Naloxone – A Life-Saving Opiate Antidote

With ultra-potent super synthetic opioid – pink – making waves across the country and having killed well over 80 people, it is a good idea to know if it has any antidote.

There are a handful opiate antidotes such as buprenorphine (Buprenex), buprenorphine + naloxone (Suboxone), naloxone (Narcan), naltrexone (Vivitrol) and methadone (Dolophine), but Naloxone is most popular, not only because it reverses opioid intoxication safely but because it does so rapidly – in about 5 minutes.

What Is Naloxone?

Naloxone is a medicine that reverses opioid overdose. Opioids are a class of drugs that are used as analgesics for incapacitating pain that does not recede with common painkillers, such as that of migraine and cancer.

Opioids are not only are extremely effective, they are also addictive. Besides providing powerful analgesia, they give a “high” which leaves the addict euphoric for what feels like hours. Most commonly abused opioids are methadone, oxycodone, hydrocodone, morphine and, of course, heroin.

When a person is overdosing on opioids, his breathing gets slow and shallow. This is an alarming situation because breathing can stop anytime and the person can die. It is a parent’s worst nightmare to see their 20something son lying in his bedroom with all attempts at reviving him going unresponsive.

In times like this, an opiate antidote such as naloxone (Narcan) comes handy.

Naloxone is a prescription medicine that stops opioid intoxication. It is literally a life-saver. A 2013 University of Washington study published in the Annals of Internal Medicine found that for every 20% of the heroin addicts, Naloxone could save 6.5% of overdose deaths. More than 2,000 lives can be saved in a population of 200,000 addicts.

This is something because stats show that heroin use is growing in the US. Over 1-2 million Americans misuse heroin or other opioid drugs and are constantly in danger of drug overdose and death.

Nalaxone comes in various brands such as NarconTM, and Suboxone.

An interesting thing about Naloxone is that it produces effect only in people who are high. If you haven’t had morphine, oxycodone or pink, naloxone won’t work.

How Does It Work?

If a person has overdosed on an opioid, say heroin or pink, and is given naloxone, the drug will quickly knock out the opioid from the brain and other opioid receptors in the body.

Naloxone binds competitively to opioid receptors in your body — mu (µ), kappa (ĸ) and delta () – blocking the effects of opioids. These receptors are found in your brain, spinal cord and gut.

Naloxone quickly restores normal breathing in a person whose breathing has slowed as a result of heroin or pink overdose. It is very important to give immediate help to an overdosed person because even a little delay can result in brain damage due to lack of oxygen supply and cause death.

Naloxone works even if you have taken opioids with alcohol or other drugs. A single push blocks opioid receptors for about 30-90 minutes.

How Is Naloxone Given?

Naloxone can be administered intramuscularly (IM), intravenously (IV), subcutaneously (SC), and as a nasal spray. It is available in following three FDA-approved formulations:

  • Injectable: A variety of companies provide naloxone injectable vials. These companies are listed under FDA’s orange box. An injectable form is administered by a trained professional.
  • Auto Injectable: EVZIO® is an easy-to-use prefilled auto-injection device that families and emergency personnel can easily and quickly inject into the outer thigh. A wonderful thing about this FDA-approved device is that once activated, it provides verbal instruction on how to deliver the medication.
  • Nasal Spray: NARCAN® is a nasal spray that requires no training and assembly. It is sprayed directly into one nostril as the knocked out person lays on their back. Narcan works in about 5 minutes. Its effect wears off after 30 minutes.

As to which route is the safest and most effective depends upon the situation; in emergency IM or IV routes are ideal. A 2009 Victoria University study compared various routes and found intranasal to be the safest and easiest that a person or a family member can use themselves.

How Long Does It Take To Reverse Opiate Intoxication?

  • IV is the quickest; provides recovery within 5 minutes.
  • IM route provides relief in about 6-8 minutes.
  • Intranasal route provides breathing restoration within 10 minutes.

Who Is Authorized To Prescribe Naloxone?

Only authorized individuals, such as physicians, paramedics and emergency room doctors are allowed to handle injectable form.

As for the prescription, the rule varies from state to state. Some states such as District of Columbia, require a physician to prescribe naloxone; while others, such as Washington, New Mexico and Rhode Island, allow pharmacies to distribute naloxone in outpatient setting.

About 40 states in the US, including Illinois, California, Kentucky, Minnesota, New Jersey, and North Carolina, have the standing order for naloxone which allows a nurse or other medical staff to administer the medication without the approval of a physician if the person meets certain criteria.

Here you can learn about laws regarding naloxone prescription and distribution in your state.

What Dose Do I Need?

The dose varies depending upon the formulation and the patient condition. Usually more than one dose is required. Naloxone is usually given in small doses at 2-3 minute intervals.

Anyone who may have to administer naloxone should read the package insert carefully that comes with the product.

Is Naloxone Safe?

Yes, it is an extremely safe drug. It works only in people with an opioid overdose. A 2015 review by Daniel Wermeling, of University of Kentucky, analyzed various studies and found naloxone to be a safe and effective antidote of opioid overdose.

However, it is not devoid of side-effects, none of which is severe and unmanageable. These include:

  • Headache
  • Nausea and vomiting
  • Changes in blood pressure
  • Rapid heart rate
  • Tremors

Is Naloxone Expensive?

A manuscript published in Annals of Internal Medicine found that providing naloxone to heroin users is cost-effective. A San Francisco Department of Public Health Review has estimated cost of naloxone to be $421 per life-year gain.

The cost varies depending on the state you live in and how you get it. Those who have insurance can check with their insurance company about the price and co-pay for EVZIO® or NARCAN® nasal spray; those without insurance should check retail costs with their local pharmacies.

For patients with financial difficulties, Kaleo, the manufacturer of EVZIO®, offers a cost assistance program.

Where Can I Get Naloxone From?

Naloxone is available on prescription in most of the states; you can buy it from a nearby pharmacy by showing the physician’s prescription. In other states, however, you can buy it without bringing a prescription. Pharmacies such as CVS stores and Walgreens stores sell naloxone. The laws vary from state to state.

Naloxone finder helps you to obtain information about where and how you can find the drug in your state.

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