Naloxone hydrochloride is a life-saving drug that is commonly used to treat people who have suffered an opioid overdose[1]. Such overdoses can be as a result of surgery or giving birth, but can also result from taking illegal narcotics such as Heroin and Opium. Since being developed in the 1960s by Sankyo, it has been listed by the World Health Organization (WHO) as one of the most essential medicines any basic healthcare system should use.

In recent years, efforts have been made to make Naloxone as integral part of every first responder’s kit. Previously, in many countries, the medication was only on hand whenever an opioid is being administered just in case something goes wrong. Yet, when first responders were attending an overdose, they could only watch on helplessly. With 335,000 heroin users in the United States in 2012 [2]; double the amount of 10 years prior, there were countless occasions when the medicine would have been useful. Indeed, in 2005, 16,000 people died because of an opioid overdose.

How Naloxone Save Lives

Naloxone works by freeing the opioid receptors in the brain. Opioids, which come from the opium poppy, are often used in medicine due to their sedative and pain relieving (analgesic) effects. They bind to the opioid receptors in the brain, the central nervous system, and the gastrointestinal tract, stimulating their effects so that people respond less to pain, pain is felt less intensely, and the pain threshold is increased. Opioids are found in many drugs, both prescription and illegal, including:

• Codeine
• Morphine
• Opium
• Heroin

Opioids reduce the response and drive for respiration in the brain. This means that if blood oxygen levels fall, and carbon dioxide levels rise, the brain may not respond correctly to alter a person’s breathing pattern in order to redress the balance. This is called respiratory depression, also known as hypoventilation[3].

Naloxone is classified as a ‘competitive opioid antagonist’. This means that Naloxone removes the opiates from the opiate receptors in the body, freeing a patient from their effects. In the case of someone who has stopped breathing, or is suffering serious respiratory depression, this allows the brain to fully control breathing again, to the extent where someone who has stopped breathing may start again. It can even work when opioids have been taken with other drugs or alcohol.

Opiates are a sedative and pain reliever that have been used for thousands of years in medicine. They are still used today, which is why women giving birth and people undergoing surgery can sometimes suffer from respiratory depression and require a Naloxone dose to counteract the effect of the opiates.

When to Use Naloxone

A Naloxone dose should always be given to somebody who is suspected of suffering an opiate overdose. Signs of an overdose include:

• Shallow or laboured breathing
• Repeated scratching of itching skin
• Very small pupils
• Slurred speech
• Lips or fingernails with a blueish tinge
• Unconsciousness, although they may still respond to outside stimulus

A single one of these symptoms could be a sign of an overdose [4]. Even if you aren’t entirely certain that opiate overdose is the cause of the symptoms, it is safe to administer Naloxone as it will do no harm to someone who is not suffering from an overdose. Usually Narcan will begin working within five minutes. If the patient is still showing signs of overdose after Narcan has been administrated, you may need to give them further doses over a period of time.

If a person is still conscious, you do not need to administer Naloxone. It is important however that you pay close attention to them, and are ready to administer a Naloxone dose should they need it. After about half an hour the drug will begin to wear off, and 90 minutes later will be mostly gone. By this point the patient’s body will have processed some of the opiates, making it much less likely that they will stop breathing again. However after a very large dose of opiates the patient may need another dose of Naloxone, and will require careful monitoring.

How is Naloxone Administered?

Naloxone can be administered in two ways. The most common is via intramuscular injection (IM), administered to the muscle of the buttocks, thighs, or arm. It can also be administered as a nasal spray, and while it is still prescribed in this form in many states, it is becoming less and less common to use it in this way.

Naloxone is often administered in a hospital setting, in which case the patient’s vital functions will be closely monitored to ensure your safety.

Why do First Responders Want Naloxone?

The advantages of having emergency services personnel carrying Narcan has already been demonstrated in Quincy, Massachusetts, where police and fire departments have already used the drug to reverse 200 overdoses in the four years since they started carrying it. According to US Attorney General Eric Holder, Naloxone has reversed 10,000 overdoses since 2001. Holder has spoken out on several occasions about the need for emergency personnel to carry Naloxone [6]. The ability to administer instant treatment to what is becoming an increasingly common problem will help the emergency services to save more lives and combat the catastrophic effects of drug use.Narcan is a safe and life-saving drug, and many people believe that more first responders should be equipped to administer it. Police, ambulance, and fire crews are often the first on the scene of an overdose, so being able to act as soon as possible greatly improves the patient’s chances of surviving without long-term side-effects or brain damage. And with the number of opiate overdoses rising; having tripled between 1999 and 2006; the need for Naloxone is becoming more and more common [5].

Recently Steps to Recovery helped fund and distribute Narcan to police departments in Bucks County, PA.

Sources:

1. What is Naloxone; Naloxone.org.uk, Scottish Drugs Forum, accessed February 16, 2015

2. Heroin; Get the Facts; DrugWarFacts.org, accessed February 16, 2015

3. Hypoventilation; U.S National Library of Medicine, National Institute of Health, accessed February 16, 2015

4. Recognizing Opioid Overdose; Harm Reduction Coalition, accessed February 16, 2015

5. AMA Adopts New Policies at Annual Meeting; American Medical Association, accessed February 16, 2015

6. Attorny Gen. Holder Gets on Board with Naloxone to Prevent Fatal Overdoses; Meghan Ralston, Huffington Post, accessed February 16, 2015

Image Credit: © Steps to Recovery