According to the National Institute on Drug Abuse, 130 Americans die every single day because they overdosed on opioids. Drug abuse is a national crisis.
It’s also expensive. The economic burden of misusing prescription opioids is $78.5 billion each year.
To combat this growing and alarming issue, Narcan is often administered to people dying of an opiate overdose. It’s been approved by the U.S. Food and Drug Administration (FDA) for treating opiate overdoses since 1971.
But what is Narcan? And how does Narcan work? If you or someone you love has an opioid addiction, it’s important to know about Narcan.
Keep reading to learn everything you need to know about this drug.
What Is Narcan?
Scientists first patented Naloxone in 1961 as a way to treat constipation caused by chronic opioid use. Mozes J. Lewenstein and Jack Fishman patented the process in the United States.
Naloxone is a relative of morphine but it contains almost no painkilling properties. Instead, Naloxone blocks opioid receptors in the central nervous system. Narcan is one of the brand names that contains naloxone hydrochloride.
Used as Emergency Treatment for Opioid Overdoses
Narcan comes in the form of a nasal spray. It’s used as an emergency treatment for known or suspected opioid overdoses.
Since most overdoses occur outside of emergency rooms and hospitals, Narcan was developed to be used by people other than doctors such as:
- First responders
- Family members
No medical training is required to administer Narcan to someone else.
Now Available without a Prescription
In 2016, Adapt Pharma began distributing Narcan nasal spray in 38 states. It was available in these states without a prescription.
Today, Narcan is available in 47 states and only Maine, Nebraska, and Hawaii require someone to obtain a prescription for Narcan. It’s also covered by most insurance plans.
How Narcan Works
How does Narcan work?
It’s the Naloxone contained in Narcan that blocks or reserves the effects opioid medications have on the body. Signs that someone is overdosing on opioids can include:
- Slowed breathing
- Loss of consciousness
- Extreme drowsiness
- Cold and clammy skin
- Tiny pupils
- Blue lips and nails
However, it’s extremely important to note that Narcan is not a substitute for emergency medical care. You should always contact 911 immediately when administering Narcan to someone.
What to Do Before Administering Narcan
If a person isn’t breathing, call 911 immediately. However, if they are breathing, begin by asking if they are okay.
If the person is unresponsive, try shaking their arm gently. If they still do not respond, try rubbing your knuckles up and down their sternum (the bone at the center of their chest.)This won’t harm them in any way, but it is quite painful. The pain should get them to wake up. However, if they still do not respond, then Narcan may be necessary.
Check Their Pulse
Check to make sure the patient still has a pulse. However, if they aren’t breathing regularly or at all, you should perform rescue breathing on them after administering Narcan.
This is important because the brain begins dying after being deprived of oxygen for only a few minutes. Rescue breathing can mean the difference between a patient living and dying.
If performing direct mouth-to-mouth resuscitation on a stranger’s mouth makes you uncomfortable, try using a fabric as a barrier between you two. A material such as the bottom of your shirt can act as a safe pass thru between your mouth and the patient’s mouth.
May Require More Than One Dose
Also, continue keeping a close eye on the patient, even if they wake up. If breathing doesn’t return to normal or the patient begins having difficulties with breathing after two to three minutes, an additional dose of the nasal spray should be administered.
To give a patient another dose, you should use a new device and administer it in the alternate nostril. You can continue to give a patient a new dose in alternating nostrils, until they respond, every two to three minutes until medical help arrives.
Other resuscitative and supportive tactics may also help while waiting for medical assistance to arrive.
How Long It Takes to Work
Every overdose is different. Typically, it takes the nasal spray between three and five minutes to begin working.
Don’t worry if the patient doesn’t immediately respond. The nasal spray is not the fastest or most effective version of Naloxone. The mist has to pass through membranes of the nasal cavity before it can enter the bloodstream.
Slower Can Be Better
Other types, such as intravenous or intramuscular injections, act faster. But Narcan is the easiest version of Naloxone for the public to use.
