Opioid Overdose Prevention/Naloxone Frequently Asked Questions
How does naloxone work?
In the brain, naloxone competes with the opioids the person used for the same receptor sites. Since naloxone has a greater affinity for the binding sites, the opioids the person used are replaced by the naloxone which reverses the overdose effects of the opioids.
What are the risks associated with naloxone use?
While you need a prescription at present to be able to get Naloxone, it is not a controlled medication. It has no street value and you cannot become addicted to it. If used by a person who doesn’t use opiates, at worst it might make them uncomfortable. The only exceptions would be for an individual who had an allergic reaction to naloxone or a woman who was pregnant or nursing.
How quickly does naloxone work?
Properly administered, naloxone usually works within 2 – 5 minutes. If there is no response during this time, a second dose should be administered.
Where do I store the naloxone?
Naloxone should be stored at room temperature (neither too hot nor too cold) and should be kept out of sunlight; but not in the refrigerator. Naloxone can be left in the car glove box overnight, but not as permanent storage.
Who do I call if I use my prescription or if my naloxone expires and I need a refill?
Prescriptions for naloxone are generally written in multiples of two, because of the possibility that the first dose may not work and a second dose may need to be given. Prescribers will vary in terms of how many refills they will be willing to write. Those individuals currently in a program should be able to get refills where they are receiving services or from a pharmacist authorized to prescribe naloxone. They could also ask their primary care physician.
Will insurance cover the cost of the naloxone?
Insurance may cover the cost of the prescription. You can check with your insurance company.
Will naloxone work if the person overdosed on something other than an opioid?
No. Naloxone will only work to reverse the effects of opioids.
Is naloxone available over the counter?
Some formulations of naloxone are now available over-the-counter without a prescription. Speak with your pharmacist to learn more about over-the-counter naloxone and whether or not you should have it prescribed to you.
Who in the state of CT is authorized to prescribe naloxone?
In Connecticut, authorized prescribers are physicians, surgeons, physician’s assistants (PAs), Advanced Practice Registered Nurses (APRNs), dentists and podiatrists and now certified pharmacists.
As a patient or a caregiver, where can I go for training and a prescription?
If you are already in a program, there may very well be prescribers on staff who could assist you. Also, your primary care doctor would be able to help. You may also go speak with a Pharmacist Certified in naloxone.
What are commonly used opioids?
Heroin, oxycodone, Fentanyl, Morphine, and hydrocodone. Methadone is also an opioid.
Can a person overdose on a prescription opioid?
Certainly a person can overdose on any opioid, regardless of whether it is a prescription medication or not.
What increases/decreases risk of an opioid overdose?
These factors increase risk of an opioid overdose:
Using too much (because you haven’t used that amount before or because it was stronger than what you are used to, or because your tolerance decreased while you weren’t using or were in a detox/program/jail/hospital)
- Using alone
- Mixing opiates with alcohol, other pills or cocaine. (Pills may include non prescription medications).
- Other health issues (Hepatitis, HIV, infections, malnutrition/dehydration, liver disease, kidney disease, heart disease or respiratory disease, asthma, sleep apnea, etc.)
- Previous overdose
- Mode of administration (Smoking and IV use are riskier)
- Age (older people and those with longer histories of drug use are more likely to die as a result of an overdose)
- Patients on very high doses of opioid medication (not all problems are due to street drugs or problem patients); even patients who are monitored correctly may overdose.
Note: A patient identified on the prescription monitoring program as having a Morphine Equivalent number value of greater than 100 mg may be a candidate to receive counseling about naloxone and the value of obtaining the naloxone. Additionally, patients that use high dose opioids and a benzodiazepine may also be good candidates for counseling about the value of obtaining naloxone.
These factors decrease risk of an opioid overdose:
- Using a consistent source/supplier
- Testing a small amount first
- Using a less rapid mode of administration (snorting)
- Using with someone else
- Using less if you haven’t used in some time, for any reason
- Not letting anyone else prepare your drugs for you
All overdoses are not the same. An overdose on a stimulant like Cocaine would potentially have some of the same signs like difficulty breathing, vomiting and loss of consciousness, but unlike an opioid overdose, might also have: chest pain, dizziness, foaming at the mouth, lots of sweating or no sweating, racing pulse and seizures. Naloxone will not work on a cocaine overdose and there is no comparable Naloxone-like medication to reverse it.
What do I do if I come across someone who has overdosed?
If someone you are close to uses opiates, you could, in fact, find yourself in this situation. The first step is to determine whether the person has overdosed on Opioids. Look for the following signs:
- Person is unresponsive or limp
- Person is awake but unable to talk
- Their breathing is slow or erratic or they are not breathing
- Their pulse is slow or erratic or they have no pulse
- Their skin is pale gray or blue, especially around the fingernails and lips
- They are making deep, slow snoring, choking or gurgling sounds
- They are vomiting
If you cannot wake or get a response from the person, call 911. If they aren’t breathing, start “Rescue Breathing” by moving them onto their back, tilting their head back and lifting their chin, and giving them 2 normal breaths. Give one breath every 5 seconds after this until they begin breathing on their own or help arrives. If you have a Naloxone kit, have someone bring it to you and administer the Naloxone. If you have to leave the person for any reason, put them into the “Recovery Position” by rolling them onto their side so that they won’t choke if they begin vomiting.
Will the person who recovers from an overdose be violent?
