Naloxone, also called narcan, is a medicine that can temporarily reverse opioid overdoses. That means it can stop an overdose long enough for the person having it to get medical help.
How does naloxone work?
Opioids, like heroin, fentanyl, and oxycodone, affect a part of the brain that regulates breathing. When someone has an opioid overdose, opioids flood the receptors in their brain, which makes the brain stop sending those signals. This is what causes someone having an opioid overdose to stop breathing.
Naloxone is a kind of drug called an opioid antagonist. During an overdose, it knocks the opioids off of the receptors in the brain, and binds itself to those receptors instead. This reverses the effects of the opioids on the body, and allows the person overdosing to breathe normally again for 30-120 minutes. That means that someone who has overdosed and been given this medicine has time to get emergency medical care at a hospital, clinic, or intervention site.
Naloxone is not a cure for overdose. Someone who has overdosed and been given naloxone still has a potentially lethal amount of opioids, or a combination of opioids and other drugs, in their body. They will still need medical help to treat their overdose.
Is it safe?
Naloxone is non-addictive and safe even at multiple doses. In fact, if one dose doesn’t take effect right away, it’s recommended to give a second dose!
Narcan is also safe to give someone who isn’t overdosing, and it doesn’t make you feel intoxicated when taken.
In some cases, naloxone can cause someone to have withdrawal symptoms, including:
- Muscle cramps
- Stomach cramps
- Fever
- Nausea and vomiting
- Diarrhea
- Increased heart rate
- Sweating
These symptoms can be very uncomfortable, but they aren’t life-threatening, and will go away on their own once the drugs wear off.
When and how to use naloxone
If you think someone might be having an opioid overdose, you can check for these common signs:
- Slow, shallow, or gasping breathing, or not breathing at all
- Pale or ashen lips and fingertips, for someone with dark skin
- Blue lips or fingertips, for someone with light skin
- The person is unconscious and doesn’t respond to their name
- When you rub their breastbone with your knuckles, they don’t react
If they’re not breathing and not responsive, you can give them naloxone. While it’s not harmful to give to someone when they aren’t overdosing, it can ruin their high and make them irritated!
Before giving someone naloxone, call 911 first. That way, an ambulance will be on the way while you administer it. If there are other people around, you can ask someone else to call 911 while you give the naloxone. Next, put on gloves to protect yourself and the person OD’ing. Most naloxone kits come with gloves, antibacterial wipes, and a nasal spray or a syringe.
- For injectible naloxone, you’ll need to open the syringe package, remove the needle cap, and fill the syringe using the vial or ampule of naloxone that came with it in the kit. Once the fluid is in the syringe, press the plunger a little bit to release any extra air bubbles. Hold the syringe at a 90 degree angle to the person’s skin and insert it directly into a large muscle, like the upper arm, thigh, or butt, and press the plunger all the way down. Put the syringe and ampule in a rigid container, a sharps box, or ask the paramedics to dispose of them for you when the ambulance arrives.
- For the nasal spray, simply remove the cap, insert the nasal spray device into the unconscious person’s nostril, and press down on the plunger to release the naloxone spray. These nasal sprays can be sensitive, so be sure not to release it until it’s in the person’s nose!
Once you’ve given someone naloxone, you can do CPR or “rescue breathing” to help them breathe until it takes effect. If it doesn’t take effect after about a minute, give them another dose and continue CPR until help arrives.
It’s important to know how to use naloxone when you’re giving it to someone. You can read more about it and watch a video tutorial here. But, doing a naloxone training is one of the best ways to make sure you’re prepared! Our parent organization, ACCM, holds trainings at least twice a year. You can also find free training sessions at Spectre de Rue and other harm reduction organizations.
Getting naloxone in Montreal
There are lots of ways to get naloxone in Montreal. And, it’s usually free!
One of the easiest ways is to get it from a pharmacy. Almost all pharmacies in Montreal carry naloxone kits, which are free upon request. The pharmacist might ask you a few questions to make sure you know how to use it, or give you a quick demonstration before giving it to you.
Another way to get naloxone is from a harm reduction organization. These include drug checking sites, as well as SextEd’s parent organization, ACCM! ACCM has free kits available during drop-in hours, or at harm reduction kiosks, which you can find at many local queer community and nightlife events.
Carrying and storing naloxone
Usually, naloxone comes in a case, to protect the containers inside. In Montreal, these cases are often black, rectangular, and close with a zipper. They might also include things like sanitary wipes, gloves, and other protective equipment. You can store a kit in your bag, backpack, or coat pocket — anywhere you have easy access to it!
Naloxone works best when stored at room temperature. Exposure to very cold or hot temperatures can make it less effective. It also has a low freezing point, which means it freezes very easily in cold weather! If you’re carrying naloxone in the winter, it can help to carry it inside your coat, or in a pocket close to your body.
Does naloxone work for non-opioid overdoses?
No. Naloxone only works on opioid overdoses. That means it works on heroin, fentanyl, morphine, coedine, oxycodone and hydrocodone. It does not work on overdoses caused by stimulants, like cocaine or meth. It also doesn’t work on overdoses caused by other types of drugs.
Can I use naloxone that’s expired?
It’s not dangerous to use expired naloxone during an overdose. However, it becomes much less effective when it’s expired. If someone is having an overdose, and your only available naloxone kit is expired, you can still use it. But it won’t work as well or as quickly as it would if it wasn’t expired.