Also, slower absorption has some positive benefits. Patients aren’t pushed into withdrawal as quickly. Therefore, they can wake up in a slower, more incremental way.
How to Use Narcan
It’s easy to administer Narcan to a patient. Each nasal spray contains enough for one dose. You’ll need to open a new pack every two to three minutes and administer it to the patient if they don’t respond.
Do not test or prime the device before you administer it. Make sure the patient is on their back.
And don’t worry about getting this wrong. The worst thing that could happen in the process is getting the nasal spray on, rather than in, their nose. In fact, there are only three steps to administer Narcan to someone overdosing:
Remove the device by peeling back the package. Place your thumb on the bottom of the plunger to hold the device. Place two fingers on the nozzle.
Place and hold the tip of the nozzle in either nostril. Keep placing the device up to the nostril until your fingers are touching the bottom of the patient’s nose. Place your hand on the back of the patient’s neck so their head can tilt back.
Next, firmly press the plunger which will release the dose into the patient’s nose.
How to Properly Dispose of Used Narcan Nasal Spray
Once the Narcan has been administered, place the used nasal spray back inside its box. Throw away the box in the garbage or trash receptacle.
Keep away from children.
Not Effective for Use Against Overdoses from Non-Opiates
While Narcan temporarily reverses the effects of opioid medicines, it won’t affect anyone not taking opioids.
If you believe someone is experiencing an opioid emergency, you should still give a patient Narcan, even if you’re not sure.
Not doing so, especially if they are having an opioid overdose, can result in severe injuries or death.
Side Effects of Opioid Withdrawal
A patient may experience serious opioid withdrawal symptoms after Narcan has been administered, including:
- Body aches
- Increased heart rate
- Runny nose
- Shivering or trembling
- Increased blood pressure
- Nausea or vomiting
Sudden opioid withdrawal in infants under four weeks old who have been receiving opioids regularly can be life-threatening. Symptoms include:
- Crying more than usual
- Increased reflexes
Infants require treatment right away.
Those at Risk of Overdosing
There are certain groups of people who are more at risk of an opioid overdose, such as:
- Those in possession of opioids (including prescription opioids)
- Those combining opioids with other substances such as sleep medications like Ativan, Xanax, and Valium
- Those combining opioids with alcohol
- Those taking prescription opioids like fentanyl or oxycodone, especially in higher doses
- Those with medical conditions such as HIV, lung/liver disease, and depression
But there are other ways to be at an increased risk. Once a person has detoxed from opioids or has transitioned from use (due to incarceration, for example) there is a heightened risk for opioid overdose with use during relapse.
How to Store and Handle Narcan
Keep and store Narcan nasal spray in the blister and cartons provided by the manufacturer. Do not freeze Narcan and keep away from direct and indirect sunlight.
Store at temperatures between 59°F to 77°F (15°C to 25°C). Narcan does expire so be sure to check the expiration date. Make sure you replace Narcan before the expiration date to ensure maximum effectiveness.
Where to Get Narcan
Thankfully, it’s easy to obtain a Naloxone kit, especially since you do not need a doctor’s prescription in most states to obtain it. Major pharmacies such as Walgreens, CVS, and RiteAid all stock Narcan.
However, pharmacies do not stock Narcan on the shelves like they do Tylenol and Advil. Instead, you’ll have to obtain Narcan directly from the pharmacist.
To avoid any issues, print out a prescription request form to present to your pharmacist. Make sure to tell the pharmacist how many boxes you’d like and how you plan to pay for it.
How to Pay for Narcan
How much does Narcan cost? It depends on whether your insurance company pays for it. Here are some payment options available to help determine the best approach to take in keeping Narcan on hand, just in case.
Fortunately, Narcan nasal spray is extensively covered by both private and public insurance. Most Americans who have insurance have access to Narcan.
Some insurance companies provide Narcan with no co-payment. However, most insurance companies either require a co-payment of $20 or less. Before heading to the pharmacy, it’s best to contact your insurance provider to find out what your co-pay requirements are so there are no surprises at the checkout.
