Naloxone – Understanding Heroin Addicts’ Potential Lifesaver

Emergency room doctors treating patient

More than 160 people die every day from overdoses involving opioids. As opioid abuse increases, public health officials have pushed to make Naloxone more widely available.

Naloxone temporarily blocks or reverses the side effects of opioids, including heroin, fentanyl, oxycodone, methadone, hydrocodone, morphine, codeine, Vicodin® and others. It is used to treat an opioid overdose in an emergency situation, but is not a substitute for emergency medical care. Although available both as an injectable and a nasal spray, the nasal spray is gaining in popularity because it is a ready-to-use, 1 ml prefilled single dose. The drug takes effect in one-three minutes, usually before medical personnel can get to the subject.

It is important to remember that Naloxone is effective for opioid overdoses only. Side effects are rare and include opioid withdrawal, resulting in irritability, runny nose, sweating, nausea and vomiting. The only contraindication for use is for individuals allergic to the ingredients. There are no contraindications for use in children or the elderly.

How to detect symptoms of opioid overdose

  • Unusual sleepiness and inability to wake the person with a loud voice or by rubbing firmly on the middle of the chest/ sternum
  • Breathing problems including slow or shallow breathing in someone difficult to awaken or look like they are not breathing
  • Pupils of the eye are very small (pinpoint) in someone difficult to wake up
  • Pale clammy skin or bluish tint; cyanosis

Current laws

In July 2016, the Comprehensive Addiction and Recovery Act was signed into law. CARA provides improved access to overdose treatment through grants, as well as additional grants for training and follow up treatment. As of July 2017, Naloxone is available as an over-the-counter medicine in all 50 states, and the majority of states now provide either criminal or civil immunity for opioid users who seek medical treatment for an overdose and those who report an overdose. As the need for Naloxone increases, so does its cost and depending upon the opioid’s strength, more than one dose may be necessary. To help combat overdoses in younger populations, Adapt Pharmaceuticals has offered more than 40,000 free doses to high schools and colleges.

In October 2017, President Trump declared the opioid epidemic a national public health emergency under federal law.

What policies should you consider when administering Naloxone?

Develop a simple strategy/policy for responding to overdose at your facility. All staff should receive training on the brand and administration of Naloxone in use at the facility.

Complete an incident report immediately if Naloxone is administered and the dosage should be replaced as soon as possible. Review all incident reports monthly.

Develop a simple strategy for responding to overdose at your facility

Policy Statement Example

All staff at this facility will be trained on the administration and use of Naloxone. Manufacturer’s directions for storage and use are to be followed.

SCARE ME Training

  • S. SIGNS of overdose include no response to stimulation, blue lips, slowed or stopped breathing.
  • C. COMMUNICATE with emergency personnel. Summon emergency medical assistance as soon as possible since Naloxone’s effects can wear off in 20-90 minutes.
  • A. AIRWAY Clear the subject’s airway
  • R. RESCUE breathing: pinch off nose and give two quick breaths every five seconds.
  • E. EVALUATE respiration, responsiveness and general physical condition.
  • M. MUCOSAL (nasal spray) into each nostril or by muscular injection. Continue rescue breathing if necessary until medical personnel arrive.
  • E. EVALUATE overall condition again and administer a second dose if necessary.

How should you store Naloxone?

Naloxone is not a controlled substance and does not need to be kept in locked storage. Although it does not provide a ‘high’, it could be subject to theft, and like other medications, should not be left in the open. It should be stored at room temperature 59-70 degrees F and in a dark place. Do not freeze or expose Naloxone to freezing temperatures. Since more than one dose may be needed for each incident, more than one dose should be on hand at all times. In organizations that may have a greater potential for an overdose, stocking additional doses may be necessary.

Check supply and expiration date at the beginning of each shift. Because Naloxone loses effectiveness over time, any expired product should be disposed of according to local regulations and manufacturer’s directions.

Sources

National Conference of State Legislature Drug Overdoes Immunity and Good Samaritan Laws¸ June 5, 2017
Centers for Disease Control, Deaths involving Fentanyl, Fentanyl Analogs and U-47700 – 10 States, July-December, 2016, Morbidity and Mortality Weekly Report, November 3, 2017
Adapt Pharma Expands Free NARCAN® Nasal Spray Program to U.S. Colleges and Universities press release, issued April 10, 2017
Opiate Recovery Podcasts Narcan Administration Training, SCARE ME
Remarks by President Trump on Combatting Drug Demand and the Opioid Crisis, WhiteHouse.gov, October 26, 2017

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This information presented is intended to provide guidance and is not intended as a legal interpretation of any applicable federal, state or local laws, rules or regulations. The loss prevention information provided is intended only to assist policyholders in the management of potential loss producing conditions involving their premises and/or operations based on generally accepted safe practices. In providing such information, Great American does not warrant that all potential hazards or conditions have been evaluated or can be controlled. It is not intended as an offer to write insurance for such conditions or exposures. The liability of Great American and its affiliated insurers is limited to the terms, limits and conditions of the insurance policies underwritten by any of them.