With the opioid crisis still ravaging America, Narcan often crops up in the news but what is Narcan exactly?
Narcan is a brand name for naloxone. This potentially life-saving medication can stop or even reverse the effects of opioid overdose.
A 2017 report by the White House Council of Economic Advisers estimated the cost of the opioid epidemic in the USA at over $500 billion with more than 400,000 deaths attributed to opioids. Those are truly sobering statistics.
It is the first FDA-approved nasal form of naloxone for the treatment of someone who is suspected of overdosing on opioids. Narcan requires no assembly and is sprayed into one nostril while patients lay on their back.
Once Narcan is used on a patient who is going through an opioid overdose, it will reverse the sedative effects of the drug and restore the individual to a natural breathing rhythm.
What Is Narcan?
Narcan, known more generally as naloxone hydrochloride, is a medication designed to arrest and swiftly reverse opioid overdose.
Narcan was the first FDA-approved nasal spray developed off the back of research funded by NIDA back in 2015. By 2019, a generic naloxone nasal spray was also approved by the FDA giving consumers much more choice.
As an opioid antagonist, Narcan binds to opioid receptors in the body and reverses the effects of other opioids.
If someone has overdosed on heroin or prescription opioid painkillers and their breathing has slowed down or stopped completely, Narcan can rapidly restore normal respiration.
Naloxone is now available in 3 FDA-approved formulations including Narcan:
- Nasal Spray
Narcan and Naloxone
Naloxone hydrochloride is an opioid antagonist and a medication that is designed to rapidly reverse and stop the life-threatening effects of an opioid overdose. Narcan is a specific brand of naloxone that comes in the form of a nasal spray. An opioid antagonist means that it will bind to opioid receptors and reverse and block the effects of other opioids. It will quickly restore normal respiration to a person whose breathing rate has slowed or stopped as a result of overdosing on and opioids prescription or heroin. The medicine can also reverse the sedative effects and unconsciousness that are common during opioid overdoses
The medicine has no effect on people who have overdosed on something other than opioid medicines. Common examples of opioids include morphine, codeine, oxycodone, hydrocodone, and more.
Naloxone is an extremely safe medication that only has a noticeable effect on individuals who have opioids in their system. Individuals who are given naloxone should be observed constantly until emergency care services arrive and by medically supervised for at least two hours after the medication is administered.
According to Surgeon General Jerome Adams, naloxone is effective at reversing the effects of an opioid overdose.
“Expanding the awareness and availability of this medication is a key part of the public health response to the opioid epidemic. Naloxone is a safe antidote to a suspected overdose and, when given the time, can save a life.”
It should be noted that there are a number of side effects associated with Narcan and naloxone. Some people will even experience sudden opioid withdrawal symptoms. Some of these symptoms include:
- Body aches
- Increased heart rate
- Runny nose
- Restlessness and more
First Generic Nasal Spray
On April 19, 2019, the FDA approved the first generic naloxone nasal spray to treat opioid overdose.
“In the wake of the opioid crisis, a number of efforts are underway to make this emergency overdose reversal treatment more readily available and more accessible. In addition to this approval of the first generic naloxone nasal spray, moving forward we will prioritize our review of generic drug applications for naloxone,” an FDA statement said.
In the statement, the FDA also expressed its intent to promote competition and reduce drug prices by improving access to safe and effective generic medicines for all types of ailments.
The new FDA generic naloxone nasal spray was developed by Teva Pharmaceuticals and received initial approval in June 2018.
The Growing Demand For Narcan
With the death toll from the opioid crisis mounting over the last decade, more access to the overdose antidote naloxone became a pressing concern.
When used in hospitals, naloxone is normally administered via an IV line or intramuscular shot.
Since the medication can also be absorbed into the bloodstream by nose, some medical technicians started fitting the IV formulation with a makeshift adapter to atomize the naloxone, allowing it to be sprayed into the nose.
From the hospital – where it’s often already too late – to police officers and firefighters, naloxone started to become more widely used.
Since the effects of opioid overdose can kick in so quickly, it makes sense for the antidote to make its way into the hands of first responders.
With this taken care of, the next logical step was to give family and the public at large the chance to carry and administer this highly effective medication. And that’s where Narcan entered the fray.
A seminal 2013 study showed a correlation between improved overdose education and the distribution of nasal naloxone in communities blighted by the opioid epidemic.
Sadly, increased demand for naloxone saw the price ratchet up in the form of the Narcan nasal spray ($150 for a 2-pack) and the Evzio auto-injector (an eye-watering $4500).
Both of these solutions were vigorously criticized for these sky-high list prices. As a result, the generic nasal spray now available steps in to bring the price down.
Most insurance policies will cover naloxone so you should be left to deal with nothing but your copay.
