Naloxone (Narcan) is a medication that can rapidly reverse the effects of severe opioid drug or medication intoxication. This property makes the medication highly useful in treating people actively experiencing an overdose.
In most U.S. states, only a licensed physician can legally give someone a dose. However, since opioid overdoses often occur far away from any access to a doctor, some states now allow friends, family members or other laypeople to administer the medication to an overdose victim, after going through appropriate training.
How naloxone reverses drug overdose
An opioid overdose can produce symptoms that include an inability to remain alert or awake, abnormally low blood pressure, pupil constriction and disrupted or inadequate breathing. If these symptoms appear in severe form and/or are left untreated, an affected individual can easily stop breathing and die. Doctors typically take steps to treat a person experiencing an opioid overdose that include ensuring an adequate supply of oxygen and taking steps to reverse overdose symptoms as quickly as possible. Most people who heavily overdose on opioids require hospitalization to improve their chances of survival.
Naloxone reverses the impact of an opioid overdose by countering the damaging central nervous system changes produced by high levels of opioid intoxication. Because it has this effect, it belongs to a group of substances that scientists commonly called opioid antagonists. In addition to playing a critical role in the treatment of confirmed overdose cases, use of naloxone can help prevent an impending overdose in someone who has taken too much of an opioid medication or drug, or act as a diagnostic tool to help doctors determine if an opioid overdose is responsible for the symptoms they observe in any given patient.
How is naloxone administered?
Naloxone is most frequently given in the form of an injection that can be administered in a vein, beneath the two outermost layers of skin or into the body of a muscle. The medication is also available as a nasally administered spray. When facing a highly dangerous situation such as an active overdose, doctors typically introduce naloxone directly into a patient’s vein; such use ensures the quickest possible medication response inside the body.
Expanding legal use of naloxone
Because naloxone is a powerful prescription medication, legal and medical precedent has typically limited its use to specific individuals identified by a licensed doctor with prescribing authority. However, for a variety of reasons, opioid overdoses tend not to occur in circumstances where preexisting medication approval from a doctor is likely or practical. This situation creates a conflict in the medical/legal community, since society has an interest in making sure that people don’t die unnecessarily from drug overdoses, as well as an interest in making sure that people don’t have unrestricted access to medications that could be used inappropriately and cause serious harm.
As of early 2014, 17 U.S. states have addressed this dilemma by passing laws that make it easier for people who don’t practice medicine to give naloxone to someone in the midst of an opioid overdose. These states are California, Colorado, Connecticut, Illinois, Kentucky, Maryland, Massachusetts, New Jersey, New York, New Mexico, North Carolina, Oklahoma, Oregon, Rhode Island, Vermont, Virginia and Washington. The federal District of Columbia has also passed such a law. In addition to making it possible for non-doctors to administer naloxone, the legal changes now in effect in these jurisdictions also commonly make it possible for other drug users to report ongoing cases of opioid overdose without fear of facing prosecution for their own substance intake.
Effectiveness of overdose programs
Naloxone administration by a layperson is only safe when that person has received training on the medication’s proper use. Currently, close to 200 opioid overdose programs have been established across the U.S. to encourage appropriate, effective naloxone treatment by non-doctors. All told, more than 50,000 people have received training from these programs, and figures indicate that well over 10,000 cases of overdose have been successfully treated or prevented by program participants. In addition, some of the communities served by lay training programs for naloxone use have experienced a substantial decline in their rates of opioid overdose-related death.
Supply and demand
The federal Centers for Disease Control and Prevention (CDC) note that the number of overdose-related deaths prevented by laypersons trained in naloxone use may actually be significantly higher than current figures indicate. Unfortunately, the CDC also notes that more than 40% of the lay naloxone programs established across the country have ongoing problems maintaining an adequate supply of the medication.