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Naloxone (Narcan): Emergency Treatment for Opioid Overdose

The Centers for Disease Control and Prevention (CDC) reports that opioids were involved in 49,860 overdose deaths in 2019.1 Naloxone is the primary active component of brand name medications such as Narcan and Kloxxado. Naloxone is intended for emergency use to counter opioid overdoses and help save lives.2 The dual epidemics of opioid overdose and opioid use disorders exist in parallel in this country, but often go hand-in-hand. Indeed, the compulsive misuse of any opioid drug can place people with opioid use disorder at risk of overdose. While naloxone can help you stay safe and avoid harm due to overdose, should you be struggling with an opioid use disorder, it’s crucial to enter a professional treatment program to address the addiction in order to prevent further risk.

What is Naloxone?

Naloxone is an opioid antagonist indicated for emergency use as an “antidote” in cases of known or suspected opioid overdose.2, 4 Opioid antagonists like naloxone attach to the brain’s opioid receptors to block further activation and reverse the potentially life-threatening effects of opioids. With prompt naloxone treatment, opioid overdose death can be avoided. Naloxone can reverse some of the adverse effects of opioids, restore breathing, and save lives.3 Due to its crucial role in reversing potential fatal opioid overdoses, the World Health Organization (WHO) considers naloxone to be an essential medication.5

Naloxone is available in several formulations, including injectable solutions for administration by healthcare professionals.6 It is also available as a prepackaged nasal spray under the brand names Narcan and Kloxxado.6, 7

What is Naloxone Used For?

As previously mentioned, naloxone overdose treatment is used to reverse the effects of opioid overdose and restore breathing. In emergency settings, it is administered to people who have overdosed. It may also be provided as a take-home medication to patients currently on a medication-assisted treatment (MAT) for opioid use disorder or to individuals who are otherwise  deemed to be at risk of overdose, including those who receive opioids as a part of their medical treatment.2, 8 In 2020, the Food & Drug Administration (FDA) strongly advised health professionals to consider prescribing naloxone to people who are deemed to have a risk of opioid overdose, which includes those who use opioids along with other substances that depress the central nervous system (which includes substances such as alcohol).8, 9

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), the chance of an opioid overdose can be higher among people who combine opioids with alcohol or certain other respiratory-depressing medications, such as benzodiazepines.2, 4 It should be noted that naloxone is only effective for managing opioid overdose; naloxone will be ineffective in reversing non-opioid overdoses, such as those involving only alcohol or benzodiazepines.4 This is not to say that naloxone should not be administered in instances of suspected mixed overdoses, or overdoses of unknown cause. Should a person overdose on opioids while using alcohol, naloxone can help counter the opioid-mediated part of the overdose to increase the person’s chances of survival.4

As an opioid receptor antagonist, naloxone can counteract overdoses involving a variety of opioid drugs, including: 4, 6

  • Heroin.
  • Fentanyl.
  • Hydrocodone.
  • Oxycodone.
  • Codeine.
  • Morphine.

Because of their high potency, overdoses involving drugs like fentanyl and other fentanyl analogs may require relatively larger doses of naloxone to fully reverse the dangerous respiratory depressing effects. Additional doses may also be needed to manage overdoses involving long-acting opioid drugs.4

H2: Can Naloxone be Used in Addiction Treatment?

Though naloxone is itself not a drug used to manage opioid use disorders, it may be given to people who are already on a medication-assisted treatment (MAT) regimen for opioid use disorder. MAT for OUD is designed to help people manage their opioid addiction through the combined use of medications and behavioral therapies. According to SAMHSA, the goals of MAT include:5

  • A full recovery from opioid use disorders.
  • Improved survival.
  • Increased retention in treatment.
  • Decreased illicit opioid use and associated criminal behaviors/problems.
  • Increased ability to obtain and maintain employment.
  • Improved birth outcomes in pregnant women who use opioids.

A healthcare professional may determine whether a person receiving MAT or otherwise has a high risk of overdose be prescribed naloxone. Clinicians and pharmacists may show the at-risk individual (as well as their friends, family members, caretakers, etc.) how to administer naloxone in case of emergencies.2

How is Naloxone Used?

Naloxone can and should be administered for the treatment of known or suspected overdose. It can be provided in both emergency and controlled settings. In emergencies, it can be administered by those who are properly trained to do so, including emergency medical technicians (EMTs), police officers, firefighters, correctional officers, and those who may have an increased risk of experiencing or witnessing an opioid overdose, such as people who abuse opioids and their families or friends.3 It can also be dispensed in controlled settings to patients in opioid addiction treatment programs, those who receive opioid prescriptions from their physicians, or those otherwise deemed to have a risk of opioid overdose.8

As an injectable, naloxone is typically administered by medical professionals or those who have received proper training. Some states allow family and friends to receive this training. Injectable formulations may be administered into muscle (intramuscularly), under the skin (subcutaneously), or directly the bloodstream (intravenously).6 Nasal spray forms of naloxone (Narcan, Kloxxado) may be self-administered by non-medical professionals or provided by bystanders in times of emergency.6 It is important to remember that the effects of naloxone only last 30-90 minutes; people who have received naloxone must seek immediate medical attention so they can be monitored for at least 2 hours after their last dose of naloxone.

Difference Between Naloxone and Naltrexone

People sometimes confuse naloxone and naltrexone. Though they are both opioid antagonists, these two medications are not used for the same purpose. As mentioned previously, naloxone is used for the emergency treatment of known or suspected opioid overdose.

