Narcan Nasal Spray for Opiate Overdose Reversal

First developed in the 1960s, Narcan nasal spray grew in popularity rapidly, receiving FDA approval for opiate reversal in 1971. In the early 1990s, Narcan was proposed as an opioid overdose antidote, based upon the favorable effects it had on hospitalized opiate reversals. By the later 1990s, the Narcan drug was being used throughout the United States, on the general public as a life-saving drug.

What is Narcan?

What is Narcan really? Narcan, also known as naloxone, is a medication administered to aid in the treatment of opioid overdose patients. Narcan uses are attributed to its prescription in conjunction with an opioid prescription, where it helps prevent abuse of the drug.

It generally works to block opioids from attaching to the receptors responsible for pleasure and reward in the brain. But narcan can also cause already attached opioids to release from receptors in the brain, thus “reversing” the effects of the drug.

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Narcan FDA Approval

When was narcan FDA approved officially? Nasal narcan spray was approved by the FDA in November of 2015. Narcan FDA approval was first established for hospitalized medical use first in the 1970s. Afterward, in the 1990s, Narcan received FDA approval for use in the general public, as a life-saving opioid overdose reversal treatment. At this time, Narcan was largely administered to patients in the form of an injection. But, it was not until deaths related to opioid overdose spiked in 2013, that the drug was considered for further certifications, in order to expedite its reversal effects. And in 2015, the FDA finally gave narcan nasal spray the full go-ahead, to be administered instead of injection, upon interaction with an opioid overdose site.

How Does Narcan Work?

How does Narcan work for opioid users now then? What is Narcan used for today? First, it is important to note that opioids are a drug intended to reduce the feelings of pain in the human body. They work well, but people can become addicted to the drug for the release it provides them with. Opioids can be too good at their job.

So, the Narcan uses, or naloxone, is designed to reverse an opioid overdose, or work in conjunction with an opioid prescription, to help try and avoid dependence. It works to restore the normal breathing pattern in a patient, as it blocks the receptors in the brain from the opioids’ effect. Narcan only works to reverse the effects of opioids. So, opioids must be in the individual’s system to work. Narcan does not work on other types of drugs.

Narcan Dose Information

A narcan dose can vary depending upon the route, or form, of which it is administered. Typically, the narcan half-life extends to about an hour, of course depending on person, doseage, and route administered.

Sometimes, a patient will need a second, higher dose of the drug, but this is also dependent on the form in which it is given as well. Typical routes for narcan administration are injection, or nasal spray. Typically, a narcan dose is started at 2 mg or 0.4 mg / ml and increased by 2 mg for recurring administrations. But, this too may vary.

Narcan Dose by Route:

  • Narcan Nasal Spray:
    • 4 mg of naloxone hydrochloride in 0.1 mL
    • Multiple doses can be given (with each spray being of a higher dosage) if patient does not respond to the spray’s effects, until medical emergency personnel arrive

Administering Narcan

There are specific steps on how to administer Narcan that should be followed, to ensure the best point of care. The staff here at St. John’s Recovery Place, are trained to know these steps in Narcan administration thoroughly, to ensure the best care and safety of clients.

Narcan Administration Steps:

Confirm Opioid Overdose

First, it is very important to confirm that the individual in need of medical attention, is indeed experiencing an opioid overdose. Opioid overdose can be hard to distinguish at times, but there are three main symptoms known as the opioid triad that everyone should be aware of:

  • Respiratory depression (erratic or absence of breathing altogether)
  • Pin-point pupils
  • Unconsciousness or unresponsiveness
  • Blue lips
  • Blue fingertips 
  • Gurgling or rattling snoring like breaths
  • Lack of heartbeat (potentially)

Prepare Narcan Dose

Narcan kits have been developed for distribution, in order to help keep this process organized, easy to work through, and fast. These kits come with instructions for how to administer narcan to a person undergoing opioid overdose. Instructions are available for all methods. 

Injection Into Muscle

  1. Open cap of naloxone vial
  2. Remove cap of needle, insert into vial 
  3. With the vial upside down, pull back the needle’s plunger until 1 ml (1 cc) of naloxone is drawn 
  4. Vials may have either one dose or multi-dose
  5. Kit may also come with auto-injector 
  6. Inject into the muscle of either the upper arms, or thighs

Administer Nasal Spray According to Labeling Instructions

Nasal sprays may also come as part of a narcan kit, and can be administered one of two ways. 

Multi-Step Nasal Spray

  1. Remove caps (yellow) from ends of applicators 
  2. Twist nasal adapter on tip of the applicator until tight 
  3. Remove cap (purple) off naloxone syringe, insert on other side of applicator and twist until tight 
  4. Push half of the naloxone (1 ml / 1 cc) into each nostril
  5. The vial contains 2 ml, so one half is given into one nostril, and the other half in the other nostril

Single-Step Nasal Spray

Peel back the tab with the circle to open, then insert the tip into either nostril and administer the full dose. Only one spray is needed to administer the whole dose

Call 911 for Emergency Assistance

It is very important to note here, the 9-1-1 should always be called when suspecting any kind of overdose, especially an opioid overdose, as they can be life-threatening, even with narcan administration. 9-1-1 should be called immediately after an overdose is suspected. 

