Naloxone

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Naloxone, also known by the brand name Narcan©, is a safe medication that temporarily reverses the effects of an opioid overdose. Opioids include drugs like heroin, fentanyl, morphine, methadone, codeine, oxycodone, and carfentanil. Naloxone knocks the opioid off of the brain’s opioid receptors and takes its place, temporarily. Naloxone only works on opioid overdoses.

Responding to an Opioid Overdose
 
What are the signs and symptoms of an opioid overdose?
The main signs and symptoms of an opioid overdose include:
  • Person can’t be woken up
  • Breathing is slow or has stopped
  • Snoring or gurgling sounds
  • Fingernails and lips turn blue or purple
  • Pupils are tiny or eyes are rolled back
  • Body is limp
Can an overdose happen to someone who has been using opioids for a long time?
Overdose can happen to anyone. Overdose can happen in some of these situations:
  • Tolerance is low (has not used in a while or are new to using)
  • Illness, dehydration, liver problems, or being tired or run down
  • Drugs are mixed with other prescription or non-prescription drugs, or alcohol
  • The drug is stronger than usual (different supplier, dealer, town)
  • The drug was cut or laced with another substance
What are the steps to responding to an opioid overdose?

There are five key steps to responding to an opioid overdose. These include:

  1. Stimulate with touch and sound
  2. Call 9-1-1
  3. Administer naloxone
  4. Perform rescue breathing and/or chest compressions
  5. Check, is it working?

The five steps to responding to an opioid overdose is available as a printable poster.

Who is qualified to administer naloxone?
Anyone can administer naloxone. A short training is offered the first time naloxone is obtained at an agency. Refresher training can be requested as needed, and questions can be answered when getting more kits.
How should someone respond to an opioid overdose if they do not have naloxone?
Call 9-1-1 immediately and begin rescue breathing and chest compressions. Opioid overdose can result in death because the overdose causes the individual to stop breathing.  Rescue breathing can keep an individual alive until an emergency medical service (EMS) arrives.
How long does it take for naloxone to start working? How long does naloxone last?
Naloxone usually starts to work in less than 5 minutes (usually 2-3 minutes). If an individual does not respond to an initial dose of naloxone they may require additional doses. Naloxone is temporary and usually lasts between 30-45 minutes.
Why might someone not regain consciousness or respond to naloxone after it has been administered?
Individuals might not respond to naloxone for a variety of reasons. These include:
  • Individual has overdosed from the use of a non-opioid
  • More doses of naloxone are needed
  • Individual may have a medical condition that has caused them to lose consciousness
What should I do after I use naloxone in an emergency situation?
Check in with a family member and/or co-worker to talk about what happened. Self-care is important! Report the overdose at a local agency or pharmacy that distributes naloxone, and pick up a new kit.
Naloxone Safety
 
Does naloxone enable or encourage people to use drugs? Can naloxone be abused?

Naloxone does not lead to increased drug use. Some studies have shown that naloxone results in decreased use of opioids. Naloxone is a non-psychoactive drug. Individuals cannot abuse or get high from naloxone use.

Is naloxone harmful? Are there risks associated with naloxone use?

Naloxone is safe to use. Giving naloxone to someone who is a child, is pregnant, has a medical condition, or has not taken opioids will not harm them.

Does naloxone make people violent and angry?

Naloxone does not directly make people violent or angry. Naloxone does temporarily reverse the effects of the opioid which can cause an individual to experience opioid withdrawal symptoms, leading to pain, distress and/or agitation.

Can I give more than one dose of naloxone?

Yes, more than one dose of naloxone can be given, and sometimes more than one dose is needed. You cannot overdose on naloxone.

If I administer naloxone and something goes wrong or the person dies from drug overdose, can I be held liable?

The Good Samaritan Act protects people who take action to help someone who is in a dangerous or life-threatening situation. If an adult is conscious and refuses your help, call 9-1-1 and stay close in case they lose consciousness. When someone is unconscious you have implied consent to take life-saving measures.

What is the Good Samaritan Drug Overdose Act? Who does it protect?

