Naloxone is an opioid antagonist, approved by the Food and Drug Administration (FDA) to treat opioid overdoses. By blocking opioid receptors, naloxone prevents opioids like heroin, morphine, fentanyl, oxycodone, and hydrocodone from binding to those receptors; during an overdose, naloxone kicks opioids off these receptors and temporarily takes their place.
An opioid overdose can occur for several reasons, including:
- A person taking prescription painkillers for pain management accidentally takes too much.
- The individual struggles with substance abuse and takes too much illicit opioid.
- The person struggles with polydrug abuse and mixes opioids with benzodiazepines (e.g., Valium, Klonopin, Xanax, etc.) or alcohol.
How Naloxone Is Used
- Itching, especially around injection site
- Rash or hives
- Trouble breathing
- Facial swelling, or swelling of the lips, tongue, or throat
The drug is prescribed in several forms, including an intranasal spray that has become popular in recent years as a straightforward way for people without medical training to administer naloxone. It can also be injected intravenously or intramuscularly. The most common brand name for naloxone is Narcan.
This opioid antagonist is also part of the withdrawal medication Suboxone. The main ingredient is buprenorphine, a partial opioid agonist, which binds to opioid receptors for a long time and eases withdrawal symptoms in people working to end their addiction to opioids. It does not induce a high in people who have a tolerance for opioid drugs already. Naloxone is added to Suboxone to prevent abuse of the drug to get high; when taken orally, Suboxone reduces withdrawal symptoms, but when snorted, crushed, injected, or otherwise abused, naloxone hits the brain first, preventing buprenorphine from binding to the opioid receptors, which can lead to withdrawal symptoms.
Naloxone does not have any effects unless the individual is allergic to the drug. It is not addictive, and it does not create euphoria. This means it is among the safest drugs available.
Naloxone to Reverse Opioid Overdoses
It is very important to note that naloxone is not a substitute for emergency medical treatment. It can be administered to temporarily reverse an opioid overdose, but it does not stop the overdose completely. Naloxone’s half-life is much shorter than opioid drugs’ half-lives, so the overdose will begin again once naloxone is processed out of the body. Naloxone only lasts in the body for 20-90 minutes, depending on the size of the dose. When a person is overdosing on opioids, call 911 and administer naloxone if it is available. Emergency medical treatment gives the individual the best chance of surviving the overdose.
Symptoms of an opioid overdose include:
- Excessive sleepiness or falling unconscious
- Depressed, shallow, or irregular breathing
- Changes to the pulse
- Small or pinpoint pupils
- Gray or clammy skin
- Bluish tint to skin around the lips, tip of nose, or fingers
For years, first responders and medical professionals were the only people authorized to use naloxone. Now, however, laws are beginning to change. The opioid abuse epidemic kills 91 Americans every day from overdoses, and over 1,000 are hospitalized due to an overdose, according to the Centers for Disease Control and Prevention (CDC). Development of Narcan and Evzio – a nasal spray and an auto-injectable, respectively – allows the public, without medical training, to safely administer a specific dose of naloxone to a person suffering from an opioid overdose.
National Laws and Changing Attitudes toward Naloxone
Doctors and harm reduction groups have used naloxone successfully to reverse overdoses since 1996. The CDC reports that at least 26,000 overdoses have been reversed, and the individuals survived, thanks to naloxone administration. Most states allow doctors to prescribe naloxone to those who use prescription opioids, but as the opioid abuse epidemic continues to take many lives, several states and drug store chains are making naloxone available over the counter. This means that people who may be struggling with heroin addiction, or another kind of opioid addiction, can purchase packages of naloxone, no questions asked.
Good Samaritan laws in just over half the states in the US and the District of Columbia protect those who call emergency responders if they witness an opioid overdose. This is because many times, the person who witnesses the overdose is also someone struggling with opioid addiction, so they may have purchased or helped administer the opioid that led to the overdose. Good Samaritan laws protect these people from prosecution for possessing or taking drugs.
States that do not have opioid immunity laws include:
- South Carolina
- South Dakota
Two major drug store retail chains, CVS and Walgreens, are expanding availability of naloxone based on state laws.
- New Jersey
- North Dakota
- Rhode Island
- South Carolina
At the end of 2016, Walgreens expanded access to naloxone in any state whose laws allow it.
Currently, the National Conference of State Legislatures (NCSL) notes only three states have not legalized any kind of wider access to naloxone:
Changing Laws for Naloxone Access in Texas
In 2015, Texas passed Senate Bill 1462, which changed provisions around naloxone availability and administration. The law went into full effect in September 2015. SB 1462 allowed prescribers to give naloxone prescriptions to those who take narcotic painkillers and to also prescribe the medicine to family members, friends, or unofficial caregivers. The prescription can be in the form of a standing order, meaning the person does not have to fill the prescription immediately; instead, the order allows the person to acquire naloxone in an emergency situation from a local pharmacy. SB 1462 also states that any naloxone prescription in the state of Texas has a legitimate medical purpose.
Emergency responders have greater access to naloxone, including:
- Emergency services personnel
- Emergency room personnel
- Volunteer responders
SB 1462 also gives immunity to prescribers and dispensers of naloxone in both civil and criminal court, as long as the professional acts in good faith and with reasonable care. This is in regard to both prescribing or not prescribing naloxone, and filling or not filling the prescription.
The Texas Pharmacy Association (TPA) expanded the standing order doctrine, starting in August 2016. The professional organization requires pharmacists to have a one-hour training course in naloxone before they can administer the medicine, but TPA expanded access to the accreditation as part of their Saving Lives Initiative.
Further, the law allows nonprofits, medical centers, rehabilitation centers, and other organizations to distribute naloxone to anyone who may use it to save lives, as long as the organization does not receive financial gain.
Most importantly, people witnessing an overdose can administer naloxone without suffering criminal penalty, civil liability, and sanction under professional statutes. This is an essential step toward greater Good Samaritan laws. Naloxone can reportedly be found in 715 Walgreens across the state.
Lingering Controversy around Naloxone
For some overdoses, one injection or spray may not be enough. This is why Narcan and Evzio have two doses per package; in the event the individual’s overdose symptoms do not improve with one dose, a second may safely be administered while waiting for emergency medical attention.
However, critics of naloxone’s wider availability believe that offering it at all increases the potential for more opioid overdoses because people struggling with opioid addiction will feel safer with something that can allegedly stop their overdose. Critics also worry that increasingly dangerous opioid abuse may lead people struggling with addiction to take too much of an opioid on purpose, then have a friend use naloxone to bring them back, only to intentionally push those limits again.
Although there is controversy around the wider availability of naloxone, many lawmakers, researchers, and public health professionals recommend changing laws to allow legal immunity to those who report overdoses and to provide greater access to naloxone. The FDA recommends the following:
- Permit third parties, including friends and family, to have access to naloxone if they know someone taking opioids, either by prescription or due to addiction.
- Permit prescription and dispensation through standing protocol order.
- Give civil and professional immunity to administrators, prescribers, and dispensers.
- Allow for “lay dispensation,” or greater access to the general public.
- Increase first responder training to include naloxone administration.