Narcan: Use for Opioid Overdose | How Does Narcan Work to Prevent Overdose?

Narcan can rapidly save a person’s life during an opioid overdose. This important medication is a key and sometimes controversial tool in combating the opioid epidemic.

Narcan is a medication widely used to combat opioid overdoses. 2017 data from the CDC on overdose deaths is sobering, revealing that:

There were 70,237 drug overdose deaths in the U.S. in 2017
That means that 19.8 per 100,000 Americans died of a drug overdose in 2017
That is a 9.6% increase from 2016
67.8% of all drug overdose deaths are from opioids, which adds up to 47,600 opioid overdose deaths

These deaths are largely preventable, whether through drug addiction treatment and recovery or through life-saving medications like Narcan.

When timely administered, Narcan can save most individuals who have overdosed on opioids long enough to get them to the hospital for definitive treatment.

What Is Narcan (Naloxone)?

Narcan (also known by the generic name naloxone) is a drug that blocks the receptors that opioids use to attach to the brain. Narcan displaces the opioids that are currently attached to brain receptors, so it is perfect for reversing the effects of opioid intoxication and poisoning.

Background & History on Narcan

Narcan was developed as an opioid antidote in the 1960s and quickly gained favor because its side effect profile was favorable compared to its predecessors. It received FDA approval in 1971, and was initially used to reverse the opioids that were given in heavy doses to people undergoing surgery or to reverse the effects of opioids in people who had bad reactions to the drugs.

In the early 1990s, as the opioid use was becoming a bigger concern, Narcan was proposed as an antidote to be given directly to people who have overdosed on opioids. By the late 1990s, many areas in the U.S. had initiated programs to distribute Narcan to the general public in an effort to make the life-saving drug available where and when it is needed.

The U.S. Food and Drug Administration (FDA) has been highly supportive of efforts to get Narcan out to the general public in forms that can be administered by non-medical staff at the point of overdose. To this end, in April 2019, the FDA approved the first generic naloxone nasal spray for use in treating opioid overdose.

Currently, there are six FDA-approved naloxone product formulations available, manufactured by eight different companies.

Use in Opioid Overdose Reversal

Narcan is highly effective in briefly reversing a potentially fatal opioid overdose. However, it has no effect on overdoses of other types of drugs, such as stimulants (cocaine, crystal methamphetamine, bath salts, etc.), cannabis, benzodiazepines (valium, clonazepam, etc.) or hallucinogens (peyote, magic mushrooms, etc.).

However, because many different types of drugs are laced with opioids — usually unbeknownst to the person using them — people with an apparent overdose to a different kind of drug may be overdosing on opioids. As such, administering Narcan is appropriate in nearly any overdose situation that resembles an opioid overdose.

How Does Narcan Work?

When people die from opioid overdose it is because opioids suppress the brain’s breathing control apparatus, thereby slowing down and stopping their breathing. This quickly leads to hypoxia (critically low oxygen levels in the body) and an inability of the body to exhale toxic carbon dioxide.

Oxygen-starved organs begin to shut down; brain death and failure of the heart quickly follow, and the individual dies.

Narcan works by blocking the receptors that opioids use to connect to the brain, relieving the brain of the toxic effects of the drugs and allowing the brain’s breathing control center to start working again. If it’s not too late, the person begins breathing again.

Narcan’s mechanism of action and rapid onset of action make it a perfect antidote to any acute problems that arise from opioid use, including overdose.

How Long Does Narcan Last?

Narcan has a very short duration of action. The “half-life” of Narcan depends on the method of administration, but between 1.24–2.08 hours. Because of this, the duration of action of many opioids may outlast that of Narcan, and further doses of Narcan may be required. People who have received Narcan should be closely monitored for the need for further doses until they are in emergency hospital care.

Forms of Narcan

The nasal version of Narcan is popular, but naloxone comes in several different forms, and it may be given in almost any format, except orally. When taken by mouth, naloxone is neutralized by the liver before it can get to the brain and reverse the opioid effects.