The Good Samaritan Drug Overdose Act, 2017 provides legal protection from charges for people involved with, or experiencing, an overdose if 9-1-1 is called. An example of this is protection from simple possession drug charges.

Naloxone Training and Kit Distribution
 
Who can be trained to administer naloxone? What type of training is involved?

Persons providing naloxone should have the training necessary to recognize the signs of an opioid overdose, and understand what steps to take.

It is recommended that these individuals have training in first aid, including cardio pulmonary resuscitation (CPR).

Training in how to respond to a potentially violent person is also necessary. Be aware that naloxone can temporarily reverse the effects of the opioid. The person given naloxone may experience acute opioid withdrawal, leading to pain, distress, and agitation.

How is naloxone administered?

Naloxone comes in two forms in Ontario; an injectable form and a nasal spray. Both types of naloxone are safe and effective in temporarily reversing an opioid overdose. Pharmacies, the Health Unit, and ACNBA distribute both the injectable and nasal spray form of naloxone. Other agencies in the Nipissing and Parry Sound districts offer the nasal spray form of naloxone.

What is included in a naloxone kit?
Each nasal spray naloxone kit includes:
  • 1 hard case
  • 2 doses of naloxone nasal spray (4 mg/0.1ml)
  • 1 one-way breathing barrier
  • 1 pair of non-latex gloves
  • 1 card that identifies the person trained to give the naloxone
  • 1 insert with instructions (English and French)

Each injectable naloxone kit includes:

  • 1 hard case
  • 2 (0.4 mg/1 ml) vials or ampoules (a small glass container) of naloxone
  • 2 safety-engineered syringes with 25g, 1” needles attached
  • 2 alcohol swabs
  • 2 devices (known as “breakers,” “snappers,” or “openers”) for opening ampoules safely
  • 1 one-way breathing barrier
  • 1 pair of non-latex gloves
  • 1 card that identifies the person who is trained to give the naloxone
  • 1 insert with instructions (English and French)
Where can I pick up a naloxone kit in my community?

Individuals who are at risk of an opioid overdose and friends or family members of people who use substances can pick up a naloxone kit at any local eligible agency.

Anyone can request a naloxone kit from a participating pharmacy and some Pharmacists may use professional judgment regarding eligibility to receive a kit.

Use the locator map to identify what local organizations and pharmacies in your area currently distribute naloxone. You can also call 1-866-532-3161 Monday to Friday 8:30 am to 5:00 pm to ask about naloxone distributors in your area.

What type of information do I need to provide if I am picking up a naloxone kit? Do I need a prescription for naloxone?

The type of information that you will need provide depends on where you pick up a naloxone kit.

A prescription is no longer needed to obtain naloxone. Participating pharmacies require individuals to provide an Ontario Health Card. This allows pharmacies to seek reimbursement from the Ministry of Health for some of the costs related to offering naloxone kits.

Other places that offer naloxone collect and securely store a name and contact information so that they can be notified if the product they received is subject to a recall.

Caring for Your Naloxone Kit
 
How long is naloxone effective for? Can I use expired naloxone if someone is having an opioid overdose?
Naloxone has a shelf-life of between 18 and 24 months. If only expired naloxone is available, it is okay to use it, but expired medication might not be as effective.  
My naloxone kits have expired. How do I dispose of them properly?

Simply scratch out the expiry date on the naloxone package with a permanent marker. Bring the dose(s) to a local pharmacy for disposal.

Please refer to this fact sheet should you have any additional questions about expired naloxone.

Where should I store my naloxone kit?
Naloxone nasal spray should be stored at room temperature, 15°C to 25°C, and injectable naloxone should be stored at 15°C to 30°C. Do not store naloxone in your vehicle as it may overheat or freeze. Naloxone that has been exposed to extreme heat or cold should be replaced. Keep naloxone away from direct light and tell others where you store your naloxone.

For more information, click the following links:

 

 

North Bay

345 Oak Street West
705-474-1400

Parry Sound

70 Joseph Street Unit #302
705-746-5801

Burk's Falls

17 Copeland Street (by appointment only)
1-800-563-2808