  • Nausea
  • Vomiting
  • Diarrhea
  • Stomach pain;
  • Fever
  • Sweating
  • Body aches
  • Weakness
  • Tremors or shivering
  • Fast heart rate
  • Irritability
  • Anxiety
  • Runny nose

How Do I Store Narcan (Naloxone)?

Storing Narcan is simple, keep it in the packaging it came in, and don’t let it freeze.

Many people will keep it in a nightstand, the first aid kit, or the medicine cabinet.

It’s important to keep it somewhere you won’t forget because in an emergency it can be easy to misplace where you stored it. The moments after finding an overdose victim and administering the Narcan effectively need to be as short as possible.

Final Word on Using Narcan (Naloxone)

Narcan is a life-saving drug used to treat opiate overdose.

It can be bought by anybody in the United States, as well as a handful of other countries.

People who have a friend or family member at risk of overdosing on opioids, including heroin, prescription pain medications, or fentanyl often keep Narcan nearby in case of emergencies.

Even with minimal training, Narcan is incredibly valuable to those who need it. Demi Lovato was recently saved by this drug after overdosing on prescription meds. Thanks to some proactive friends who administered Narcan, her life was saved.

She’s not alone. Every year thousands of people face opiate overdose and rely on the lifesaving interventions of family, friends, and bystanders. Narcan is one of the most important first aid tools to have on hand if this happens. 

References

  1. Jolley, C. J., Bell, J., Rafferty, G. F., Moxham, J., & Strang, J. (2015). Understanding heroin overdose: a study of the acute respiratory depressant effects of injected pharmaceutical heroin. PloS one, 10(10), e0140995.
  2. Wheeler, E., Davidson, P. J., Jones, T. S., & Irwin, K. S. (2012). Community-based opioid overdose prevention programs providing naloxone—United States, 2010. MMWR. Morbidity and mortality weekly report, 61(6), 101.
  3. Rudd, R. A., Aleshire, N., Zibbell, J. E., & Gladden, R. M. (2016). Increases in drug and opioid overdose deaths—United States, 2000–2014. American Journal of Transplantation, 16(4), 1323-1327.
  4. Lewanowitsch, T., Miller, J. H., & Irvine, R. J. (2006). Reversal of morphine, methadone and heroin induced effects in mice by naloxone methiodide. Life sciences, 78(7), 682-688.
  5. Coffin, P. O., Fuller, C., Vadnai, L., Blaney, S., Galea, S., & Vlahov, D. (2003). Preliminary evidence of health care provider support for naloxone prescription as overdose fatality prevention strategy in New York City. Journal of Urban Health, 80(2), 288-290.
  6. Feng, Y., He, X., Yang, Y., Chao, D., H Lazarus, L., & Xia, Y. (2012). Current research on opioid receptor function. Current drug targets, 13(2), 230-246.