Injectable Naloxone: This method is best used when the rescuer has had prior training. Injectable naloxone is given by syringe into the upper arm or thigh and the shot may be given through the clothes.
Auto-Injectable Naloxone: The auto-injector (Evzio®) device has a voice recording that talks the rescuer through the simple injection. This particular device delivers an especially high dose of Narcan (2mg) due to the increasing prevalence of ultra-potent synthetic opioids (such as fentanyl and carfentanil), as well as the increasing numbers of overdose victims who require multiple Narcan doses by the time they get to the hospital. Evzio® comes packaged in a two-dose format in case a second dose is needed.
Nasal Spray: Naloxone nasal spray comes in two formats. These are sprayed into only one nostril. The nasal spray format marketed as Narcan requires no assembly. Each package comes with a second dose. A nasal atomizer is a device that uses a syringe that is modified for spraying the drug into a nostril.

Administering Narcan

The ability to recognize an opioid overdose is facilitated by being aware of the three main symptoms (known as the “overdose triad”):

Pinpoint pupils
Unconsciousness and unresponsiveness
Respiratory suppression (slow or erratic breathing, or not breathing at all)

People who have overdosed on opioids may have no pulse (heartbeat), they may be snoring deeply or gurgling (“death rattle”), and they may have blue lips and fingertips.

What to Do if You Suspect an Overdose:

Step 1: Call 911.

The rescuer should ask someone else to call, but if the overdosed individual must be left alone while the rescuer calls 911, the overdosed individual should be placed in the recovery position in case of vomiting.

Step 2: Give Narcan.

If you are unsure if an unconscious person has overdosed, or if you are unsure if the overdose involved an opioid, Narcan should be given regardless. It is a safe medication and unlikely to do harm, and may save a life in an unsure situation. Narcan kits are designed to be easy-to-use with clearly marked, simple instructions printed on the packaging.

Step 3: Start CPR, if necessary.

If the individual has overdosed on opioids, Narcan will typically work very quickly and the person will start breathing, so CPR will not be necessary. However, if the individual remains pulseless and not breathing, CPR should be initiated.

Step 4: Stay with the individual until help arrives.

Unfortunately, many people will abandon an overdosed friend for fear of being arrested for drug possession or worse. However, 40 states and Washington D.C. have enacted “Good Samaritan” laws that protect people who overdose or those who report drug overdoses from charges for possession of drugs or paraphernalia. Many states also provide immunity from violations of parole and probation conditions.

Overdosed individuals will usually be confused and disoriented, and may vomit. Placing them in the recovery position and remaining at their side ensures that they are in a safer position until help arrives. If help takes longer than expected, a second dose of Narcan may be required if the first dose wears off and the individual becomes unresponsive and stops breathing again.

Being directly involved in an overdose situation is a traumatic event, even if the overdosed individual survives. The commotion of the event may numb rescuers’ perceptions at the time, but once the adrenaline wears off, the emotions and feelings involved can be intense. People who have been involved as rescuers should speak to a trained counselor after the fact.

Side Effects

The major risk associated with Narcan use is causing a severe opioid withdrawal in people who have a high tolerance to opioids from prolonged and heavy abuse of the drugs. This brings on all the symptoms of an intense withdrawal in a matter of seconds, including:

Body aches
Diarrhea
Rapid heart rate
High blood pressure
Nausea and vomiting
Shivering
Anxiety
Irritability
Intense drug craving

People may mistake side effects from the withdrawal from opioids as side effects of Narcan. However, Narcan is a safe medication. Other than the uncommon occurrence of an allergic reaction to the drug, Narcan has few significant side effects of its own.

Where to Get Narcan

A major focus of the U.S. National Drug Control Strategy is to reduce the death rate from opioid overdose, and a priority for the FDA, is to expand access to Narcan by:

Removing the need for prescription control of access
Creating user-friendly labeling
Lowering the cost (ultimately, making it free)
Educating the public about naloxone
Creating dosage forms that require no prior training or experience

Every state and D.C. has adopted new state laws to increase Narcan availability. The specific laws and policies for Narcan access vary widely between states, but the overall approach is to make the drug more easily accessible.

Many cities and counties have their own programs for Narcan access, all designed to put the drug in an easily administered format into the hands of anyone who may need to use it.

People who wish to access Narcan can usually get it for free without any hassle. To find out where and how to get Narcan, a person can call a local pharmacy or your local city hall.

