Naloxone

NALOXONE

• Opioid overview
• Naloxone – Read about naloxone, the opioid overdose reversal drug, find Naloxone administration training videos, and learn about possible side effects
• How to Purchase Naloxone
• Cost
• Naloxone Training Available Statewide
• Learn about the 911 Good Samaritan Law

Opioid Overview – general information; signs of overdose:

A significant increase in the late 1990’s in the number of individuals receiving opioid prescriptions, a surge in availability of illicit, highly potent synthetic opioids and the fact that some illicit drugs are laced with fentanyl, have all resulted in a sharp increase in overdose deaths. The availability of naloxone to patients using or abusing opioid prescriptions for pain, to people with an opioid use disorder, and to friends and family of those with an opioid use disorder or using illicit drugs, is critical. The Surgeon General advises that knowing how to use naloxone and having it within reach can save a person’s life. If you or someone you care about is at risk of experiencing an opioid overdose, it is vital that you talk to your doctor or pharmacist about obtaining the opioid reversal drug naloxone.

Common opioids include prescription pain medicines such as hydrocodone, oxycodone, morphine, codeine and fentanyl, as well as the illegal drug heroin. An overdose can happen when a person uses illicit drugs such as heroin, which may also be mixed with extremely potent opioids such as fentanyl. An overdose can also occur when a person misuses a prescription, either deliberately, due to an error by a physician or pharmacist, or due to a patient misunderstanding the directions for use. It can occur when an individual takes opioids in combination with other prescribed medications, including benzodiazepines such as Xanax, Klonopin, Valium or other medications, or when an individual takes opioids with illicit drugs or alcohol; these combinations may cause respiratory depression and death. Serious warning signs can alert you that a friend or loved one is misusing or abusing opioids.

Warning signs that someone may be experiencing or at-risk of an overdose:

Common warning signs that someone is abusing opioids include: small or pinpoint pupils, nodding out or sleeping at odd times, needle marks on the arms or elsewhere, IV paraphernalia (used syringes, spoons with residue or burn marks), empty or missing bottles for prescription opioid drugs, and behavioral signs such as loss of interest in normal activities, neglecting work or school, and avoiding family and friends. It is important to have the opioid reversal drug naloxone on hand in case someone you care about is at risk of experiencing an opioid overdose.

Symptoms of an opioid overdose include:

• Slow, shallow, or stopped breathing
• Extreme sleepiness, or unresponsive
• Inability to speak
• Pale, blue or gray skin, lips and/or nail beds
• Loud snoring, gurgling or rattling sounds
• Vomiting
• Slow or no pulse

Below you will find general information about naloxone, how it works, how to use it in case of an opioid overdose emergency, possible side effects, and how to obtain it.

Naloxone

Naloxone (naloxone hydrochloride) is an opioid antagonist medication designed to rapidly counter or reverse the life-threatening effects of an opioid overdose, including depression of the respiratory and central nervous systems.  Naloxone molecules work by binding to opioid receptors in the brain with a greater affinity than opioid molecules, displacing those opioid molecules and reversing the life-threatening effects of an overdose.

Naloxone restores normal respiration to a person whose breathing has slowed or stopped in the event of an opioid overdose. Naloxone is safe and effective for use in an opioid overdose emergency, and is not addictive.  Naloxone only works if a person has opioids in their system, and has no effect if opioids are absent from a person’s system. Naloxone takes 2-5 minutes to take effect, and may require more than one dose. It lasts for 30-90 minutes following administration, therefore does not replace the need for emergency medical assistance. Since the effects of naloxone are not long lasting, and there may be side effects and medical complications after an overdose that require medical attention, it is urgent that an individual who experiences an opioid overdose be seen by professional medical personnel as soon as possible after receiving naloxone. Always call 911 as a first step if you think someone is experiencing an opioid overdose, and stay with the victim until emergency medical assistance arrives.  You may administer rescue breathing if necessary while waiting for assistance to arrive.

Forms of Naloxone:

There are four forms of naloxone:

1. Injectable Naloxone:

The intramuscular injection is frequently used by hospitals and first responders, but may also be used by laypeople with training. For instructions on how to administer injectable naloxone, click on the video.

Attach video from prescribe to prevent (video downloads) on intramuscular injection. http://prescribetoprevent.org/patient-education/videos-for-download/

1. Intranasal Use:

The use of a mucosal atomizer device (“MAD”) is also prevalent to deliver naloxone intranasally.^[1] This product requires the assembly of a prefilled syringe of naloxone hydrochloride to a mucosal atomizer device. For instructions on how to administer naloxone intranasally using the MAD device, click on the video below.

