Gemini on Question 16, Sep 15

Disclaimer: This information is for educational purposes. If you suspect an opioid overdose, call 911 immediately before or while administering naloxone.

Naloxone (commonly known by brand names like Narcan or Kloxxado) is a life-saving medication that can rapidly reverse an opioid overdose. Here is how it works and when a bystander should use it.

How Naloxone Works

To understand how naloxone works, it helps to understand how opioids cause an overdose. Opioids (such as fentanyl, heroin, oxycodone, hydrocodone, and morphine) fit into specific receptors in the brain—like a key fitting into a lock. When opioids fill these receptors, they block pain, but they also slow down the central nervous system, which can cause breathing to slow dangerously or stop entirely.

Naloxone is an opioid antagonist.

• •The "Bulldozer" Effect: Naloxone has a stronger affinity for the brain's receptors than opioids do. When administered, it rushes into the brain and knocks the opioids off the receptors.
• •Restores Breathing: Once naloxone takes over the locks, it blocks the opioids from attaching. Because naloxone itself does not slow down breathing, the person's normal breathing is usually restored within 2 to 3 minutes.
• •Temporary Fix: Naloxone only lasts in the body for 30 to 90 minutes. Many opioids remain in the body much longer than this. Therefore, a person can slip back into an overdose once the naloxone wears off, which is why medical intervention is always required.

When Should a Bystander Use It?

You should use naloxone any time you suspect someone is experiencing an opioid overdose.

Because bystanders often do not know what drugs a person has taken, you must rely on physical signs. Look for the following signs of a life-threatening overdose:

1. Unresponsiveness

• •The person will not wake up when you shout their name or shake them.
• •They do not respond to a "sternum rub" (rubbing your knuckles hard up and down the center of their chest bone).

2. Breathing Issues

• •Breathing is very slow, shallow, or has stopped completely.
• •You hear deep snoring, gurgling, or choking sounds (often called the "death rattle").

3. Color Changes

• •Lighter skin: Lips and fingernails may turn blue or purple. Skin may look pale or clammy.
• •Darker skin: Lips and fingernails may turn gray or whitish. The skin may look ashen or washed out.

4. Pinpoint Pupils

• •The dark center of their eyes is shrunk to the size of a pinhead (though this can be hard to check quickly).

What to Do (Step-by-Step)

If you see the signs above, take these steps:

• 1.Call 911 immediately. Tell the dispatcher someone is unresponsive and not breathing.
• 2.Administer Naloxone.
• •Nasal spray (Narcan): Insert the nozzle into one nostril and press the plunger firmly.
• •Injectable: Inject it into the muscle of the outer thigh, shoulder, or buttocks.
• 3.Support breathing. If you are trained, begin CPR or rescue breathing. Oxygen deprivation is what causes brain damage or death in an overdose.
• 4.Wait 2 to 3 minutes. If the person does not wake up or resume normal breathing, give a second dose of naloxone. (Most nasal spray boxes come with two doses for this reason).
• 5.Stay with them. Once they wake up, they may be confused, agitated, or feel sick. If they begin breathing on their own but are not fully awake, roll them onto their side (the recovery position) to prevent them from choking on their own vomit. Stay until paramedics arrive.

Three Crucial Facts for Bystanders

• •It cannot hurt someone who isn't overdosing: If you find someone unresponsive and you aren't sure if it's an opioid overdose (for example, it might be a heart attack or alcohol poisoning), give them naloxone anyway. It has no effect on a person who does not have opioids in their system. It is always better to be safe.
• •It causes sudden withdrawal: Because naloxone rips opioids off the brain's receptors instantly, the person may wake up in severe, immediate withdrawal. They may be angry, sweating, nauseous, or experiencing body aches.
• •It only works on opioids: Naloxone will not reverse overdoses caused by alcohol, cocaine, methamphetamine, or benzodiazepines (like Xanax)—though it will still cause no harm if administered. Note: Because street drugs like cocaine and counterfeit pills are frequently laced with fentanyl, naloxone should still be given to anyone showing overdose signs, regardless of what drug they thought they took.