1) Naloxone is an opioid overdose reversal drug.
Naloxone is a generic drug that is also known by the brand-name, Narcan. First responders, including police officers, paramedics, and ER doctors, use naloxone frequently to reverse opioid overdoses. Narcan is available as a nasal spray and as an injectable solution. When a person overdoses on an opioid, such as heroin or fentanyl, their breathing can slow down and even stop. Slowed breathing leads to low oxygen levels and, eventually, death. When a healthcare provider or bystander gives Narcan to a person who is overdosing, the effects of the opioid are immediately blocked. The person starts to breathe again. Narcan has saved their life. The way that naloxone works is that it blocks opioid receptors. It is such a potent blocker that it knocks opioid molecules off of the receptors, and it keeps them away by continually blocking. When the receptors are blocked, the person wakes up from their overdose and starts breathing again. They also will experience opioid withdrawal symptoms.
2) Naloxone has been around for a long time. You can get naloxone without a doctor’s prescription.
During the past few years, we have heard a lot about Narcan, naloxone, and harm reduction. You may believe that naloxone is a new drug, designed as a tool to save people from opioid overdoses in the current opioid epidemic. The fact is that naloxone became patented in 1961. The FDA approved naloxone to treat opioid overdoses ten years later. We have had this powerful opioid overdose reversal drug for decades. Naloxone is safe and effective. The protocols for using it are well understood. Soon, naloxone may be available to the public as an over-the-counter drug. Currently, you can get Narcan without a doctor’s prescription at many pharmacies. It is essential to identify pharmacies or other places where Narcan or generic naloxone are available in your area. You should also look into training for how to use naloxone. There are online training courses that can help. The CDC has an online training series for healthcare providers. Some programs provide education and training to people who have no background in healthcare as well. If you or a family member takes a prescribed opioid or uses opioids illicitly, you should have naloxone in your home at all times, and you should know how to use it.
3) Naloxone does not last for very long.
Since you may find yourself, one day, in a situation where you must administer Narcan to someone who has just overdosed on an opioid, you must understand that naloxone wears off quickly. It starts working in minutes, but the effects may only last for an hour or less. Why is this so important to remember? Many opioids that people abuse are long-lasting. The fentanyl that drug dealers combine with street heroin can have a very long half-life. If you successfully reverse an overdose with naloxone, the effects may only be temporary. The overdose victim may again start overdosing as the naloxone wears off. When you use naloxone to revive someone from an overdose, it is essential also to call 911. If the paramedics take a long time to arrive, you may have to administer naloxone again. There is an auto-injector device that contains five doses of naloxone. The reason for this is that you may have to give several doses of naloxone while you are attending to the person who overdosed.
4) Naloxone has no potential for abuse.
Sometimes, in the healthcare and addiction treatment business, we take our knowledge for granted, assuming that most people already understand the basics. Yet, even when we are speaking to a highly intelligent and successful person, we must not assume that they know what we consider to be straightforward. If you are someone who has experience in addiction treatment or healthcare, you already know that naloxone has no potential for abuse. There is no need to keep the Narcan locked up to keep it safe in rehab or a sober living home. A person who is addicted to opioids or any other drug has no way to get high with naloxone. It simply isn’t possible. Why is it so important to be aware of this fact? I have spoken to family members of people who have opioid use disorder about the importance of having Narcan in the house. Even after explaining what it is for, some family members have locked up the Narcan to keep it safe from being abused. Why is this a bad idea? Imagine if their loved-one overdoses in the house. Time is of the essence when it comes to giving Narcan to reverse an overdose. You do not want to be fumbling with the key for a locked box or safe while your family member is unconscious, on the floor, and not breathing.
5) Naloxone is just one component of effective harm reduction.
Have you learned how to use Narcan nasal spray or injectable? Are you prepared if someone overdoses nearby? Do you have Narcan in your home and with you when you go out? If so, you are doing your part to reduce harm to people who are addicted to opioids. Harm reduction means to help people stay safe, healthy, and alive during the time that they continue using drugs. A naloxone dose given promptly can save a life. Naloxone is a vital part of harm reduction, but there is more to it than just carrying Narcan. People who use heroin or fentanyl with a needle should have safe access to clean supplies, including sterile syringes and needles. In the U.S., we have a handful of clean needle exchange programs.
In some countries, there are supervised consumption sites, also known as safe injection sites, where people can use drugs in a supervised setting. At these sites, the drug users can get clean supplies, and if they overdose, the staff will provide treatment to reverse their overdose. Additionally, the team can make connections with local drug users, gaining their trust, and helping them to recover from their addiction when they are ready. There are other harm reduction programs in some countries where drug users use medical prescription heroin. These programs surprisingly have a high success rate in helping people to stay safe and eventually get clean.
Tough love does not work.
For many years, addiction support groups have preached “tough love.” What is tough love? It means that if you have a loved one who is having trouble quitting drugs, you should not do anything that might help them to continue their drug-using lifestyle. That means that you don’t feed them, you don’t let them in your home, you do not give them money. If your spouse or child ends up homeless on the streets, tough love dictates that you are doing the right thing, not helping them. The idea is that if you practice tough love, they will hit their “bottom” faster. When they hit their bottom, they will be ready to finally accept that there is a problem and that they need help. Unfortunately, tough love does not work, especially with the deadlier street heroin cut with fentanyl. Tough love is more likely to lead to an overdose death. If your family member is out on the streets using drugs, who will be there to give them Narcan?