People who overdose generally don’t realize what has happened to them. They just come out of it feeling sick. They may misinterpret the situation to think that someone took their drugs and be agitated or upset. The best thing to do is to explain what happened.
Can a person re-overdose after the naloxone has been given?
Yes, depending on how much the person used and the type of opioid they used. naloxone lasts for about 30 – 90 minutes, so it is possible that at the end of that time, the person could re-overdose. The other possibility is that the person will want to use more drugs now that they are feeling sick after the naloxone. Under no circumstances should they do this as it will increase the chances of re-overdosing. This is why it is important to call 911.
Overdose kits are a handy way to be prepared by having everything needed in one place. A bag of some sort is necessary to keep all the pieces together. The kit should include 2 doses of naloxone, 2 alcohol wipes for cleaning the injection site, a pair of gloves, and a set of instructions. Some kits include other items, such as a Rescue Breathing mask.
Should I report if I use the naloxone and reverse the overdose?
If you reverse an opioid overdose, congratulations! You can report this good news to the agency where the naloxone was prescribed and/or email Christy Knowles at the Department of Mental Health and Addiction Services at Christy.Knowles@ct.gov.
Will I be arrested if I call 911 when there’s been an overdose?
Public Act 11-210 An Act Concerning Emergency Medical Assistance for Persons Experiencing an Overdose and the Designation of Certain Synthetic Stimulants as Controlled Substances (provide link) concerns consequences for possession of different substances, but makes an exception in section g, for persons who in good faith seek medical assistance for a person that they reasonably believe is overdosing. Consequently, you should be protected from arrest by this “Good Samaritan” law.
Where can a person go for treatment of an addiction?
People who need treatment for an addiction have a number of choices. If they have insurance, they should call the number on the insurance card for a referral. Those who don’t have insurance or who have a program like Husky or Medicaid LIA should check the DMHAS website (link here) for a list of programs. All programs receiving funding from DMHAS must take some clients without insurance. Also, some programs are designed to treat individuals without insurance (like Blue Hills in Hartford and Connecticut Valley Hospital - Merritt Hall in Middletown). Programs range from Detox to outpatient to inpatient. Most programs should begin by asking you about your substance use so they can try to match you to the level of care that best meets your needs.
As a pharmacist, how do I get certified to prescribe naloxone?
If naloxone is now available over-the-counter, do I still need to prescribe it?
While some formulations of naloxone have become available for sale over-the-counter (OTC), the Department encourages licensed pharmacists who are certified to prescribe naloxone to continue prescribing the medication for patients when appropriate. For more information, please see this notice sent to pharmacists regarding OTC naloxone.
What is required on a prescription when I prescribe naloxone to a patient or caregiver?
- Name and address of the patient
- Name and address of the prescribing practitioner
- Date written
- Name and strength of the prescribed drug
- Quantity prescribed
- Directions for use of the medication
What should I put in a naloxone kit when I dispense it from my pharmacy?
Suggested Intranasal Naloxone Kit Components
2 x 2 mg/mL prefilled naloxone cartridges
2 plastic syringes
2 mucosal atomization devices A rescue breathing mask
Step-by-Step instructions for responding to an opioid overdose (See Naloxone Handout above)
Directions for naloxone administration (See Naloxone Handout above)
Sample Prescription for Intranasal Kit (use Adobe Acrobat for best results)
Suggested Intramuscular Naloxone Kit Components
- 2 naloxone 0.5 mg/mL vials
- 2 intramuscular plastic syringes
- A rescue breathing mask
- Step-by-Step instructions for responding to an opioid overdose (See Naloxone Handout above)
- Directions for naloxone administration (See Naloxone Handout above)
- Sample Prescription for Intramuscular Kit (use Adobe Acrobat for best results)
- VA Intramuscular Counseling Video
Suggested Auto Injector Naloxone Kit Components
- Commercially available as a twin pack with audio instructions in English from the device
- A rescue breathing mask
- NOTE: If the naloxone auto-injector is prescribed a copy of the Naloxone Handout may still be provided
- Sample Prescription for Auto Injector Kit (use Adobe Acrobat for best results)
- VA Auto Injector Counseling Video
Who can I prescribe naloxone to?
Is a handout available for me to demonstrate the different administration methods for naloxone?
Is a handout available for step-by-step instructions for responding to an opioid overdose?
Can I supply a first responder organization with naloxone?
- Having a Wholesale license and
- Receiving a medical order from a medical director.
If I am an institutional pharmacist and I prescribe naloxone for an outpatient or a discharged in-patient, will my prescription be honored by an outside pharmacy?
If I prescribe naloxone for a patient but it is unavailable at my place of employment can another pharmacist honor the prescription?
Is this prescription like any other?
Who is responsible for relaying information to the prescription recipient; the prescribing pharmacist or the dispensing pharmacist (if different)?
Should I only focus on individuals who are abusing or suspected of abusing opiates?
- Medication knowledge
- Medication Pharmacokinetics
- Medication Interaction
- The Prescription Monitoring Program (including the Morphine Equivalent)
- Communication ability with prescribers
These patients may suffer a change in metabolism which causes altered excretion rates, there may exist drug-drug interactions, drug-diet interactions, etc. These individuals are not abusers but may suffer the same outcome as an abuser. Education, in combination with naloxone, may be an appropriate resolution to discuss with the patient or caregiver, and of course, in consultation with the patient’s physician.