Pay Directly to the Pharmacy
In every state, residents can legally purchase Narcan nasal spray directly from their pharmacist as part of a Statewide Naloxone Standing Order or Collaborative Practice Agreement. If you don’t have insurance, ask them if they have a generic form of Naloxone which costs much less than Narcan.
Some pharmacies also offer a coupon to help people get Narcan for a lower cost. Ask your pharmacy or check online.
Getting Narcan for Free
Do some research ahead of time to see if your local public health organizations or community groups currently have a Narcan program in place. If they do, they may be able to provide you with Narcan free of charge.
Another resource, the National Institute on Drug Abuse, offers information on where to find naloxone for free.
Know Your Risk of Opioid Overdose
If you or a loved one is at risk of an overdose, you may want to discuss potential risks with a trusted healthcare provider. Your ability to be honest and transparent about your level of use and current state of health, as well as pre-existing medical conditions, will be instrumental in getting the help needed.
Opioid abuse is especially concerning to those:
- Pregnant or may become pregnant
- Breastfeeding or plan to
- With heart problems
It’s important to note that Narcan may cause withdrawal symptoms in an unborn child. If Narcan has been administered on a pregnant person, both mother and fetus should get checked out by a healthcare provider immediately. It’s also unknown if Narcan can get passed from mother to child through breastmilk at this time.
Counter indications are also of concern as many people who use opioid medications may also be prescribed other drugs or combine use with other illegal substances and alcohol. This increases the risk for accidental overdose. Alert your healthcare provider about any other medications being taken such as:
- Prescription medications
- Illegal substances
- Over-the-counter medicines
- Herbal supplements
The Good Samaritan Law
Even if you don’t believe you’re at risk for opioid overdose today, or don’t know of anyone in your life at risk, you may still want to carry Narcan with you. You never know when you may need to save a stranger’s life.
If you’re worried about being sued should something go wrong when administering the drug, you’re protected. Most states have a Good Samaritan law on their books which protects people once they administer Naloxone to another person during an overdose emergency.
Create a Calm Environment
It’s not only a good idea for you to stay calm while administering Narcan, but it’s also better for the patient as well. After the Narcan goes to work and the patient “comes to”, they may feel confused, disoriented, and frightened.
Staying calm helps reassure that what he or she is feeling is a natural part of the process. In most cases, the only reason patients react irrationally after Narcan takes effect is when they awaken to a chaotic scene with people yelling at them.
Don’t panic and allow the drug to take effect.
Before You Need Narcan
Preventative measures taken can go a long way to help circumvent an opioid overdose from ever happening. The best thing anyone can do is to never need Narcan. If you recognize that you or someone you love has an opioid addiction, don’t wait to get help.
People from all walks of life become addicted to opiates. Some become addicted due to prescription medications while others become hooked on heroin or developed codependency on suboxone or methadone, common during medication-assisted treatment in addiction recovery.
How you became addicted doesn’t matter. And there’s no shame in asking for help.
The sooner you get help, the easier the process is to get your life back on track.
Taking Control Again
Opioid addiction and other substance abuse is the visible symptom of the root causes for use. While Narcan will block the progression of an overdose averting a fatal end, it doesn’t address the personal and emotional mechanisms that led to the disease.
When you’re ready to uncover the pain, we’re here and ready to design an effective and realistic outpatient treatment program that enhances your life, not impede it.
Ask Continuum Recovery Center about the latest medical technology available to ease the opioid withdrawal process, as well as our progressive suite of therapies that alleviate stress and help put past traumas where they belong – behind you.
Geffen has been in the field for over 20 years, and has worked in every facet of substance abuse treatment. Using his own personal experience in recovery and the education he has learned while in the field, Geffen can relate and connect with clients in a way that promotes recovery, self love and the desire for clients to achieve the best for themselves. Geffen is licensed in Arizona as a substance abuse counselor and has an IC&RC certification, as well as a life coaching certification.