Naltrexone is an FDA-approved medication used in MAT to treat both alcohol use disorder and opioid use disorder. Naltrexone is available in generic form as an oral tablet.12 In its extended-release intramuscular injectable form, it is known as Vivitrol.13 When used, naltrexone is thought to blunt some of the rewarding or reinforcing effects of alcohol and opioids, which helps discourage use of these substances so a person can remain sober, avoid relapse, and stay committed to treatment.14

How Much does Naloxone Cost?

The price of naloxone can vary depending on your insurance coverage, your copay, your deductible, whether you pay out-of-pocket, the type of naloxone you receive, whether you receive the generic or brand name formulation, the pharmacy where you get it, and other factors.6, 15, 16, 17 You may also receive naloxone as a part of your addiction treatment program as a component of an OEND (opioid education and naloxone distribution) program, in which case the cost of naloxone can also vary.18, 19 To determine the cost of naloxone, it’s best to speak to a medical professional, or to contact your insurance provider for more information.

Does Insurance Cover Naloxone Treatment?

According to SAMHSA, most private health care plans, Medicare, and Medicaid cover naloxone. However, exact coverage and policies could vary depending on the state you live in.4 The Affordable Care Act (ACA) states that treatment for substance use disorders, which includes MAT, is one of the ten elements of essential health benefits. This means that insurance sold on Health Insurance Exchanges or provided by Medicaid must cover these services.20 However, plan limitations, such as naloxone fill limits with Medicaid or some insurance companies, could still be an obstacle for some people.21, 22 To determine if your plan covers naloxone, contact your insurance provider or check your coverage online.

Sources:

  1. Centers for Disease Control and Prevention. (2021, March 3). Drug overdose deaths.
  2. Substance Abuse and Mental Health Services Administration. (2021, July 8). Medication-assisted treatment: Naloxone.
  3. American Society of Addiction Medicine. (2021, July 21). Public policy statement on the use of naloxone for the prevention of opioid overdose deaths.
  4. Substance Abuse and Mental Health Services Administration. (2018). SAMHSA opioid overdose prevention toolkit. HHS publication no. (SMA) 18-4742. Rockville, MD: Substance Abuse and Mental Health Services Administration.
  5. Substance Abuse and Mental Health Services Administration. (2021, September 16). Medication-assisted treatment (MAT).
  6. National Institute on Drug Abuse. (2021, June). Naloxone DrugFacts.
  7. S. Food & Drug Administration. (2018, March 7). Evzio (naloxone auto-injector) approved to reverse opioid overdose.
  8. S. Food & Drug Administration. (2020, July 23). New recommendations for naloxone.
  9. Costardi, J. V., Nampo, R. A., Silva, G. L., Ribeiro, M. A., Stella, H. J., Stella, M. B., & Malheiros, S. V. (2015). A review on alcohol: from the central action mechanism to chemical dependency. Revista da Associacao Medica Brasileira (1992), 61(4), 381–387.
  10. Overstreet, D. H., Kampov-Polevoy, A. B., Rezvani, A. H., Braun, C., Bartus, R. T., & Crews, F. T. (1999). Suppression of alcohol intake by chronic naloxone treatment in P rats: tolerance development and elevation of opiate receptor binding. Alcoholism, clinical and experimental research, 23(11), 1761–1771.
  11. S. Department of Health and Human Services—Food & Drug Administration. (2015, November). Labelling–Medication guide: Narcan.
  12. S. Department of Health and Human Services—Food & Drug Administration. (2013, October). Labelling–Medication guide: Revia.
  13. S. Department of Health and Human Services—Food & Drug Administration. (2010, October). Labelling–Medication guide: Vivitrol.
  14. Substance Abuse and Mental Health Services Administration. (2021, September 15). MAT medications, counseling, and related conditions.
  15. Barenie, R. E., Gagne, J. J., Kesselheim, A. S., Pawar, A., Tong, A., Luo, J., & Bateman, B. T. (2020). Rates and costs of dispensing naloxone to patients at high risk for opioid overdose in the united states, 2014-2018. Drug safety, 43(7), 669–675.
  16. Gupta, R., Shah, N., & Ross, J. (2016, December 8). The rising price of naloxone — risks to efforts to stem overdose deaths. New England Journal of Medicine, 375, 2213-2215.
  17. Guadamuz, J. S., Alexander, G. C., Chaudhri, T., Trotzky-Sirr, R., & Qato, D. M. (2019). Availability and Cost of Naloxone Nasal Spray at Pharmacies in Philadelphia, Pennsylvania, 2017. JAMA network open, 2(6), e195388.
  18. Weiner, J., Murphy, S., & Behrends, C. (2019, May 29). Expanding access to naloxone: A review of distribution strategies. LDI/CHERISH Issue Brief, 1-7.
  19. Blanchard, J., Weiss, A. J., Barrett, M. L., McDermott, K. W., & Heslin, K. C. (2018). State variation in opioid treatment policies and opioid-related hospital readmissions. BMC health services research, 18(1), 971.
  20. Abraham, A. J., Andrews, C. M., Grogan, C. M., D’Aunno, T., Humphreys, K. N., Pollack, H. A., & Friedmann, P. D. (2017). The affordable care act transformation of substance use disorder treatment. American journal of public health, 107(1), 31–32.
  21. Roberts, A. W., Look, K. A., Trull, G., & Carpenter, D. M. (2021). Medicaid prescription limits and their implications for naloxone accessibility. Drug and alcohol dependence, 218, 108355.
  22. Pennsylvania Pharmacists Association. (2017, September). Naloxone implementation guide.

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