That said, finding naloxone can be challenging so where can you get it?
Identifying an Opioid Overdose Emergency
About every 12 minutes someone overdoses on opioids. These overdoses can happen at any time and can even occur when opioids are used as directed but are especially prevalent when taken at higher doses with other substances.
Overdoses happen when the body has been overloaded with medication or illicit drug. Because they affect the part of the brain that controls breathing, if opioid levels are too high it can cause breathing to slow down to dangerous levels and can even result in death.
Common signs and symptoms of opioid overdose include:
- Unusual sleepiness or unresponsiveness
- Slow breathing
- Slow heartbeat
- Cold or clammy skin
- Tiny pupils
- Blue lips and nails
Some people are at a higher risk than others for opioid overdoses. For example, those taking higher doses or those taking opioids in combination with other medications or alcohol are at a much higher risk of overdose. Others who may also be at higher risk include:
- People with medication conditions like depression or HIV
- Household members of people in possession of opioids
- Those with a history of substance abuse
- People with reduced tolerance following detoxification or incarceration
Overall, anyone who uses opioids for long-term chronic pain, as well as illicit opioids or misuse prescriptions, are at risk for an overdose.
How To Administer Narcan
Narcan was developed to be used at home without the need for medical training. It was made for anyone to use and if you suspect that someone has overdosed on opioids, you may need to administer Narcan. To administer Narcan remove the packaging for the device and hold it with your thumb on the bottom the plunger and two fingers on the nozzle. Then, place and hold the tip of the nozzle in either nostril and press the plunger to release the dose into the patient’s nose. If breathing does not return to normal after two to three minutes, give the person an additional dose of Narcan in the other nostril using a new device.
It should be noted that Narcan is not a substitute for medical care and that you should always call emergency services as soon as possible, even if the person wakes up and becomes conscious again.
CVS Pharmacies has a guide for responding to an overdose with naloxone on its website:
1. Identify The Overdose — Opioids will suppress the body’s breathing. If you notice this, try calling the person’s name or rubbing your knuckles on their chest, if there is no response, the person may be experiencing an overdose.
2. Call 911 — It is important to get professional help as soon as possible. Make sure to call 9-1-1 and give a clear address and location. Tell the operator that the person is unresponsive and not breathing or having difficulty breathing.
3. Give Rescue Breaths — Giving a person who is experiencing an overdose basic CPR can be an effective way to deal with the situation. Be sure that nothing is in the person’s mouth that is blocking breathing, place one hand on the person’s chin and tilt the head back and pinch their nose, administer two slow breaths and look for the person’s chest to rise.
4. Give Naloxone — It is best to follow the specific instructions set out on the form of naloxone that you have. Following administering naloxone, continue to give rescue breaths, one breath every five seconds.
5. Wait For Help — Stay with the person, even if their breathing returns to normal. Wait until paramedics arrive.
Where Can I Get Naloxone?
Not too long ago, naloxone was only available with a doctor’s prescription. However, recently every state in the country has loosened the regulations around naloxone, making it easier to obtain the medicine. In fact, from 2010 to 2014, access to naloxone increased dramatically. Specifically, between those years the number of local sites providing naloxone more than tripled and there were more than 2.5 times the number of overdose reversals reported.
Generally, doctors write blanket prescriptions for pharmacies. By doing this, pharmacies are able to provide Narcan and naloxone to anyone who comes in to ask for it. Similarly, Narcan is covered under most insurance plans. In fact, 97 percent of U.S. insured lives have access to Narcan nasal spray.
Can Narcan Be Abused?
Narcan and naloxone do not have abuse potential and is not addictive. Narcan and naloxone is a life-saving drug. Opioids cause euphoric and sedative highs, if Narcan is used the drug will reverse that high and stop the effects of the opioid drug which, sometimes, will put a person in a state of withdrawal. It is not possible to overdose on Narcan and, again, if someone were to take it with no opioids in their system, it would have no effect at all.
Naloxone is safe, there is no evidence of significant adverse reactions. Administering naloxone may cause withdrawal symptoms if the person is dependent on opioids. These withdrawal problems will be uncomfortable but will not be life-threatening. The benefits of using Narcan or naloxone greatly outweigh the potential consequences.
Side Effects of Narcan
Narcan is extremely safe with a noticeable effect only on someone with opioids in their system.
While naloxone can cause mild withdrawal symptoms, when set against the consequences of an opioid overdose, these symptoms are negligible.
In the worst scenario, using Narcan can cause:
- Changes in blood pressure
Someone who has been using opioids regularly might experience sudden opioid withdrawal symptoms after a spray of Narcan.