Monitor Individual Response

Narcan is normally very quick to act once administered. That however does not mean that all individuals will respond quickly, or to only one dose. Individuals should be monitored, and if breathing or heart rate does not regulate or return, and consciousness is not regained, CPR should be administered, along with following doses of narcan every two to three minutes.

Repeat Narcan Administration if Patient Does Not Improve

  1. As stated above, if an overdose patient does not improve, and they are not breathing, CPR, or rescue breathing, should be administered, along with following doses of narcan (in potentially increasing dosages) every two to three minutes, until medical emergency personnel arrive. 
  2. Try not to leave the individual alone at any time following overdose. If absolutely necessary to leave the individual unattended, place them in the recovery position (on their side, with their top arm and leg crossed over their body)
  3. Rescue breathing = 1 breath every 5 seconds 
  4. Stay with the individual until help arrives 

Who Should Use Narcan?

Professional research has determined that anyone who is at risk of an opioid overdose, should have a take-home naloxone prescription, or narcan kit. Narcan should only be taken by those who are experiencing an opioid overdose

What Drugs Does Narcan Reverse?

The drugs narcan works to reverse the effects of are opioids, and only opioids. Narcan does not work to treat any other type of drug overdose, or general overdose symptoms. Drugs that narcan reverses the effects of include (but are not limited to):

  • Morphine overdose
  • Heroin overdose
  • Fentanyl overdose
  • Dilaudid
  • Oxycodone
  • Codeine
  • Hydrocodone
  • Methadone

Narcan is NOT a Cure!

Narcan Side Effects

Narcan is not a controlled medication or substance. An individual cannot become addicted to Narcan, and it does not have any street value. The most prominent Narcan effect is its ability to reverse opioid overdose symptoms, allowing patients the ability to breathe normally until emergency medical assistance arrives. These are all very good characteristics and facts for the drug, but it should also be noted that although Narcan comes with minimal risks, and that Narcan side effects can occur after overdose.

Narcan Side Effects After Overdose

After administering Narcan, the most severe Narcan effect is that it has the potential to onset opioid withdrawal symptoms within patients who used the drug heavily, or for extended amounts of time. Or rather, Narcan side effects after an overdose, can result in the onset of opioid withdrawal symptoms. Thus, Narcan side effects can include:

  • Body aches
  • Rapid heart rate
  • Diarrhea
  • Nausea
  • Vomiting
  • High blood pressure 
  • Shivering 
  • Anxiety 
  • Intense drug craving
  • Irritability
  • Restlessness
  • Nervousness
  • Dizziness
  • Chills
  • Slight fever
  • Stomach pain
  • Aggression

Rarer, more severe side effects Narcan can bring on (also associated with opioid withdrawal) are:

Typically, these types of symptoms only occur with higher doses of Narcan. The higher the dose of Narcan, the higher the risk for the individual experiencing opioid withdrawal symptoms after administration. 

Narcan Contraindications

Research shows that there are currently no absolute narcan contraindications in the event of an emergency. The only known relative contraindications for narcan, is the result of hypersensitivity in patients to naloxone itself.

Can you Overdose on Narcan?

Narcan is used to reverse the side effects of opioid overdose. It itself is not a controlled substance, and is considered to be non-addictive. Therefore, although narcan is used to help treat an overdose, it is not possible to overdose, as a result of taking “too much” narcan. Although, taking increased amounts of narcan can result in the onset of acute opioid withdrawal symptoms, following use. 

Narcan Statistics

Narcan statistics show that in 2018, the United States as a whole, reported 67, 367 overdose-related deaths – which was 4.1% fewer nationally recorded deaths than in 2017. Of these deaths, opioids were cited to have been the cause of 70%, or 46, 802, of those recorded endings. Narcan facts also noted in the year 2018, the state of Florida was recorded as having the highest national average for opioid prescriptions, at a rate of 53.7 prescriptions per 100 people. Access to Narcan, or naloxone, has helped reduce the number of opioid-related deaths in Florida though. 

Narcan Facts

  • August of 2016, the Florida Department of Children and Families, introduced the opioid overdose prevention program, statewide
  • 40,000 Narcan kits distributed to over 76 providers, enrolled in the program 
  • Each Narcan kits includes two doses of nasal spray
  • 3,100 individuals trained to recognize opioid overdose statewide
  • In November 2018, the Department launches the Opioid Overdose Prevention Awareness Campaign
  • 2018 also saw the opening of 52 Opioid Treatment Programs statewide 

Narcan Treatment & Your Recovery

Opioid addiction is a very serious matter, that many struggle to live with every day. Narcan is a life-saving drug, used to reverse the effects of an opioid overdose. Intranasal Narcan and Narcan injections can be used in the event of an emergency, with few Narcan contraindications occurring. At St. John’s Recovery Place, our staff are trained to administer Narcan with the utmost concern for professionalism and client safety however it is important to understand that Narcan nasal spray is not a cure for opioid addiction, and should not be relied upon heavily to save anyone’s life. While it can help, we recommend seeking treatment for opioid addiction if you, or someone you love, is struggling. Call our admissions team at 833-397-3422 to learn more about Narcan for opioid overdose and the various opioid rehab options available at SJRP.