Naloxone is a short-acting opioid antagonist that is used for the treatment or reversal of opioid overdose. It has a long clinical history of successful use and has a critical role in harm reduction strategies for the opioid crisis. Naloxone is on the WHO Model List of Essential Medicines and should be available in all health-care facilities that may be called upon to respond to an opioid overdose.
For more information: Opioid Crisis Management: Foundation Roadmap
We are interested in generating some discussion on this topic in our Opioid Crisis Management Community. Please visit this space to join the conversation.
Naloxone is a drug that can be used to counteract the effects of a drug overdose. Naloxone binds very tightly to opioid receptors, replacing other opioids that may be there and blocking other opioids from binding. Specifically, naloxone is used to counteract life-threatening depression of the respiratory system and the central nervous system, induced by opioid overdose, allowing an overdose victim to breathe normally and prevent overdose-related death. The medication has no effect if opioids are absent and naloxone has no potential for abuse.
Upon injection, naloxone may induce withdrawal symptoms independent opioid users under the influence. These symptoms are, however, short-lived and significant adverse effects of naloxone are extremely rare.
Naloxone Use and Training
Although traditionally administered by emergency response personnel, naloxone can be administered by minimally trained laypeople, which makes it ideal for treating overdose for individuals who use prescription or illicit opioids.
The ideal dose of naloxone is one that improves respiration without inducing opioid withdrawal. Training should cover dosing management as the initial dose may sometimes need to be repeated. Upon administration, the effects of naloxone last for 30-90 minutes, which, in most cases is sufficient to prevent death. Naloxone may be injected into the muscle, vein or under the skin, or it can be administered as a spray into the nose using an atomizer.
Laws responsible for the availability of naloxone throughout communities vary from country to country. In the US, Law is at least partially responsible for a lack of access. State practice laws generally prohibit the prescription of medications to a person other than the one to whom they will be administered (a process referred to as third-party prescription) or to a person with whom the prescriber does not have a prescriber-patient relationship (a process referred to as prescription via standing order). Additionally, some medical professionals are wary of prescribing or dispensing naloxone because of liability fears, despite the fact that there is rarely a legal basis for such concerns. Compounding the problem, people who witness an overdose may be afraid to call for help for fear of being prosecuted for possession of illegal drugs, drug paraphernalia, or other crimes.
In March 2016, the government of Canada changed the prescription status of naloxone to increase public access. Instead of requiring a prescription for each individual in need of naloxone, pharmacies are now able to proactively give out naloxone to those who might experience or witness an opioid overdose. Additionally, switching naloxone to non-prescription enabled emergency responders to administer naloxone without having to wait for a prescription to be ordered for each individual in need.
In Europe, take-home naloxone initiatives currently operate at city level in Denmark, Germany, Estonia, Ireland, Italy, the UK (England) and Norway, and at regional level in Spain (Catalonia) and the UK (Scotland and Wales). A number of other EU countries are also exploring the practice and considering adding take-home naloxone to the existing range of interventions to prevent drug-related deaths.
While not all opioid overdoses are fatal, the provision of naloxone by laypeople to an overdosing person who would otherwise not receive medical intervention saves hundreds of lives each year. Additionally, timely provision of naloxone may help reduce some of the morbidities (i.e. medical complications or conditions) associated with non-fatal overdose. Because opioid overdose often occurs when the victim is with friends or family members, those people are often the best situated to act to save his or her life by administering naloxone. Unfortunately, in many cases, neither the victim nor his or her companions have the medication on hand.
Generally speaking, access to Naloxone can be expanded through:
- Distribution through local, community-based organizations
- Access and use by law enforcement officials
- Standing orders at pharmacies in eligible countries
- Training on how to administer the drug for basic emergency medical service staff.
- The Opioid Crisis: What is it?
- The Opioid Crisis: Preventing Overdose
- The Opioid Crisis: Harm Reduction Strategies
- The Opioid Crisis: Treating Addiction
- Open Data Repository: the Opioid Crisis
- Opioid overdose: preventing and reducing opioid overdose mortality
- Legal Interventions to Reduce Overdose Mortality: Naloxone Access and Overdose Good Samaritan Laws
- Reverse Overdose to Prevent Death
- Guide to Developing and Managing Overdose Prevention and Take-Home Naloxone Projects
- FAQs: Access to naloxone in Canada
- New EMCDDA insights into naloxone, the overdose antidote that can help save lives
- What is the Opioid Crisis?