The number of opioid overdoses in the U.S. is staggering. More than 16,000 deaths were attributed to prescription opioids in the U.S. in 2013. Heroin was related to another 8,000 deaths. In rural areas, the rate of opioid-related deaths is at least 45% higher than in urban areas.
Access is a key factor in drug addiction. In this case, access to medical treatment is a key factor in mortality rates. According to a study by the Centers for Disease Control (CDC), making the life-saving drug naloxone more widely available could cut down on opioid overdose deaths significantly. The Department of Health and Human Services has made reducing opioid deaths a priority in part by encouraging rural communities to train more emergency personnel on the use of naloxone.
What Is Narcan?
Narcan is actually one of the brand names for naloxone. Naloxone is a narcotic antidote used for opioid overdose, reversing opioid sedation and opiate dependence in combination with analgesics for pain and chronic pain.
Brand names for naloxone include:
- Narcan Nasal Spray
Naloxone was patented in 1961 by the Sankyo company, a Japanese pharmaceutical company that goes by the name of Daiichi Sankyo today. In 1971, the Food and Drug Administration (FDA) approved the use of naloxone for opioid overdose, and it became the standard of care in hospitals and by first responders for opioid emergencies.
How Does Naloxone Work?
Naloxone reverses the effects of an acute opioid overdose and reduces respiratory and mental depression. When injected, naloxone begins to work within the first minute and continues for about 45 minutes. Sometimes an additional dose is necessary because its effects do not last as long as the opioids.
Opioids reduce pain by attaching to certain receptors in your body. Your brain and central nervous system use a complex system of cells to send chemical messages that communicate pain. Opioids attach to the receptors throughout your system that normally receive and relay pain messages. By preventing the receptors from receiving their messages, opioids shut down your ability to feel pain.
Like all drugs, opioids have side effects, though. While they are blocking those pain messages, the opioids also slow down other vital information in your brain. Opioids affect the pleasure centers of your brain, which is why they can produce a euphoric feeling. Their interference with normal brain functioning can also produce nausea, confusion, constipation and, in larger doses, the slowing down of respiratory functioning.
Naloxone is an inverse agonist that binds to the same receptors as opioids but has the opposite effect. It acts almost immediately to block the receptors in the central nervous system that opioids act on. It is also an antagonist, which means that if there are no opioids present in the system, naloxone has no effect at all.
What Are the Side Effects of Narcan?
The most pronounced Narcan side effect is the immediate onset of withdrawal symptoms. Withdrawal is usually experienced during detox and consists of several uncomfortable and possibly life-threatening symptoms. When the drugs are removed from the system, the brain goes through a little period of shock. It has become used to functioning with these drugs and takes some time to adjust and find its new balance.
When Narcan is administered, it begins to work almost immediately to block the effects of the opioids and reverse any systemic depressions. The side effect is the equivalent of an immediate detox. Suddenly, and very quickly, your brain is not being controlled by drugs. The euphoria is gone, and you are just left with the pain of withdrawal.
Withdrawal symptoms can include:
- Runny nose
It is possible to have an allergic reaction to Narcan, which would be indicated by hives, trouble breathing or swelling of the face, neck, throat or tongue. An allergic reaction this severe would require immediate medical attention.
Other possible side effects of naloxone are:
- Weak pulse
- Chest pain
- Irregular heartbeat
- Light headedness
- Shortness of breath
- Ringing in the ears
While a dose of Narcan can prevent an opioid overdose death, it can still have some dangerous side effects and needs to be followed by medical attention.
Is Narcan Effective?
Naloxone, or Narcan, is very effective in emergency situations. It enters the bloodstream quickly and reverses the effects of the opioids to prevent death. Naloxone is actually prescribed for people taking high doses of opioids such as morphine for pain. Although a high dose of opioid pain relievers might be medically necessary, there is still a risk of overdose. Naloxone is standard protocol for reversing an overdose in this situation as well. Sometimes an additional dose of Narcan needs to be administered because its effects are not as long-lasting as opioids.
When Should Narcan Be Used?
Narcan has become the standard protocol for drug overdoses. If you witness an overdose, you will only have a few seconds to administer the drug. Recognizing an emergency overdose situation could save a life. Here are the signs to look for:
- Respiratory depression
- Pinpoint pupils
The World Health Organization (WHO) refers to this as the “opioid overdose triad.” When these three conditions exist, you are witnessing an overdose and should begin administering Narcan right away.
