Gemini on Question 16, Sep 20

Naloxone (commonly known by the brand name Narcan) is a life-saving medication designed to rapidly reverse an opioid overdose.

Here is a breakdown of how it works and when a bystander should use it.

Part 1: How Naloxone Works

To understand how naloxone works, it helps to understand how opioids affect the body.

Opioids (like heroin, fentanyl, oxycodone, and morphine) fit into specific receptors in the brain, much like a key fits into a lock. When these receptors are activated, they block pain and cause euphoria, but they also slow down the central nervous system. In an overdose, they slow down the system so much that the person stops breathing.

Naloxone is an "opioid antagonist."

• •The Takeover: Naloxone has a stronger affinity for these brain receptors than the opioids do. It acts like a stronger key that violently kicks the opioid "keys" out of the locks.
• •The Reversal: Once naloxone binds to the receptors, it does not activate them (it doesn’t cause a high). Instead, it acts as a shield, blocking the opioids from re-attaching.
• •The Result: Because the opioids are blocked from the brain, the central nervous system wakes up, and normal breathing is usually restored within 2 to 3 minutes.

Note: Naloxone only works on opioids. It will not reverse overdoses caused by alcohol, cocaine, or benzodiazepines (though it will not harm the person if administered in these cases).

Part 2: When a Bystander Should Use It

You should use naloxone immediately if you suspect someone is experiencing an opioid overdose.

Because naloxone is incredibly safe and has no negative effects on someone who does not have opioids in their system, the golden rule is: When in doubt, administer naloxone.

Signs of an Opioid Overdose:
A bystander should look for the following signs to determine if naloxone is needed:

• •Unresponsiveness: The person will not wake up, even if you shout their name or firmly rub the center of their chest (their breastbone) with your knuckles.
• •Breathing issues: Breathing is very slow, shallow, or has completely stopped.
• •Abnormal sounds: The person is making choking, gurgling, or snoring sounds (often called the "death rattle").
• •Skin color changes: In lighter-skinned people, the lips and fingertips may turn blue or purple. In darker-skinned people, the inside of the lips may turn blue, and the skin may appear grayish or ashen.
• •Pinpoint pupils: The black centers of the eyes are extremely small.
• •Limp body / Clammy skin: The person is entirely limp, and their skin feels cold and sweaty.

What to do if you spot these signs:

If you are a bystander and suspect an overdose, take the following steps:

• 1.Call 911 immediately. Naloxone only lasts for 30 to 90 minutes in the body, while opioids can last much longer. The person could slip back into an overdose once the naloxone wears off, so professional medical help is mandatory.
• 2.Administer Naloxone. If using the nasal spray (Narcan), lay the person on their back, insert the tip of the nozzle into one nostril, and press the plunger firmly.
• 3.Support their breathing. If you know how to do rescue breathing or CPR, begin doing so.
• 4.Wait 2 to 3 minutes. If the person does not wake up or start breathing normally after 2 to 3 minutes, give a second dose of naloxone (in the other nostril, if using the spray). Because of powerful synthetic opioids like fentanyl, many overdoses now require multiple doses of naloxone.
• 5.Stay with them. Keep them on their side (the "recovery position") so they don’t choke on their vomit if they throw up. Stay until paramedics arrive.

A note on waking up: When naloxone kicks the opioids off the receptors, it can instantly throw the person into opioid withdrawal. The person may wake up confused, agitated, sweating, or angry. Stay calm, reassure them that they overdosed, and explain that medical help is on the way.