This document provides an overview of naloxone for laypersons. It discusses the background and use of naloxone, including how it works as an opioid antagonist to reverse overdoses. The target population for naloxone administration is those with depressed respiratory drive due to opioid overdose. Instructions are provided for administering naloxone via the intranasal and intramuscular routes by laypersons. It emphasizes the importance of calling 911 and performing CPR if needed before and after naloxone administration.

1. Idaho State Board of Pharmacy
Naloxone Overview
Robert S. Cole
Ada County Paramedics

2. Disclaimer
• Nothing to sell
• No conflicts of interest.
“I'm just a poor boy, nobody loves me.
He's just a poor boy from a poor family,”

3. Objectives
• Background on Naloxone
• Opioids on the streets
• Naloxone on the Streets
• Setting up Naloxone for Lay Persons
• Vital Information for the Lay Person
Administering Narcan
• Post-Narcan Care
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4. Background on Naloxone
• Patented in 1961, and rapidly adopted in
emergency medicine and EMS by the mid 70’s.
• Patent Expired
• On the WHO list of essential medications
• Currently, there are an estimated 16,000 deaths
annually in the US attributed to Opoids
• Likely under estimated
• In 2014, FDA (Fast Tracked) approval for lay
public/Non Medical responder formulations
• IM: Auto Injector “Evzio”
• IN: Narcan Nasal Spray
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6. Basic information
• Pure Opioid Antagonist
• Works predominantly on the Mu Opioid receptors in the
central Nervous System
– Very little effect on the other opioid receptors
• Clinical effect typically 20-40 minutes.
– ½ live 30-80 minutes
– Clinical effect shorter than many opioids
• Most effective when administered IV, IM, SQ, SL, and IO.
– Wide dose range based on clinical situation for HCP
– Limited dose range and routes for lay public (2-4 mg IV, IM)
• Limited inconclusive research on possible use in sepsis,
and certain other CNS depressants.

8. Opioid Toxidrome
• The Opiate Toxidrome consists of:
– Altered mental status
– Miosis*
– Unresponsiveness
– Shallow respirations
– Slow respiratory rate
– Decreased bowel sounds
– Hypothermia
– Hypotension*
• * these symptoms are very subjective, and may
not be present in polypharmacy overdoses.
KEY POINT:
Miosis and Hypotension are not definitive for ruling in or
ruling out a opioid overdose.

9. Opioids on the
streets
• Shooting
• Skin Popping
• Muscle Popping
• Chasing the dragon
• Freebasing
• Plugging and Shelving
• Transdermal

10. So why do people overdose?
• IV opioid use
• Poly-pharmacy Overdose
• Returning to opioid use from abstinence
– Jail?
– Detox?
• The Weekend Warrior
• Using opioids alone
• New supply of Drug

11. According to the CDC
• Misuse of opioids accounts for 1000 ER visits a
day in the US
• Over 40,000 deaths per year (2014 stats)
• Over 16,000 related to prescription opioids
• Most common prescription opioid deaths:
• Methadone
• Oxycodone (such as OxyContin®)
• Hydrocodone (such as Vicodin®)
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12. “Speed Balls”

13. Poly Pharmacy Opioid Situations

14. The New Opioid: Poly-Opioid Mixes

15. Key Points
• Narcan may not be enough
• May not be effective
• May not be only an opioid
• May have been down too long
• May need to redose
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16. Naloxone on the Streets

17. Target Population
The target population for naloxone is persons who may
have overdosed on opioids and whose respiratory drive
is at a depressed life-threatening level.
Naloxone is for depressed respirations, not depressed
mental status.
Opiate use alone (without depressed respirations) does
not merit the use of naloxone.
17
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18. cc: c@rljones - https://www.flickr.com/photos/17149966@N00

19. Intranasal Naloxone
• Minimizes risk for blood
borne pathogen
exposure (no needle)
• May be administered
rapidly and painlessly
• Onset of action is 3-5
minutes, peak effect is
12-20 minutes
Protect naloxone from light
Avoid temperature extremes
19

20. Intranasal Naloxone

21. Intranasal Naloxone

22. Intranasal Naloxone

23. Intranasal Dose
•2-4 mg
•1/2 of dose in each
nostril

24. Intramuscular Naloxone
• Intramuscular likely more reliable
– Needle Risk
• Lay Public Dose: 2-4 mg
• Locations:
– Any large muscle mass
– Thigh
– Upper Arm
– Buttocks

25. Vital Information for the Lay Person
Administering Narcan
• Call 911 first without delay
• CPR takes priority OVER Naloxone
• “Hands Only CPR is OK if no face mask
• Naloxone often causes vomiting
• Roll on side if not doing CPR
• Keep airway clear
• DON’T STOP CPR FOR NARCAN
ADMINSITRATION
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26. Post-Narcan Care
• Roll on side if CPR is not
needed
• If CPR is needed, do CPR until
the patient wakes up
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27. In Closing
• Narcan does not always work
• Dose is 2-4 mg for lay public, IV or IN
• Call 911 early as possible
• CPR (If needed) as early as possible,
even if Narcan is given
• Continue CPR (if needed) until the
patient wakes up, or EMS directs
otherwise.
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