Below, Dr. Hawk talks more about naloxone and how it works.
What is naloxone, and how does it prevent an opioid overdose?
When a person overdoses on opioids, their breathing slows or stops. As a result, not enough oxygen reaches the brain or heart, leading to a coma, brain damage, or death.
“It’s helpful to define what we are talking about when it comes to an overdose. The first sign is a period where the person’s respiratory rate lowers,” Dr. Hawk says. “If you are an outsider looking in, the person who has overdosed becomes less responsive, and their pupils will be small. Someone who takes opioids will often be a little sleepy, but the key difference between that and overdose is the level of alertness and decreased breathing.”
Naloxone is what’s known as an opioid antagonist, which means the medication attaches to opioid receptors in the brain, and reverses and blocks the effects of opioid drugs. “By binding to the opioid receptors, naloxone prevents other opioids in the bloodstream from binding to them,” Dr. Hawk says. “And by knocking opioid drugs off the receptors, normal breathing is restored if naloxone is given quickly enough.”
People who have a physical dependence on opioids may begin to experience symptoms of withdrawal (headache, change in blood pressure, rapid heart rate, nausea, vomiting, sweating, and tremors, for instance) within minutes of receiving naloxone. The symptoms are unpleasant, and, in general, those who use opioids go to great lengths to avoid them, Dr. Hawk adds. "However, for those without opioid dependence, there should be no reaction to the medication," she says. "Likewise, if you don’t have any opioids in your system, naloxone will not affect you."
How is naloxone administered?
There are two FDA-approved forms of naloxone: injectable and a prepackaged nasal spray.
Injectable naloxone is sold by several companies, and it can be injected into a muscle, under the skin, or into a vein. The nasal spray, which comes in a generic form and is sold under a few brand names, including Narcan, is a pre-filled device that should be sprayed into one nostril.
In the emergency department, naloxone is typically administered by injection, Dr. Hawk explains. “That’s an advantage because we can titrate it, meaning we can give a smaller dose and then give more if necessary,” she says. “With the nasal spray, one spray goes into the nose, and we are unable to titrate it based on symptoms. But if we inject it, we can wake them up just enough so that they are breathing, without precipitating, or triggering, vomiting and other severe withdrawal symptoms.”
Naloxone should work within two to three minutes of being administered. If the person has not responded after three minutes, another dose should be given.
How quickly must naloxone be used to prevent an opioid overdose?
Naloxone's opioid-reversal effects can last between 30 and 90 minutes and should be given immediately after an overdose. But some opioids may remain in the body longer than that, making it possible that someone could have an overdose after a dose of naloxone wears off.
If naloxone is administered outside of a medical setting, 911 should be called immediately, and the person who received naloxone should be observed for a period of time to ensure that no additional doses are needed. In addition, those individuals should be offered harm reduction and treatment resources, including the ability to initiate treatment for opioid use disorder in the emergency department.
What are the risks of naloxone?
Naloxone is considered very safe and effective and can even be used in infants, explains Dr. Hawk. As noted earlier, for those who are physically dependent on opioids, using naloxone will bring about withdrawal symptoms.
Who should have naloxone on hand?
Families with loved ones who have opioid use disorder should have naloxone on hand, experts advise. People with OUD should also carry it with them and let their friends know where it is, adds Dr. Hawk.
How does expanded naloxone access fit into harm reduction?
Broadening the use of naloxone and reducing the stigma associated with it is an important element of harm reduction, Dr. Hawk explains. “As a physician, I think, ‘How can I help support the patient to be as healthy as they can be?’” she says. “When I talk to a patient about diabetes, I understand they aren’t going to cut all sugar out of their diet. Instead, we frame discussions around taking medicines that are in their best interest or helping reduce harms associated with certain behaviors.”
In the emergency department, this means talking to those with a substance use disorder about overdose prevention, including not using alone as well as having naloxone and clean syringes on hand, she adds.
“For those who are not yet interested in treatment, I help them be as healthy as they can be; I keep them alive so they can access treatment resources when they are ready,” Dr. Hawk says. “Many people are not able or ready to completely stop using drugs. Naloxone provides a safety net until we can get them into treatment.”
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