Naloxone

• Opioid Overdose – An Overview
  • Common warning signs that someone is misusing prescription opioids and/or using illicit opioids
  • Symptoms of an Overdose
• Naloxone Overview
  • Forms of Naloxone
  • How to Obtain Naloxone

Opioid Overdose – An Overview

In the United States, a person has a greater statistical likelihood of dying from an accidental opioid overdose than in an automobile accident.[1]  In 2022, across the country, over 106,000 people died from drug overdoses.[2]   This is a staggering number from any objective measure.

New Jersey has not been spared.  In 2022, there were 2,892 suspected drug-related deaths in New Jersey according to the Office of the Chief State Medical Examiner.[3]  This number represents a 7.4% decrease from the 3,124 suspected drug deaths in 2021 and, if confirmed, would be the fewest number of fatal overdoses in New Jersey since 2017. So, while overdose deaths continue to climb nationwide, New Jersey appears to be bucking the trend. However, New Jersey still has a long way to go to overcome the opioid crisis.

An overdose can occur when a person misuses prescription medication (e.g., hydrocodone, oxycodone, morphine, codeine) deliberately or accidentally, or uses illicit drugs such as heroin.[4]  Whether they are prescription or illicit, taking opioids in combination with other central nervous system depressants such as alcohol, xylazine, or prescribed medications such as benzodiazepines (e.g., Xanax, Klonopin, Valium) can also lead to respiratory depression and death.[5]

Common warning signs that a person is misusing prescription opioids and/or using illicit opioids:

• Small or pinpoint pupils
• Skin abnormalities such as skin infections, needle marks on the arms or on other parts of the body
• Intravenous (“IV”) paraphernalia, e.g., used syringes, spoons with residue or burn marks
• Empty or missing bottles of prescription opioid drugs
• Abnormal behavior such as drowsiness, change in sleep habits, weight loss, frequent flu-like symptoms, decreased libido, lack of hygiene, loss of interest in normal activities, neglecting work or school, isolation from family and friends, stealing from family members, friends or businesses, and/or new financial difficulties.[6]

Symptoms of an opioid overdose include:

• Slow, shallow, or stopped breathing
• Unconsciousness or unresponsiveness (doesn’t wake up when shaken or called)
• Inability to speak
• Blue or gray lips, gums, or fingertips
• Loud snoring, gurgling or rattling sounds
• Vomiting
• Slow or irregular heartbeat or pulse[7]

The opioid reversal drug naloxone should always be available for emergency situations where an overdose victim has stopped breathing or is in danger of stopping breathing.

Naloxone Overview

Naloxone, an opioid antidote, reverses an opioid overdose by restoring normal respiration to an overdose victim whose breathing has slowed or stopped.[8]  If someone is experiencing a medical emergency other than an opioid overdose—such as a diabetic coma or cardiac arrest—giving them naloxone will generally not have any effect or cause them additional harm.[9]  And naloxone can be given safely to people of all ages, from infants to adolescent to older adults.[10]  Because naloxone is safe and non-addictive, [11] it should be administered whenever an opioid overdose is suspected.[12]

If you think that someone is overdosing on an opioid or another substance, you should:

• Call 911 immediately.
• Give naloxone as quickly as possible, if available. Don’t wait for emergency workers to arrive before giving naloxone.
• Try to keep the person awake and breathing.
• Lay the person on their side to prevent choking.
• Stay with the person until emergency workers arrive.[13]

Naloxone takes 2-5 minutes to take effect.[14]  It may require more than one dose, especially if an overdose involves illicitly manufactured fentanyl. Because the beneficial effects of naloxone usually subside after 30 to 90 minutes, and because there may be side effects and medical complications after an overdose, it is important to have the person checked by a medical professional as soon as possible after receiving naloxone.[15]

Naloxone comes in two FDA-approved forms: an intramuscular injection and a prepackaged nasal spray. No matter which form you use, it is important to receive training on how and when to use naloxone.[15]

• Injectable

The intramuscular injection is frequently used by hospitals and first responders, but may also be used by laypeople with training.  It is a needle that can be injected straight into muscle in the shoulder (like a flu shot) or thigh. For instructions on how to administer injectable naloxone, please visit:  https://prescribetoprevent.org/patient-education/videos/

• Nasal Spray

A mucosal atomizer device (“MAD”) is a prefilled device that sprays medication into the nose.  For instructions on how to administer naloxone intranasally using the MAD device, please visit:  https://prescribetoprevent.org/patient-education/videos/

○     NARCAN® Nasal Spray

NARCAN^® is an FDA-approved ready-to-use nasal spray that contains 4 mg of naloxone HCl.  NARCAN® is available without a prescription (over-the-counter).[16]  The product comes with two spray devices per box.  Visit https://www.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.

○     Kloxxado™ Nasal Spray

Kloxxado™ is an FDA-approved ready-to-use nasal spray that contains 8 mg of naloxone HCl. Kloxxado™ is available by prescription only. The product comes with two spray devices per box.  Visit https://kloxxado.com/ for more information on Kloxxado™, including administration, important safety information, storage information, and the full prescribing information.

How to Obtain Naloxone

New Jersey pharmacies are authorized to dispense naloxone without a prescription pursuant to a standing order from the New Jersey Department of Health.[17]

A limited number of pharmacies are providing naloxone for free, anonymously, without a prescription or appointment, to people 14 years or order.  This initiative is called Naloxone365.  A list of participating pharmacies in Naloxone 365 may be found at: stopoverdoses.nj.gov.