How Much Does Narcan Cost?

Prices for Narcan vary by state and area. Increasingly, there are more available programs for providing Narcan kits cost-free to anyone who wants one, no questions asked. Some insurance providers will cover Narcan purchases. Contact a local pharmacy or health department to find out about local free access Narcan programs.

Narcan Products’ Average U.S. Retail Price:

Evzio® auto-injector: $4,641
Narcan nasal spray: $142
Nasal atomizer: $29
Naloxone pre-filled syringe: $35

Why Narcan Is Not a Substitute for Emergency Medical Care

Narcan is not a substitute for emergency medical care in suspected overdoses. It merely affords additional time to rush overdosed individuals to the hospital. As such, even if the overdosed person awakes and doesn’t want to go to the hospital, they should still be taken for emergency care.

Depending on the type of opioid involved in the overdose, the fatal effects of the opioid can return once the Narcan wears off, and it may be hours before overdosed individuals are safe from fatality. They will almost certainly require supplemental oxygen, intravenous fluids and medications to treat the withdrawal symptoms and other supportive medical care.

Some opioid overdoses are suicide attempts, so overdose survivors are carefully assessed for their mental state of mind in the hospital after an overdose resuscitation. Opioid overdose is indicative of a serious substance use problem and while in the hospital, this matter can be discussed with the individual in a safe and healthy environment.

What Drugs Does Narcan Not Reverse?

Since Narcan is an opioid antagonist, it only reverses the effects of opioids. This means that if someone overdoses on any other kind of drug, including benzodiazepines or any kind of stimulant, it’s not going to reverse the effects. It works specifically on opioids only. It’s not a reversal medicine for all types of drug overdoses, and it’s important for people to realize that.
If someone were to mix substances, for example, opioids and benzodiazepines like Xanax, the Narcan would reverse the effects of only the opioids and not the benzos.

While Narcan doesn’t reverse the effects of drugs outside of opioids, it’s starting to become common for public health officials to recommend anyone who uses drugs to have access to Narcan. This is because so many drugs, including drugs like Xanax, that are purchased on the streets have fentanyl added in, without the knowledge of the person using the drugs. This is why so many accidental deaths occur, and if a drug has been mixed with fentanyl, Narcan can reverse the overdose.

Getting Opioid Addiction Treatment

Narcan can save the life of someone who has overdosed on opioids, but it is not in any way a treatment for opioid addiction. Addiction to substances is a complex disease involving profound physical, mental and emotional pathology. In many cases, there is a co-occurring mental health disorder that must be identified and properly treated in order to address the addiction.

Proper and effective opioid addiction treatment should address the underlying physical, mental and emotional conditions, and should be provided by professionals who are specialized and experienced in treating addiction.

The Recovery Village offers comprehensive assessment and treatment programs for addiction to substances and co-occurring mental health disorders. Our treatment programs take a holistic approach to treating the whole person rather than the disease alone, and we have staff with the necessary training and experience to provide first-rate care. Please contact us for a confidential discussion to learn more about treatment for yourself or a loved one.

Additional Resources

Additional information about the drug Narcan and its use is available from many different sources and services:

Get Naloxone Now is an online resource (funded by the U.S. National Institutes of Health) for teaching people how to respond to an opioid overdose. They provide online training modules free of charge.
The U.S. National Institute on Drug Abuse has information and videos on opioid overdose reversal with naloxone.
The U.S. Food and Drug Administration (FDA) maintains a web page with links to credible resources about naloxone.
The Recovery Village provides information about Narcan uses, side effects, interactions and warnings, with links to other articles.

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Medically Reviewed By – Dr. Andrew Proulx, MD

Andrew Proulx holds a Bachelor of Science in Chemistry, an MD from Queen's University, and has completed post-graduate studies in medicine. He practiced as a primary care physician from 2001 to 2016 in general practice and in the ER. Read more

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Editor – Renee Deveney

As a contributor for Advanced Recovery Systems, Renee Deveney is passionate about helping people struggling with substance use disorder. With a family history of addiction, Renee is committed to opening up a proactive dialogue about substance use and mental health. Read more

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