Naloxone 101: How to Use It to Save Lives From Opioid Overdose
By Peg Rosen
You’ve probably heard of naloxone, also known by the brand name Narcan. It’s a lifesaving medication that can quickly reverse an opioid overdose.
Naloxone is now sold over the counter, which means you do not need a prescription to buy it at pharmacies across the U.S. Many agencies and advocacy groups also offer naloxone online and locally, often at no charge.
Why Carry Naloxone?
According to the Centers for Disease Control and Prevention, the U.S. is facing a drug overdose and death epidemic. It is reported that over 100,000 Americans died from drug poisoning in 2021, and 66% of those deaths were attributed to synthetic opioids — mainly fentanyl.
That information is not meant to scare you, but, rather, to help you understand the risk so you can keep yourself and your friends safe. It’s a good idea to carry naloxone, because opioid overdoses are widespread and addiction does not discriminate. People from all backgrounds and walks of life can struggle with drug addiction, including friends, family members, neighbors, and people you are friendly with at school or work.
Who Should Carry Naloxone?
It’s a good idea for everyone to carry naloxone, and it is especially important if you use drugs or spend time around people who do.
Naloxone kits are small and easy to stow in your backpack, purse, or car console. It’s also good to keep some at home in a spot you can see and access easily, such as on top of the refrigerator or in a kitchen drawer or night table.
Let people close to you know you have naloxone and where you keep it. It can feel weird sharing that info with your parents, but they’ll probably get it if they know what’s going on with fentanyl. If they aren’t aware, you could even share this article with them.
How Naloxone Works
Naloxone reverses an overdose by knocking opioids out of receptors in the brain and then blocking those opioids from returning to those receptors. You can think of it as naloxone bumper cars coming into a parking lot, pushing opioid cars out of their parking spaces, and then taking up the parking spots so the opioid cars don’t come back. But remember: Those opioid cars can come back in as few as 30 minutes after administering naloxone, so be sure to get the person medical help right away.
When people overdose, their breath slows to dangerous levels or stops altogether. Naloxone is powerful and fast-acting, and it can restore breathing to normal levels within minutes.
What’s great about naloxone is that you can’t harm someone by giving it to them. Let’s say you think someone is overdosing but aren’t sure, or you don’t know if it was opioids that caused them to go unconscious. Bottom line? If opioids aren’t in someone’s system, naloxone will have no effect on them. When in doubt, get the naloxone out and call 911. Read more about how to give naloxone to someone below.
How Naloxone Is Packaged
Naloxone comes in a few different forms:
- As a vial filled with a serum that you inject with a traditional syringe (like what you’d get at a doctor’s office)
- Loaded into an auto-injector (like an EpiPen that people with allergies often carry)
- As a nasal spray, which is sold under the brand name Narcan
For most people, Narcan nasal spray is the easiest form to use, because it comes preassembled and doesn’t involve needles. Plus, you can often find a resource that will give you Narcan for free.
How and Where to Get Naloxone
As of 2022, you can get naloxone without a prescription in all 50 states, plus Washington, D.C., and Puerto Rico. Most places that distribute naloxone will give you detailed instructions for how to recognize an opioid overdose and how to give the drug to someone who needs it.
NEXT Distro has a helpful naloxone finder that can tell you what’s available where you live. Googling “naloxone” + the name of your city, county, or state will also score helpful results.
Options typically include:
- Community-based naloxone distribution programs. It could be a clinic, your town’s health department, or a local harm-reduction center, such as a clean needle exchange. Many of these programs offer naloxone for free.
- Online local, state, and national naloxone programs. Many cities and states run programs that mail naloxone kits free of charge.
- Harm-reduction vending machines. Depending on where you live, you may be able to take advantage of the machines, which dispense naloxone, fentanyl test strips, clean injection supplies, wound-care kits, and safe-sex kits. (Google “harm reduction vending machines” + your county, city, or state.)
- Local pharmacies.
How to Buy Naloxone From a Pharmacy
You can usually get naloxone from a pharmacy the same day or next day. Keep in mind:
- Pharmacies generally charge for naloxone. A two-dose Narcan kit starts at about $35.
- Most insurance companies cover the cost, but you’ll need your insurance information and the transaction may show up on your insurance paperwork.
- Pharmacists have the right to refuse naloxone to someone who is under 16. It’s not very common, but it’s a possibility.
- Some states require a parent or guardian’s consent if you are under 18.
- If you don’t want to run into people you know while getting naloxone, consider going to a pharmacy outside your neighborhood.
- If you are a minor, find out first if you need consent from your parent or guardian. They may actually be relieved you’re being careful. Whether you go alone or with them, just walk up to the pharmacy counter and ask for naloxone. There’s no need to explain anything. The pharmacist will give you a brief training on how to use naloxone and provide you with printed instructions to go along with your kit.
How to Use Naloxone
Keep a naloxone kit at home and another on yourself while you are out in public. Most Narcan kits come with two doses, since it sometimes takes more than one dose to revive someone. If you think someone is overdosing:
- Call 911 right away and give as much detail as possible, including if the person is breathing and conscious, and if their skin has changed color. Don’t let fear of getting in trouble stop you from calling for help if you or someone you care about needs it. Most states in the U.S. have something called Good Samaritan Laws, which protect you from arrest or prosecution for drug use or drug possession if you call emergency services for help.
- Use naloxone or Narcan, even if the person is not breathing.
If you have Narcan nasal spray:
- Don’t test it first. Hold the person by the back of their neck, tilt their head, and put the nozzle in one of their nostrils as far as possible. Press the plunger firmly to give the full dose.
- If the person does not respond to the medication in two minutes, give the second dose. You can continue giving doses every 90 seconds.
- While waiting for help, turn the person on their side, bend their knee, and turn their face to the ground to prevent them from choking on vomit if they start to throw up.
If you have injection naloxone, follow these steps from the New York State Department of Health:
- Remove the cap (it’s usually orange) and insert the needle through the rubber stopper.
- Pull the plunger upward to draw fluid into the syringe. Double-check that the syringe fills with the naloxone liquid, not air.
- Inject the needle straight into the person’s shoulder muscle or the front of their thigh. You do not need to remove their clothing to inject the naloxone.
- If the person doesn’t respond in three to five minutes, give another dose of naloxone.
Naloxone wears off after 30 to 90 minutes. After that, it’s possible for someone to go into overdose again if they still have drugs in their body. That’s why it’s important to call 911 or get to the nearest emergency room even if naloxone helped them. You can also continue to give naloxone every two to three minutes until help arrives.
What Else to Keep in Mind
Opioid overdoses can be scary and upsetting. It’s important that you take time to process and heal from what you experienced.
Learn more about coping with traumatic events.
After you’ve had some time to recover, it’s a good idea to restock your supply of naloxone so you are not caught without it. It should be replaced every two to three years, but if you have expired naloxone and someone is experiencing an overdose, you should still use it since it may remain effective.
It may also be time to consider seeking additional help for yourself or a friend who is struggling with opioid use. It’s never too late to ask for support and get on a path toward recovery.