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Naloxone (NARCAN®)

Naloxone Hydrochloride

Naloxone temporarily blocks or reverses the side effects of opioids, including heroin, fentanyl, oxycodone, methadone, hydrocodone, morphine, codeine, Vicodin® and others. It is used to treat an opioid overdose in an emergency situation, but is not a substitute for emergency medical care. Although available both as an injectable and a nasal spray, the nasal spray is gaining in popularity because it is a ready-to-use, 1 ml prefilled single dose. The drug takes effect in 1-3 minutes, usually before medical personnel can get to the subject.

It is important to remember that naloxone is effective for opioid overdoses only.1 Side effects are rare and include opioid withdrawal, resulting in irritability, runny nose, sweating, nausea and vomiting. The only contraindication for use is for individuals allergic to the ingredients. There are no contraindications for use in children or the elderly.

Current laws

Although naloxone is a prescription drug, it is not a controlled substance. Its use and availability are governed by local and state law, not federal. Walgreens announced in 2016 that it will make naloxone available without a prescription in 35 states.2CVS made a similar news release in 2016. According to the Network for Public Health Law, as of April 15, 2016, all but five states have passed legislation designed to improve layperson naloxone access.1 , making it easier to obtain the drug and use it to save lives. Many states have also enacted Good Samaritan laws for bystanders. Pennsylvania made naloxone available to public high schools in 2016; Ohio has similar legislation pending. There is also legislation pending in Congress that would allocate federal funds to fight the opioid epidemic.


Symptoms of opioid overdose
• Unusual sleepiness and inability to wake the person with a loud voice or by rubbing firmly on the middle of the chest/sternum
• Breathing problems including slow or shallow breathing in someone difficult to awaken or look like they are not breathing
• Pupils of the eye are very small (pinpoint) in someone difficult to wake up
• Pale clammy skin or bluish tint; cyanosis


Develop a simple strategy/policy for responding to overdose at your facility. All staff should receive training on the brand and administration of naloxone in use at the facility.
An incident report should be completed immediately if naloxone is administered and the dosage should be replaced as soon as possible. All incident reports should be reviewed monthly.


Naloxone is not a controlled substance and does not need to be kept in locked storage. Although it does not provide a ‘high’, it could be subject to theft and like other medications, should not be left in the open. It should be stored at room temperature 59-70 degrees F and it is light sensitive. Naloxone should not be frozen or exposed to freezing temperatures. Since more than one dose may be needed for each incident, more than one dose should be on hand at all times. In organizations that may have a greater potential for an overdose, stocking additional doses may be necessary.
Supply and expiration date must be checked at the beginning of each shift. As naloxone loses effectiveness over time, any expired product should be disposed of according to local regulations and manufacturer’s directions.