Opioid Overdose

 

The misuse of and addiction to opioids—including prescription pain relievers, heroin, and synthetic opioids such as fentanyl—is a serious national crisis that affects public health as well as social and economic welfare.

More than 192 Americans die every day from a drug overdose--that’s equivalent to three full 747 airliners crashing every week. According to the CDC, drug overdoses far surpass car accidents as the leading cause of injury-related death for Americans aged 25 to 64. In 2017, there were more than 70,237 drug overdose deaths in the U.S., of which two- thirds involved an opioid.

Fortunately, opioid overdose is reversible through the timely administration of the drug naloxone (Narcan®) and the provision of emergency care.

What is naloxone?

Naloxone is a fast-acting opioid antagonist that binds to opioid receptors and blocks the effects of other opioids. Because of its fast action, naloxone can reverse the effects of an opioid overdose by restoring normal respiration to a person whose breathing has slowed or stopped.

A study conducted by the CDC found that providing naloxone kits to non-medical professionals does not lead to increased misuse or riskier use of opioids and can actually lead to increased enrollment in treatment for SUD.

How is naloxone administered?

There are currently three FDA-approved formulations of naloxone:

Nasal Spray

NARCAN® Nasal Spray is a pre-filled, needle-free device that requires no assembly and is sprayed into one nostril.

Auto-injectable

EVZIO® is a prefilled auto-injection device that is injected into the outer thigh. Once activated, the device provides verbal instructions to the person administering the medication.

Injectable (professional training required)

Generic brands of injectable naloxone vials are offered by a variety of companies listed in the FDA Orange Book  under "naloxone - injectable".

Who can administer naloxone?

States have different regulations governing who can obtain naloxone and whether a prescription is required. Some states require a physician to prescribe naloxone; in other states, pharmacies may distribute naloxone without an individual prescription. To learn about the laws regarding naloxone in your state, visit the Prescription Drug Abuse Policy System website.

What dose can be provided?

Dosage varies depending on the formulation. Sometimes more than one dose is needed to help the patient start breathing again. Anyone who may have to use naloxone should carefully read the directional insert that comes with the product. Copies of the insert for EVZIO® and NARCAN® Nasal Spray can be found on the FDA’s website.

What precautions are needed when giving naloxone?

In the event of an overdose 911 should always be called, even if the individual is revived with naloxone. The effects of naloxone do not last as long as some other opioids (such as fentanyl) so the person may need additional doses over the next few hours. People who are given naloxone should be accompanied until emergency care arrives and observed by a medical clinician for at least two hours after the last dose of naloxone was administered.

What are the side effects?

Naloxone is an extremely safe medication that has no significant effects if the person does not have opioids in their system. Naloxone can (but does not always) cause withdrawal symptoms that may be very uncomfortable, but are not life-threatening. Withdrawal symptoms may include headache, changes in blood pressure, rapid heart rate, sweating, nausea, vomiting, and tremors.

Where can I get naloxone?

Naloxone is a prescription drug, but in certain states it can be purchased at a pharmacy without an individual prescription from a physician.

Resources

https://www.cvs.com/content/prescription-drug-abuse/save-a-life

https://www.narcan.com/availability

https://www.evzio.com/hcp/evzio2you/

How much does naloxone cost?

The cost of naloxone varies depending on where and how it is purchased. Patients with insurance should check with their insurance company to see what their copay is for EVZIO® or NARCAN® Nasal Spray. Patients without insurance can ask about the retail cost at their local pharmacies. Kaleo, the maker of EVZIO®, has a cost assistance program for patients with financial difficulties and no insurance. In some states, naloxone is being distributed for free or at low-cost to people at risk of experiencing or witnessing an overdose.

Learn more:

Prescribe to Prevent

Naloxone for Opioid Overdose: Life-Saving Science (NIDA)