The NJ Department of Human Services, in partnership with the Attorney General’s Office and NJ Department of Health, offers direct shipments of free naloxone online to first responders (such as law enforcement and EMS), harm reduction agencies, county prosecutor’s offices, libraries, shelters, mobile outreach providers, re-entry programs, opioid treatment programs, DMHAS-contracted peer recovery centers, DMHAS-contracted family support programs, and DMHAS-contracted treatment programs.[18]   Agencies who believe they meet the eligibility requirements can obtain more information by emailing:  Naloxone@dhs.nj.gov.[19]

For more information on how and where to receive naloxone and trainings on naloxone, visit:

• NJ CARES Community Resources: https://www.njoag.gov/resources/covid-19-resources/nj-cares-community-resources/
• NJ Department of Heath page on Naloxone: https://www.nj.gov/health/integratedhealth/home/naloxone.shtml
• NJ Division of Mental Health and Addiction page on Naloxone:  https://www.state.nj.us/humanservices/dmhas/initiatives/naloxone.html

[1]              See National Safety Council, “Preventable Deaths, Odds of Dying.” (https://injuryfacts.nsc.org/all-injuries/preventable-death-overview/odds-of-dying/).
[2]              See Centers for Disease Control and Prevention, “Provisional Drug Overdose Death Counts.” (https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm).
[3]              See Office of the Chief State Medical Examiner, “Dashboard.” (https://ocsme.nj.gov/Dashboard).
[4]              See National Institute of Health, NIDA, Prescription Opioid DrugFacts, Jun. 1, 2021 (https://nida.nih.gov/publications/drugfacts/prescription-opioids).
[5]              See National Institute of Health, NIDA, Benzodiazepines and Opioids, Nov. 7, 2022 (https://nida.nih.gov/research-topics/opioids/benzodiazepines-opioids).
[6]              See Johns Hopkins Medicine, “Opioid Use Disorder.” (https://www.hopkinsmedicine.org/health/conditions-and-diseases/opioid-use-disorder).
[7]              See FDA, “Access to Naloxone Can Save a Life During an Opioid Overdose.” Mar. 2023. (https://www.fda.gov/consumers/consumer-updates/access-naloxone-can-save-life-during-opioid-overdose).
[8]              See Michael Hufford, Ph.D, & Donald Burke, M.D., “The Costs of Heroin and Naloxone:  A Tragic Snapshot of the Opioid Crisis.” Stat.  Nov. 8, 2018.  (https://www.statnews.com/2018/11/08/costs-heroin-naloxone-tragic-snapshot-opioid-crisis/).
[9]              See FDA Access to naloxone Ca Save a Life During an Opioid Overdose, Mar. 29, 2023 (https://www.fda.gov/consumers/consumer-updates/access-naloxone-can-save-life-during-opioid-overdose).
[10]             See Centers for Disease Control and Prevention, “5 Things to Know about Naloxone.” (https://www.cdc.gov/drugoverdose/featured-topics/naloxone.html).
[11]             See American Society of Addiction Medicine (ASAM), “Public Statement of the Use of Naloxone for the Prevention of Opioid Overdose Deaths.” (https://downloads.asam.org/sitefinity-production-blobs/docs/default-source/advocacy/public-policy-statement-on-the-use-of-naloxone-for-the-prevention-of-opioid-overdose-deaths-final_a95dd99b-7fb0-4d11-bb05-02d793622053.pdf?sfvrsn=f7c177c2_0).
[12]             See US Dept. of Health & Human Services, “U.S. Surgeon General’s Advisory on Naloxone and Opioid Overdose.” (https://www.hhs.gov/surgeongeneral/reports-and-publications/addiction-and-substance-misuse/advisory-on-naloxone/index.html).
[13]            See Centers for Disease Control and Prevention, “Frequently Asked Questions about Naloxone.” (https://www.cdc.gov/stopoverdose/naloxone/faq.html).
[14]             See SAMHSA Opioid Overdose Prevention Toolkit. (https://store.samhsa.gov/sites/default/files/d7/priv/five-essential-steps-for-first-responders.pdf).
[15]             See id.
[16]             See National Institute of Health, NIDA, “Naloxone Drug Facts, Jan. 11, 2022.” (https://nida.nih.gov/publications/drugfacts/naloxone).
[17]             See FDA News Release, “FDA Approves First Over-the Counter naloxone Nasal Spray.” Mar. 29, 2023 (https://www.fda.gov/news-events/press-announcements/fda-approves-first-over-counter-naloxone-nasal-spray).
[18]             See DOH, “Second Revised Standing Order for Pharmacists to Dispense Opioid Antidote for Overdoes Prevention.” Control No. 2021-01 (2nd rev.) Sept. 7, 2022. (https://www.nj.gov/governor/news/news/562021/docs/DOHSO202101.pdf).
[19]             See Governor’s press release.  “ICYMI:  Murphy Administration Launches Naloxone Distribution Program.” Jul. 28, 2022. (https://www.nj.gov/governor/news/news/562022/20220728a.shtml).
[20]             See DHS press release.  “Murphy Administration Launches Naloxone Distribution Program.” Jul. 28, 2022.  (https://www.state.nj.us/humanservices/news/pressreleases/2022/approved/20220728.html).