Harm reduction starts at home.
Harm reduction is nearly the opposite of tough love. Yet, it does not mean that you are enabling someone to continue using drugs. Harm reduction does not include buying drugs on the street for your loved one. It does not mean that you give them drug money. What it might consist of is allowing your loved one to continue living at home, eat meals with you, and still be a part of the family. By connecting with your family member who struggles with addiction, and letting them know that you are there to help, they will turn to you for support when they are ready to quit.
Is the naloxone in Narcan the same naloxone that is in Suboxone?
We should discuss other naloxone uses. Remember how naloxone works. When a person gives naloxone to someone who is overdosing, the molecules block the opioid receptors. Any opioids in their system are knocked off and kept away from the receptors. Because of this, the person who gets the naloxone will experience discomfort from opioid withdrawal symptoms. Opioid withdrawal is not dangerous, but it is very unpleasant. People who misuse opioids are often aware of opioid withdrawal and will avoid it at all costs. Precipitated withdrawal caused by giving an opiate blocker, like naloxone, is especially unpleasant because it starts abruptly. Another thing to keep in mind is that naloxone has little to no effect if a person swallows it or puts it under their tongue.
Because naloxone has these properties, it is uniquely suited to be an abuse-deterrent.
Should I be worried about naloxone side effects from my Suboxone?
Suboxone is a brand-name drug that contains buprenorphine and naloxone. Buprenorphine is a unique opioid drug that treats opioid addiction. Naloxone is present as an abuse-deterrent. The idea is that if a patient who gets Suboxone tries to inject their Suboxone to get high, it will make them sick with immediate withdrawal symptoms. Is naloxone effective as an abuse-deterrent? Does naloxone help to keep Suboxone patients on track, taking their medication as directed? Realistically, it is unclear that naloxone works well to prevent abuse of Suboxone. There have been no studies to demonstrate that naloxone is an effective abuse-deterrent. However, physicians who provide medication-assisted treatment with Suboxone-type medications are encouraged by addiction experts and regulatory officials to prescribe opioids with naloxone as an abuse-deterrent whenever possible. Naloxone side effects are not generally an issue for the vast majority of patients who take their Suboxone as directed by their doctor.
Remember that naloxone is an opioid overdose rescue drug first!
Please do not be distracted by other naloxone uses. Naloxone should be seen first and foremost as a rescue drug that saves lives. Have you looked at the wall in many public buildings and seen a machine on the wall labeled AED? An AED is an automated external defibrillator, which is a life-saving device for people who suffer from heart rhythm abnormalities. Why are these machines on the walls in buildings? Because they save lives. Heart problems kill many people who might have lived if the proper tools were available at the right time to save their lives. Why do we not have naloxone kits on the walls next to the AED? You may soon see them there if they are not there already. In addition to making naloxone available in public places, you can do your part and carry naloxone with you. Keep it in your handbag or backpack. Naloxone is far cheaper than an AED.
How much does Narcan cost?
Currently, you may pay around $150 for Narcan nasal spray if you buy it at the pharmacy counter without a prescription. If you do have a doctor’s prescription for Narcan, you may get a bit of a discount on the price. However, naloxone does not cost $150/dose to manufacture. The cost is only pennies to make enough naloxone for a naloxone dose, nasal spray unit, or injection kit. So, why is it so expensive? Unfortunately, pharmaceutical companies continue to profit off of the misery of the public. While a drug company has a right to charge what they want to charge, why is there no competition? How is it that a drug approved for the treatment of opioid overdoses in 1971 is still not available as an affordable generic? Moving forward, we may soon see naloxone on the shelves of pharmacies and grocery stores at a fair price. Naloxone nasal spray should be in the price range of other over-the-counter nasal sprays on the shelves. When the FDA is finally successful in fast-tracking naloxone’s approval for OTC use, we should expect to see prices driven down to $10 or less per unit.
How can I get a naloxone dose for free?
While the price is a barrier for many people to buy naloxone right now, there are other options. Various organizations are working to make naloxone available to people at little or no cost. It may take some effort to find a group in your region that is giving out free naloxone and free naloxone training, but you should be able to find one close to you. Keep an eye out for free naloxone events also. Harm reduction groups sometimes hold special events throughout the year, where you can get free naloxone.
Are there discounts for Narcan?
You should be able to find manufacturer coupons and other discounts to get Narcan for less than the current price of $150. GoodRx offers a discount with their card of about $20 off. You may even be able to get it for just under $100 at some pharmacies with special discounts. It may be worth it to look for these special offers.
Do all doctors prescribe naloxone?
While in many states, you do not need a prescription to get Narcan from the pharmacist, it may still be helpful to have a doctor’s prescription. It is also a good idea for doctors to document that they are in favor of their patients having Narcan by writing the Narcan prescription and having a conversation about it. Doctors should prescribe Narcan nasal spray to any patient who takes opioids, prescribed or abused, and to any patient who comes in contact with someone who uses opioids. An additional benefit to getting a prescription is that insurance may help to pay for part of the cost. I would urge everyone who sees a doctor to ask their doctor for Narcan at their next visit.