These symptoms can include:
- Aching body
- Goose bumps
- High blood pressure
- Increased heart rate
- Nausea and vomiting
- Runny nose
- Stomach cramps
Once you’ve administered Narcan, you should closely observe the person until medical help arrives. Inform medical personnel of the timing of the last dose of Narcan. The person will need to be monitored for at least 2 hours after that.
Remember: Narcan will have no negative effects unless someone has opioids in their system. If you’re at all concerned about the side effects, they are non-issues compared to the real risk of death from opioid overdose.
Can You Abuse Narcan?
A common and perfectly understandable concern about using any drug to treat an opioid-related problem is the issue of abuse potential.
Fortunately, Narcan and naloxone are not addictive and do not have the potential to be abused. If you use Narcan after taking opioids, the euphoric effects of the drug are blocked. Not only is the high reversed, the person is sometimes even thrown into a state of opioid withdrawal. If someone used Narcan with no opioids in their system, there would be no noticeable effect.
Since Narcan has no abuse potential and no significant adverse reactions, the benefits of using this medication vastly outweigh the drawbacks.
Where do we go from here, then?
Narcan is effective. It will quickly restore a person’s breathing to normal and can save their life. Case studies have shown just how effective it can be, a naloxone distribution program in Massachusetts was effective in reducing opioid overdoses by 11 percent.
More broadly, from 1996 to 2014, at least 26,500 opioid overdoses in the United States were reversed using naloxone.
The need for Narcan may be the reason that medicine has been used more frequently over the past few decades. In recent years, the United States has been facing a drug epidemic that has caused some to call for a state of emergency. The drug epidemic, fueled by opioids, has led to the death of tens of thousands of people.
In fact, just in 2017, there were over 70,000 drug overdose deaths in the country. This means that more Americans died in one year due to drugs than during the Vietnam War. This is just one year, if you take a step back and look at overdose deaths over the past 18 years, you will find that more died from the drug epidemic than in World War I, The Vietnam War, and the Korean War combined.
As the opioid crisis has grown, so has Narcan and naloxone administrations. While there is still more work to be done to make this medicine more widely available, it has still helped save the lives of thousands of individuals.
A study found that fatal poisonings, a majority of which were drug overdoses, have increased by nearly 600 percent over the past three decades. In the past few years, federal and state legislators have worked to expand the access to naloxone to first responders including EMTs and police officers.
In fact, a study in one large county found that by giving EMTs access to naloxone would reduce the time of delivery of the medicine by nearly half. This case study found that police officers and firefighters who participated in the naloxone program were associated with reduced overdose deaths.
The Future of Overdose Protection Solutions
The NIDA is continuing to funnel funding into the development of overdose-reversal medications with the potential for longer action. This is especially valuable where powerful synthetic opioids like fentanyl are involved.
Researchers looking into longer-action opioid antagonists are focusing on an intra-nasal version of nalmefene which already comes FDA-approved in injectable form. MCAM (methocinnamox) is another substance showing promise for longer-acting reversal.
NIDA-bankrolled research has shown a wearable device might have promise. This device automatically administers a large dose of naloxone if overdose-induced respiratory failure is detected. This is achieved in line with a smartphone app that shows promise in identifying breathing problems and other factors linked to acute opioid toxicity.
The future is promising for these early warning systems and overdose-reversal agents.
Narcan and naloxone can be effective in treating an overdose but is not approved to treat opioid addiction or dependency. For treatment for opioids, or other substances, it is best to seek out the help of a rehabilitation facility.
Drug and alcohol treatment centers can offer patients access to medically assisted detoxification to help patients safely deal with the side effects and withdrawal symptoms associated with short-term sobriety. Following detoxification, patients will go through individual and group therapy sessions as they learn more about addiction and how to prevent relapses.
Following discharge from a residential facility, many patients choose to continue treatment through an outpatient facility that will help them continue down their individual care path as they adjust to an independent, sober life.
Overall, treatment is an option that should be taken very seriously when you or your loved one suffers from an opioid overdose. Treatment, while not always successful, can help open someone’s eyes to the damage that is being done not only to them but to their entire social network.
Narcan and naloxone can be life-saving medicine, it can be used to reverse an opioid overdose and restore someone’s respiratory problems to normal. While problems can arise following the administration of naloxone, such as the onset of withdrawal symptoms, these are nothing compared to the life-threatening consequences of an overdose. Surviving an overdose can be a traumatic experience and some will look to start living a sober life after this happens. However, many will not know where to begin.
Now that you're probably able to answer the question "what is Narcan?" you may want to learn more about treatment that is available to help your loved one. Landmark Recovery is a drug and alcohol treatment center that is dedicated to helping as many people as possible. If you are interested in learning more about a personalized treatment plan, please visit our website and reach out to our admissions staff today.