Narcan Uses, Side Effects & Risk Factors

Narcan is a prescription nasal spray that reverses opioid overdoses. It has not been shown to be addictive. However, prescription opioids are classified as Schedule II drugs, which means they are highly addictive.
Evidence Based
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What is Narcan?

Narcan is a nasal spray treatment that reverses opioid overdoses. The name Narcan refers to a specific formulation of the generic drug naloxone, although people commonly call other naloxone drugs “Narcan.” It is an opioid antagonist that binds to, and blocks, opioid receptors in the brain, preventing further effects of an overdose.

Symptoms of an opioid overdose include:

  • Slow or shallow breathing
  • Vomiting
  • Unconsciousness
  • Faint heartbeat
  • Very small (pinpoint) pupils
  • Inability to speak
  • Limp arms and legs
  • Purple lips and fingernails
  • Pale skin

The Food and Drug Administration (FDA) has approved three forms of naloxone: nasal spray (Narcan), injectable, and auto-injectable (Evzio). All three forms are highly effective at reversing an overdose. However, Narcan is easier for families and non-medical personnel to administer compared to injections, making it an ideal overdose treatment.

From 2012 to 2016, the rate of naloxone administrations increased 75.1 percent, which mirrors a 79.7 percent increase in the age-adjusted opioid mortality rate.

Centers for Disease Control and Prevention (CDC)
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How is Narcan Used?

To administer Narcan, lay the patient flat on their back and spray once into their nostril.
Make sure to support their neck and let the head tip back to ensure the drug enters the body. Following dosing, contact emergency medical services (EMS) immediately, as overdoses are life-threatening.

Narcan works immediately to stop an overdose but is only effective for 30 to 90 minutes. If the patient does not respond, or relapses into unresponsiveness, you must administer additional doses. Each nasal spray contains a single dose of naloxone and can only be used once. Therefore, you must use a new spray to give the patient a dose every two to three minutes, alternating nostrils each time.

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Side Effects of Narcan

Narcan was given in a study to healthy adult volunteers to determine its side effects, which include:

  • Headache
  • Nasal dryness
  • Nasal congestion and edema (fluid)
  • Nasal inflammation
  • Increased blood pressure
  • Muscle aches and pains

Other side effects have since been reported in patients after surgery, including:

  • Changes in blood pressure
  • Irregular heartbeat
  • Difficult or labored breathing
  • Pulmonary edema (fluid in the lungs)
  • Heart attack

These side effects occur most often in patients who have cardiovascular disorders or receive other drugs that have similar effects. In addition, excessive doses of Narcan given to these patients eliminated pain relief from opioids.

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Risks of Narcan

A symptom of opioid overdose is respiratory depression or slow and ineffective breathing. After the administration of Narcan, these symptoms should improve. However, due to the duration of action of most opioids, the patient can relapse back into respiratory depression. This process will continue until enough Narcan is given to reverse the overdose.

If someone is physically dependent on opioids, Narcan can induce acute opioid withdrawal. Symptoms of this include:

  • Fever
  • Body aches
  • Tachycardia (fast heartbeat)
  • Nausea/vomiting
  • Abdominal cramps
  • Diarrhea
  • Yawning
  • Restlessness
  • Irritability
  • Nervousness
  • Increased blood pressure
  • Sweating
  • Shivering/trembling
  • Weakness

Narcan is approved for use in infants and children to treat opioid overdoses. The dosing depends on body weight, ranging from 0.005 milligram/kilogram (mg/kg) to 0.01 mg/kg. Unlike adults, Narcan’s action on children may be delayed or unpredictable. As such, children are monitored for at least 24 hours in case a relapse occurs.

In children and infants, Narcan can induce acute opioid withdrawal syndrome, which is described previously in this section. However, this syndrome is life-threatening to neonates (infants less than four weeks old), and symptoms include:

  • Excessive crying
  • Convulsions
  • Hyperactive reflexes

Narcan crosses the placenta, and administration to a mother dependent on opioids may result in withdrawal in the fetus. This can be life-threatening, and both the mother and fetus should be monitored closely after treatment.

Geriatric patients (ages 65 and older) are more likely to have decreased liver, kidney, and cardiac function. Additionally, they may take more medication or develop other health conditions as a result of increased age. When these patients receive Narcan, it is metabolized differently compared to healthy adults, resulting in more exposure to the drug.