Assessing the risk factors will heighten your awareness. The people at greatest risk for an opioid overdose include:
- Those suffering from opioid addiction
- Those who live in a household with an opioid user
- Those who inject opioids
- Those who combine opioids with alcohol or other drugs
- Those who take high doses of prescription opioids
- Those with a history of substance abuse
Of course, the people at risk for opioid overdose will not be able to help themselves if the overdose should occur. They will have to rely on witnesses to recognize the emergency and act quickly. You are most likely to witness an overdose if:
- You or a family member is at risk of opioid overdose
- You work in healthcare
- You work in emergency services
- You work in a drug treatment program
If you are at risk of opioid overdose or are likely to witness an overdose, it is a good idea to get access to Narcan. Learn how to use Narcan so you will react quickly if it is ever needed. Share information about the risk of opioid overdose and the signs with your friends and family members. If you ever suffer an opioid overdose, you’ll want to know someone close by can help you.
How Is Naloxone Administered?
Naloxone, or Narcan, is used in emergency situations when opioid overdose is suspected. Because opioids suppress the messaging system in the brain and central nervous system, overdose can cause a depression of the respiratory system. Breathing could slow or even stop.
Although the opioid user may have a prescription for Narcan and carry it with them, they will not be able to administer it themselves if it is needed. Someone else will have to know when and how to use the drug. Naloxone nasal spray is administered one dose at a time to restore normal respiration. Additional doses can be given two or three minutes apart until respiration resumes and medical help arrives.
In a hospital setting or with trained emergency medical personnel, Narcan can be given intravenously. Naloxone is typically diluted in saline for intravenous use and administered in doses between 0.4 and two mg initially. Follow-up doses are measured based on the patient’s reaction. If there is no effect after 10 mg of Narcan, the presence of opioids may be ruled out.
Is Naloxone Readily Available?
The number of opioid pain relievers prescribed in the U.S. has increased significantly in the last 25 years. 76 million opioid prescriptions in 1991 grew into 207 million by 2013. The U.S. is the biggest consumer of opioids in the world, and the addiction and overdose problems are growing, too.
To help reduce the overdose death rate, in November 2015, the FDA approved an over-the-counter version of naloxone. Previously, Narcan was only available by prescription and only used by medical personnel to treat acute opioid overdose. The OTC variety of naloxone nasal spray will make the drug more accessible, especially in rural areas where medical treatment is further away.
One of the largest pharmacies in the country, CVS quickly expanded its sale of naloxone over the counter to 14 states. The states where CVS is selling OTC naloxone nasal spray are:
- New Jersey
- North Dakota
- Rhode Island
- South Carolina
Competing national pharmacy chains Walgreens, Duane Reade and Rite Aide are selling the drug as well. Narcan is now available without a prescription in almost every community across the country.
Who Can Administer Narcan?
Up until recently, Narcan was only administered in an emergency situation by medical personnel. Hospitals stocked the drug for intravenous use in suspected overdose cases. Some emergency responders were also trained to carry and administer Narcan in the field if they suspected an overdose. In the case of an opioid overdose, when respiration slows or stops, the antidote needs to be given right away. Many overdose victims die before they can get medical help.
Now that naloxone nasal spray is available without a prescription, it is easier for anyone to administer. There are no dangerous needles involved. Still, it is important to know how to administer naloxone and what to expect. If you know someone who uses opioids and there is a likelihood that you could witness an overdose, here are some things you should know about using Narcan:
- A person experiencing an opioid overdose cannot help themselves, so you will have to take charge of the situation. They may not be able to answer your questions or tell you where they keep the Narcan.
- Narcan is considered safe for adults and children. If there is no opioid presence, Narcan will not do any harm.
- When you administer Narcan, you must also call 911. Even though Narcan will reverse the overdose, the subject will still need medical treatment.
- Narcan almost immediately ends the opioid high and induces withdrawal symptoms. This will likely get a negative reaction from the subject. They may quickly go from being delirious or unconscious to feeling extreme anxiety and being angry or combative.
- Once you begin administering Narcan nasal spray, you need to stay with the subject and monitor their behavior until medical helps arrives.
How Is Narcan Nasal Spray Helping?
The CDC includes Narcan distribution to lay-people who have no medical training as part of recent efforts to reduce the number of opioid overdose deaths. In 2013, there were still 20 states that did not have a Narcan distribution organization in place. In nine of the states that were distributing Narcan to lay-people, there was only one person in every 100,000 who had received a naloxone kit. Of the states with the lowest distribution rates, 11 had opioid overdose death rates that were higher than the national average.