Attach video from prescribe to prevent (video downloads) on intranasal naloxone administration using the atomizer.

http://prescribetoprevent.org/patient-education/videos-for-download/

1. Evzio Handheld Auto Injectable: 

The Evzio handheld auto injectable delivers a dose of naloxone into the muscle or under the skin.  It is packaged with two single use injections. See Evzio.com for a complete training video, step by step instructions on how to administer Evzio in an opioid overdose emergency, and important safety and storage information. Or click on the video, below.

Attach video from Prescribe to Prevent (video downloads) on auto injector

http://prescribetoprevent.org/patient-education/videos-for-download/.

 NARCAN®  (or generic naloxone hydrochloride) Nasal Spray (both FDA approved)

NARCAN® is an FDA approved intranasal form of naloxone. A generic naloxone hydrochloride nasal spray was also approved by the FDA in April of 2019. NARCAN®  nasal spray is needle free, and is also packaged with two single use devices. NARCAN®  shipped on or after December 14, 2020 has a 36-month shelf-life.[2] See NARCAN® .com for a complete training video, and step by step instructions on how to administer NARCAN®  in an opioid overdose emergency. Important safety and storage information is also provided.  Click below for the video.

Attach downloadable video from the Press Kit on the Emergent Biosolutions website

Side Effects of Naloxone

Naloxone may cause adverse effects for people with opioids in their system. These are opioid withdrawal symptoms, and may include the following:

• Body aches
• Diarrhea
• Increased heart rate
• Nausea/vomiting
• Stomach cramping
• Shivering/trembling
• Fever
• Runny nose
• Sneezing
• Goosebumps
• Sweating
• Yawning
• Nervousness
• Restlessness/irritability
• Weakness
• Increased blood pressure

There are no harmful effects caused by administering naloxone to someone not taking opioids.

How to Purchase Naloxone

You may obtain a prescription for naloxone from a physician, physician assistant, or advance practice nurse, and have it filled at your local pharmacy, even if you are not the intended user but a third party individual (friend, family member, caregiver, etc.) who may assist someone in an opioid overdose emergency. Many pharmacies dispense naloxone without an individualized prescription, pursuant to a standing order from a physician or the Department of Health. Walgreens, Walmart, CVS, Rite Aid, ShopRite, Costco, Acme, Sav-on, Sam’s Club and Wegmans all have standing orders to dispense naloxone. These pharmacies generally always keep naloxone in stock.  If naloxone is out of stock, it can usually be obtained within one business day.

Find a pharmacy in your area that has a standing order to dispense naloxone.

(Link to standing order pharmacies here)

Cost of Naloxone

Evzio:

For commercially insured patients, there is no out of pocket cost for Evzio. Under the Evzio 2 You program, Evzio provides a free direct delivery service to your home or health care provider’s office. If Evzio is not covered by your insurance, your out of pocket cost will be covered by the manufacturer Kaleo. For Medicare patients, some Medicare Part D plans cover Evzio, but the individual may have out of pocket costs. For questions about eligibility, you may contact 1-855-77-EVZIO, or 1-855-773-8946. Individuals without commercial insurance who have an annual household income lower than $100,000, may receive Evzio at no cost through the Kaleo Cares Patient Assistance Program. For individuals with an income greater than $100,000 per year and no insurance, the cash price of Evzio is $360 for a carton containing two auto injectors and a trainer.

NARCAN® :

NARCAN®  has extensive public and private coverage; approximately 97% of insured lives have access to NARCAN® .

Contact your insurer to find out your coverage and co-pay requirements.   For those who have no insurance, or who choose to pay cash, talk to a pharmacist who can dispense naloxone without a prescription to see if they may offer coupons at the point of purchase which can lower the cash price.

Naloxone Training Available Statewide

[link to narcan training on COVID-19 page]

Call 911 –“The “Good Samaritan” Law

The Overdose Prevention Act or “Good Samaritan” law provides witnesses who seek emergency help in overdose emergencies with immunity from arrest and prosecution. A person who in good faith seeks medical assistance (calling 911) for someone experiencing an overdose may not be arrested, charged, prosecuted or convicted for possession or use of drugs or drug paraphernalia. The person who experiences a drug overdose and is the subject of a request for medical assistance is also provided with immunity from arrest and prosecution.  

If you administer naloxone to someone you believe is having an overdose, you will not be liable.  If you administer naloxone in an emergency when you believe that another person is experiencing an opioid overdose, you will not be subject to any criminal or civil liability. When you obtain naloxone, be sure to review the patient overdose information provided by your pharmacist.

[1] The FDA advises that “naloxone levels following off-label use by the intranasal route are lower than by the approved routes of administration.” (FDA Advisory Committee on the Most Appropriate Dose or Doses of Naloxone to Reverse the Effects of Life-Threatening Opioid Overdose in the Community Settings 2016)

[2] Individuals should follow the expiration date on their existing boxes if they currently have Narcan released prior to December 14, 2020.