Narcan and Other Drugs

Buprenorphine is a medication that treats opioid use disorder. If someone who uses the drug has an opioid overdose, it will bind to and block the same receptors as Narcan. Buprenorphine also has a longer duration of action and stays on receptors longer, stopping Narcan’s effects. As a result, treatment may need to be repeated multiple times to reverse the overdose.

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Narcan and Addiction

Narcan has not been shown to be addictive. However, prescription opioids are classified as Schedule II drugs by the Drug Enforcement Administration. These are defined as, “drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence.” Along with this, they are considered highly dangerous.

Heroin is an illicit opioid classified as a Schedule I drug, with no currently accepted medical use and a high potential for abuse.

Addiction is characterized by a set of behaviors surrounding drug use. Someone who is addicted to opioids might be unable to stop using them, may continue to do so despite knowing it is harmful and may have cravings when not taking them.

Signs of opioid addiction and abuse include:

  • Drowsiness
  • Changes in sleep patterns
  • Frequent flu-like symptoms
  • Changes in exercise habits
  • Money problems
  • Lack of hygiene
  • Weight loss
  • Decreased libido
  • Isolation from family or friends
  • Stealing from family, friends, or businesses
  • Associating with people who encourage addiction
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Addiction Treatment Options

Narcan is a life-saving drug that stops an overdose in its tracks, allowing the recipient the chance to overcome their addiction. There are a wide variety of programs to treat opioid addiction and abuse.

Medication-assisted treatment (MAT) combines drugs such as buprenorphine, naltrexone, and methadone with therapy to provide a “whole patient” approach.

Different programs and counseling options help facilitate lifestyle changes and thoughts around drug use. Options include:

  • Individual counseling— one-on-one sessions focused on goal setting and discussions on recovery and progress. It can include specific types of therapy, including:
  • Group counseling— classes that encourage conversation and allow you to learn from one another. Often group members share the same experiences, which can help you feel that you are not alone.
  • Family counseling— includes spouses, partners, and other family members that help repair and improve family relationships.

Overcoming an opioid addiction is difficult to do alone. Find treatment today.


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Resources

Cash, Rebecca E., Kinsman, Jeremiah, Crowe, Remle P., Rivard, Madison K., Faul, Mark, Panchal, Ashish R. “Naloxone Administration Frequency During Emergency Medical Service Events — United States, 2012-2016.” Morbidity and Mortality Weekly Report, US Department of Health and Human Services/Centers for Disease Control and Prevention, Aug. 2018, https://www.cdc.gov/mmwr/volumes/67/wr/pdfs/mm6731a2-H.pdf

Centers for Disease Control and Prevention. “2018 Annual Surveillance Report of Drug-Related Risks and Outcomes.” CDC, Aug. 2018, https://www.cdc.gov/drugoverdose/pdf/pubs/2018-cdc-drug-surveillance-report.pdf

Centers for Disease Control and Prevention. “Using Naloxone to Reverse Opioid Overdose in the Workplace: Information for Employers and Workers.” CDC, Oct. 2018, https://www.cdc.gov/niosh/docs/2019-101/pdfs/2019-101.pdf

Drug Enforcement Administration. “Drug Scheduling.” DEA, https://www.dea.gov/drug-scheduling

Food and Drug Administration. “NARCAN (naloxone hydrochloride).” FDA, Nov. 2015, https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/208411lbl.pdf

Johns Hopkins Medicine. “Signs of Opioid Abuse.” Johns Hopkins Medicine, https://www.hopkinsmedicine.org/opioids/signs-of-opioid-abuse.html

MedlinePlus. “Opioid Misuse and Addiction Treatment.” MedlinePlus, Aug. 2018, https://medlineplus.gov/opioidmisuseandaddictiontreatment.html

National Institute on Drug Abuse. “Effective Treatments for Opioid Addiction.” NIDA, Nov. 2016, https://www.drugabuse.gov/publications/effective-treatments-opioid-addiction/effective-treatments-opioid-addiction

National Institute on Drug Abuse. “Naloxone.” NIDA, Sept. 2019, https://www.drugabuse.gov/publications/drugfacts/naloxone

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Updated on: July 17, 2020
Author
Addiction Group Staff
About
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Medically Reviewed: March 21, 2020
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Annamarie Coy,
BA, CADACII/ICADC, ICPR, MATS
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