The CDC distribution program is still young, but some basic conclusions could be drawn:
- Heroin overdoses were reversed more often than other opioids, indicating that the Narcan kits were getting to people who witness heroin overdoses.
- People who use drugs themselves are most likely to witness an overdose and have occasion to use Narcan to save a life.
- In some areas distribution was hindered when, in the middle of 2014, prices of naloxone nasal spray increased significantly.
There seems to be anecdotal evidence to suggest that access to Narcan without a prescription and its distribution to a wider range of people beyond just medical and first responders is saving lives. There are still agencies that do not collect reversal reports, so the statistics cannot be compiled accurately.
Does Easy Access to Narcan Increase Opioid Abuse?
It seems like a natural conclusion to draw that if you have access to a drug that can pull you out of an opioid overdose, then you will feel comfortable increasing your opioid use. Of course, this is assuming that you are addicted to opioids and not just taking them as prescribed for the pain of an acute injury.
The logic that is overlooked in this assumption is that people suffering from addiction are not governed by logic most of the time. Addiction is a strong force that changes the way you think and behave. When those opioids interfere with your brain chemistry and produce a high, they take over your ability to think rationally.
People suffering from opioid addiction are focused on getting their next high because the addiction has taken over their lives. They take risks with their health that they normally wouldn’t take because the addiction is driving them. People addicted to opioids are going to abuse those drugs as much as they need to satisfy their addiction, whether there is Narcan or not.
Because drug abuse has a negative stereotype in our society and some people who are not well educated about addiction want to say that it is a result of poor upbringing or bad character, the Narcan distribution efforts have come under some criticism. According to the National Insitutes of Health (NIH), there is no research data to support the idea that access to Narcan increases opioid abuse.
How Does Narcan Affect Opioid Addiction?
Opioid addiction is becoming a national health crisis with the number of prescriptions increasing. Meanwhile, an increase in the world-wide supply of heroin has driven the price of that drug, derived from opium, down and made it more readily available in most communities. One of the consequences is a high rate of opioid overdose deaths.
Here are some startling overdose statistics:
- Drug overdose deaths in the U.S. reached an all-time high in 2014.
- Almost 500,000 people died of drug overdose between 2000 and 2014.
- Prescription pain relievers and heroin, or opioids, are involved in a majority of drug overdose deaths.
- Between 2013 and 2014, the rate of drug overdose deaths from prescription opioids almost doubled.
- Heroin overdoses nearly tripled in the last four years.
- Approximately 28,647 deaths in 2014 were attributed to opioids.
- The number of prescription opioid deaths increased 9% in 2014 after remaining constant for the previous two years.
The wider distribution and availability of Narcan seems to be reducing the number of deaths from overdoses. It may, in fact, be reversing heroin overdoses that would have gone unreported or untreated because of the stigma surrounding illicit drug use. The efforts to make Narcan available in every community and to those most likely to witness an overdose are just beginning, though.
Narcan reverses opioid overdoses and saves lives, but it does not cure drug addiction. Once a person suffering from opioid addiction has been treated with Narcan for an overdose, they are still addicted to opioids. Addiction is a powerful force that destroys lives, ruins careers and separates families. For many people, the experience of almost dying from an overdose will not be enough to end their addiction.
Learn More About Opioid Addiction
Opioid overdose is a serious problem in this country, and Narcan distribution could reduce the mortality rate. But that should not detract from the bigger problem of addiction. By addressing the problem of addiction with quality treatment programs, we could not only save lives, but also make those lives healthier, happier and more productive. With fewer people suffering from opioid addiction, the risk of death from overdose would also be diminished.
You can save lives in your own community, in your own family, by recognizing the problem of addiction, talking about it like the disease it is and getting help for those in need. Overcoming addiction starts at home, with you.
If you or someone you love is suffering from addiction, whether it involves opioids or some other substance, reach out to 12 Keys for help. Our compassionate staff is experienced and dedicated to ending the suffering caused by addiction. We recognize that addiction causes everyone to suffer — your family, your co-workers, your friends, your neighbors, your whole community. We want to help you end the suffering.
When you call 12 Keys, we’ll answer all of your questions about opioid addiction, naloxone and other addiction treatment topics. Most importantly, we’ll listen to your story and offer you suggestions for how to make your life better and what next steps to take. Whether it is you or a loved one suffering from addiction, 12 Keys wants to help end the suffering, so call us today.