Narcan (Naloxone) How Does It Work?

The opioid crisis has become a significant public health concern in the United States, with over 80,000 overdose deaths reported in 2021.

Emergency treatments play a crucial role in combating this crisis, and Narcan (naloxone) has come out as an important tool in addressing opioid overdoses.

To have a better understanding of how Narcan works, we will explore its proper use, its role in emergency overdose treatment, and its potential side effects and risks.

How Does Narcan (Naloxone) Work?

Narcan is an opioid antagonist medication and acts as a temporary antidote for opioid overdose.

During an overdose, there are spots in the brain where opioids latch on and cause problems like slowed breathing and unconsciousness. Narcan comes in contact with the same spots and sticks to them to eliminate the opioid and take its place.

Since the opioid is blocked, the medication can help the person breathe more easily and regain consciousness. It works fast, usually starting within a few minutes, but sometimes an extra dose is needed.

Its effects are temporary, lasting between 30 and 90 minutes. That's why calling for immediate medical help is crucial⁠—the opioid might still be in the body even after Narcan wears off.

When Is Narcan Used?

Narcan is used in emergency situations where someone might be overdosing on opioids. This could include prescription pain medication, heroin, or even fentanyl, a powerful synthetic opioid.

Signs of overdose to watch for include:

• Unconsciousness or someone who can't be woken up
• Slow, shallow, or stopped breathing
• Blue or purple lips and fingernails
• Very small pupils

How Is Narcan Administered?

Narcan is available in several forms, including nasal sprays and intramuscular (IM) or subcutaneous (SubQ) injections. The nasal spray form is popular due to its ease of use and recent OTC approval.

How to Administer Narcan Nasal Spray

To administer Narcan nasal spray:

1. Lay the person on their back.
2. Tilt their head back.
3. Insert the nozzle into one nostril.
4. Press the plunger firmly to release the dose.

Call 911 immediately after administering the first dose and continue administering additional doses every 2 to 3 minutes if needed until emergency personnel arrive.

How to Administer Narcan Subcutaneous Injection

To administer Narcan subcutaneous injection:

1. Remove the cap from the naloxone vial.
2. Draw the naloxone into a syringe.
3. Inject into the muscle of the thigh, upper arm, or buttocks.
4. Call 911 immediately and administer additional doses as needed.

You must call emergency services immediately after administering Narcan, even if the person becomes responsive. Medical professionals need to monitor the person as Narcan's effects are temporary and additional treatment may be necessary.

Narcan is an emergency treatment and not a substitute for comprehensive addiction treatment and prevention efforts.

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Side Effects and Risks of Narcan

Narcan (naloxone) may be a life-saving medication used to reverse opioid overdoses. While it is generally safe and effective, it can have common and rare yet severe side effects, and associated risks.

Common Side Effects of Narcan

The most common side effects of using Narcan manifest among opioid-dependent people. These side effects are often related to opioid withdrawal, such as:

• Body aches, fever, sweating 
• Runny nose, sneezing, yawning
• Nausea, vomiting, diarrhea
• Stomach cramps
• Nervousness, restlessness, irritability
• Increased heart rate and blood pressure
• Tremors, shivering
• Headache
• Muscle or bone pain
• Dizziness, lightheadedness

Severe Side Effects of Narcan

While rare, Narcan can cause severe adverse reactions, including:

• Severe allergic reactions (rare but possible)
• Cardiovascular issues like irregular heartbeat or cardiac arrest (in postoperative patients)
• Pulmonary edema
• Seizures (especially in neonates)
• Hallucinations

Risk Factors of Using Narcan

Risks associated with Narcan use include:

• Sudden and severe opioid withdrawal: This can be particularly dangerous in neonates and opioid-dependent people.
• Temporary effect: Narcan's effects are short-lived (30-90 minutes), while opioids may remain in the system longer. This creates a risk of re-overdose if additional opioids are taken after Narcan wears off.
• Inadequate reversal: In some cases, especially with potent synthetic opioids, a single dose of Narcan may not be sufficient to fully reverse the overdose.
• Complications in patients with pre-existing conditions: People with cardiovascular disorders may be at higher risk of adverse effects when receiving Narcan, especially in postoperative settings.
• Potential for rebound pain: In people using opioids for chronic pain management, Narcan can cause a sudden return of severe pain.
• Risk of injury: The sudden reversal of opioid effects can cause disorientation and agitation, potentially leading to self-harm or aggression towards others.

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Where Can You Obtain Narcan?

Narcan (naloxone) has become increasingly available and accessible in recent years as a critical tool for reversing opioid overdoses. Learn about where you can obtain Narcan and the regulations surrounding its distribution.

You can get Narcan from the following:

• Pharmacies: Narcan is available without a prescription at pharmacies in all 50 states, Washington D.C., and Puerto Rico. Major pharmacy chains like CVS, Walgreens, and Rite Aid carry Narcan.
• Over-the-counter: As of March 29, 2023, the FDA approved Narcan nasal spray for over-the-counter (OTC) sale. This means it will be available on store shelves without needing to ask a pharmacist.
• Community programs: Many states and local health departments offer free Narcan through community distribution programs.
• Online: Some organizations offer free Narcan by mail after completing a brief online training.
• Healthcare providers: Doctors can prescribe Narcan to patients at risk of overdose or their family members.

Laws and Regulations that Make Narcan More Accessible

A wave of laws and regulations are making Narcan more accessible. Most states allow pharmacists to dispense Narcan without a prescription due to "standing order" laws. This means you don't need to see a doctor first.

In many states, family and friends of people at risk can even get Narcan for them through "third-party prescribing" laws. Good Samaritan laws offer peace of mind by protecting those who administer Narcan in good faith during an overdose emergency.

Some states are taking a proactive approach by requiring or recommending healthcare providers prescribe Narcan to high-risk patients.

Looking beyond healthcare settings, some places, like Ontario, Canada, are mandating that high-risk workplaces keep Narcan kits on hand. These legal measures are working together to ensure Narcan is readily available when it's needed most.

Why Does Narcan Matter in High-Risk Places?

Narcan's presence in high-risk environments matters for many reasons. Having it readily available during an overdose can be life-saving due to its ability to rapidly reverse the effects of opioids.

Distributing Narcan in places like emergency departments or areas with high opioid use allows it to reach those most likely to experience or witness an overdose.

This widespread availability also helps reduce the stigma associated with carrying Narcan, providing opportunities to educate people about overdose risks and proper use of the medication.

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