Responding to Overdose with Naloxone

NALOXONE SAVES LIVES

A variety of drugs and drug combinations carry the risk of fatal overdose. Emergency protocol for any suspected overdose includes calling 911. However, in the case of opioids, which includes heroin and prescription pain medications like Vicodin, OxyContin and Percocet, naloxone (also known by the brand name Narcan) can reverse an overdose, potentially saving a loved one’s life.

What Puts One at Risk for Overdose?

Anyone using opioids, whether for recreational purposes or otherwise, can be at risk for overdose. Other risk factors include:

  • Using or taking drugs alone
  • Mixing opioids with other drugs like alcohol, benzodiazepines (e.g., Xanax and Ativan) and prescription stimulants (e.g., cocaine and Adderall)
  • Having lower tolerance due to recent detox/drug treatment, incarceration or illness
  • Not knowing what drugs one is consuming (e.g. using heroin cut with fentanyl)

What are the Signs of an Overdose?

Overdose results when the dose taken causes suppressed breathing such that oxygen can not reach vital organs, and the body begins to shut down. An overdose can occur anywhere from 20 minutes to 2 hours after drug use. Signs of an overdose include:

  • Face is clammy to touch and has lost color
  • Blue lips and fingertips
  • Non-responsive to his/her name or a firm sternum rub using the knuckles.
  • Slow or erratic breathing, or no breathing at all
  • Deep snoring or a gurgling sound (i.e. ‘death rattle’)
  • Heartbeat is slow or has stopped

What To Do if You Suspect an Overdose?

1. Call 911

If you suspect an overdose and your loved one is unresponsive, call 911. If you must leave the person alone to make the call, put them in the recovery position – on their side with the bottom arm under the head and top leg crossed over the body. This is to avoid aspiration if he or she vomits. Give the address or location and as much information as you can (i.e., unconscious, not breathing, drugs used if known, etc.)

2. Administer Naloxone

Note that naloxone is only effective in the case of an opioid overdose. However, if you are unsure of the substance(s) involved, it is not dangerous to administer naloxone, because it is not known to cause any harm in the case of a non-opioid overdose. See directions below for how to properly administer.

3. Conduct Rescue Breathing

If the person has labored breathing or is not breathing at all, it is necessary to conduct rescue breathing. Tilt the head back, pinch the nose closed and give one slow breath every 5 seconds until the person resumes breathing on their own or until the paramedics arrive. Watch to see that their chest rises and falls with each breath.

4. Comfort and Support

Once the person is breathing on their own, place them in the recovery position until paramedics arrive. Comfort the person as he or she may be confused, upset and dope sick when revived. Do not allow them to use drugs.

5. Aftermath of an Overdose

Once your loved one has been stabilized, this may be an opportunity to suggest detox and treatment. Call the Partnership’s toll-free helpline at 1-855-DRUGFREE to speak with a trained counselor and begin getting the help your family needs.

How to Administer Naloxone

If the naloxone is in the form of a nasal sprayer, assemble as necessary, tilt the head back and spray half of the atomizer/nasal sprayer into each nostril. Provide rescue breathing (one breath every 5 seconds as described above) for 2-4 minutes. If there is no response, give a second dose of naloxone.

how to administer nasal spray naloxone for opioid overdose

If the naloxone is in the form of an auto-injector, place the black end against the middle of the person’s outer thigh, through clothing (pants, jeans, etc.) if necessary, then press firmly and hold in place for 5 seconds.

how to administer auto-injector naloxone for opioid overdose

Provide rescue breathing. If there is no response, an additional injection using another auto-injector may be needed. Give additional injections using a new auto-injector every 2 to 3 minutes, and continue to provide rescue breathing until the person can resume breathing on his or her own.

Frequently Asked Questions

Will naloxone help if the person overdosed on drugs other than opioids?
No, it only works to reverse an overdose involving opioids.

If I don’t know what the person used, should I administer naloxone anyway?
Yes, naloxone is a very safe drug and will not adversely impact someone who has overdosed on other drugs or alcohol.

I’ve heard friends say that a cold shower, coffee or other stimulants can help with an overdose. Should I try that?
No, if someone is in respiratory distress the best course of action is to call 911 and administer naloxone along with rescue breathing.

If the person begins breathing on their own after giving them naloxone, why should I bother calling 911?
Naloxone only last for 30 to 90 minutes so it’s possible that the person could go into respiratory arrest again due to the opioids still in their system. Medical professionals can help provide the necessary treatment to prevent respiratory failure.

I’ve heard that fentanyl is so powerful that 1 or 2 doses of naloxone may not be enough. Is that true?
Yes, overdoses involving fentanyl may require repeated administrations of naloxone to restore breathing.

My son is in rehab and I expect that he will be committed to recovery when he gets out, so why do I need to get a naloxone kit?
The relapse rate associated with opioid use has been estimated to be as high as 90 percent. 1 As a precautionary measure, it’s important to have naloxone in the home. Just as you don’t anticipate having a fire, you probably have a smoke detector in the home – this is the same kind of precautionary measure that you hope you never have to use.

Won’t the person who overdosed be arrested for possession and potentially other charges if 911 is called and the police arrive?
Many states have passed overdose prevention laws, which support treatment instead of arrests. Check your state’s laws.

What legal protections are there for the person administering the naloxone so that if something goes wrong, they aren’t held responsible?
Most states have passed Good Samaritan Laws for the protection of the person administering the naloxone. Check your state’s laws.

If I don’t have any naloxone and someone has overdosed, what should I do?
Call 911 and perform rescue breathing until the paramedics arrive.

Where can I get naloxone?
In addition to some independent drugstores, Walgreen’s, CVS, Rite Aid, Target and Wal-Mart are providing naloxone in many states through their pharmacies without requiring a prescription. You can also find training programs and naloxone here.

Does naloxone expire?
Yes, check the packaging for the expiration date. Some people find it helpful to put a reminder on their calendar app on their cell phones.

Will naloxone go bad if it is stored in a place that’s too hot or cold?
Yes, check the packaging to see what temperature range is recommended. Generally, room temperature is advised.

If I keep naloxone in the house, won’t my child think that he or she can use more drugs because there’s an antidote available?
There are no studies that indicate increased usage due to having naloxone available.

1 NCBI

Download the Continuing Care eBook

Our free Continuing Care eBook covers extensive information on overdose prevention and treatment, what to do when your child completes treatment and more.

Continuing Care eBook