Opioid Overdose Prevention/Naloxone (Narcan) Initiative

Susan Bouffard, Ph.D. - (860) 418-6993 susan.bouffard@ct.gov

Naloxone, also known as Narcan, is a prescription medication that reverses opioid overdoses. It is a safe and easy to use medication that you can get from your doctor or a certified pharmacist. CT Medicaid and most commercial insurance cover naloxone, although there may be a co-pay or deductible.

All 50 states now have naloxone access laws designed to make the medication more available. It is impossible to abuse naloxone as its only job is to reverse opioid overdoses. Naloxone is only effective on opioids (heroin, OxyContin, Vicodin, fentanyl, etc.) Persons given naloxone who have not overdosed on opioids will not be harmed. Persons dependent on opioids who are given naloxone will experience opioid withdrawal. In any overdose situation, 9-1-1 should be called and naloxone should be administered if opioids are involved or suspected to have been involved.
 

How Can I Get Naloxone?

 

Other Related Services and Supports

Responding to opioids involves multiple state agencies, including:

Department of Public Health (DPH)

Department of Consumer Protection (DCP)

Governor's Office

Has supported legislation related to opioids and naloxone.

 

Training Materials

Any of the following materials can be printed. For convenience, the one-page two-sided brochure listed below contains information for identifying and responding to an opioid overdose with naloxone.

Helpful Resources and Links


Frequently Asked Questions
 
What are the risks associated with naloxone (Narcan) use?
Naloxone (Narcan) is a safe prescription medication. Its sole purpose is to reverse an opioid overdose. Unless a person is known to be allergic to naloxone (Narcan), it is safe to administer.
 
How quickly does naloxone (Narcan) work?
Properly administered, naloxone (Narcan) usually works within 2 – 5 minutes. If there is no response during this time, a second dose should be administered.
 
Who in the state of CT is authorized to prescribe naloxone (Narcan)?
In CT, authorized prescribers are physicians, surgeons, PAs, APRNs, dentists, podiatrists and, with the 2015 legislation, Pharmacists who have been trained and certified.
 
Where can I go for training and a prescription kit?
Any pharmacist who has been trained and certified can prescribe and dispense naloxone (Narcan). The pharmacist will educate the person requesting the naloxone (Narcan) on its use. Additionally, your primary care provider (physicians, surgeons, PAs, APRNs, dentists, and podiatrists) would be able to prescribe naloxone (Narcan) to you. Many programs providing treatment for substance use also have mechanisms in place to provide education and access (through prescriptions or kits) to naloxone (Narcan). You may also check the map of pharmacies with pharmacists approved to prescribe naloxone on the Department of Consumer Protection's website.
 
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 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.
 

What do I do if I come across someone who has overdosed?
An overdose is a medical emergency requiring an immediate response. The 2 most important things to do are:

  1. Give the person naloxone
  2. Call 911


If you are able to, provide rescue breathing using the following steps:

  1. With the person flat on their back and you kneeling beside them, tilt their head back, lift their chin and pinch their nose shut
  2. Using a face shield, if available, cover their mouth with your mouth, provide 2 breaths, then 1 breath every 5 seconds
  3. Continue breathing for the person until they revive or EMS arrives or you are too exhausted to continue
 
How does naloxone (Narcan) work?
In the brain, naloxone (Narcan) competes with the opioids the person used for the same receptor sites. Since naloxone (Narcan) has a greater affinity for the binding sites, the opioids the person used are replaced by the naloxone (Narcan) which reverses the overdose effects of the opioids.
 
What increases/decreases risk of an opioid overdose?

These factors are associated with increased risk of an opioid overdose:

  • Using too much (more than the usual amount; stronger than expected) 
  • less tolerance due to not using for at least a few days because of arrest, incarceration, hospitalization, rehab, etc.
  • Using alone
  • Mixing opiates with other substances, especially other respiratory depressants like alcohol and/or benzodiazepines (tranquilizers)
  • Other health issues 
  • Previous overdose
  • Mode of administration (Smoking and IV use are riskier)

These factors are associated with decreased 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
What are commonly used opioids?
Heroin, Oxycontin, fentanyl, morphine, Vicodin, and Percocet. 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.
 
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 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 and CVH Merritt Hall).  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. DMHAS has a 1-800 number for persons struggling with opioids who want to be connected to services: 1-800-563-4086.
 
Are all overdoses the same?
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 (Narcan) will not work on a cocaine overdose and there is no comparable naloxone (Narcan)-like medication to reverse it.
 
Where do I store the naloxone (Narcan)?
Naloxone (Narcan) should be stored at room temperature (neither too hot nor too cold) and should be kept out of sunlight; but not in the refrigerator.
 
What is an overdose “kit”?
Overdose kits are a handy way to be prepared by having everything needed in one place. A container of some sort is necessary to keep all the pieces together. The kit should include 2 doses of naloxone (Narcan), 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.
 
Who do I call if I use my prescription or if my naloxone (Narcan) expires and I need a refill?
Prescriptions for naloxone (Narcan) 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. They could also ask their primary care physician. This website also has a list of providers who can write prescription refills.

 

Should I report if I revived someone with naloxone?
Individuals are not required to report having revived someone with naloxone. At present, EMS, hospitals, and others because of their jobs are required to report naloxone reversals.

 

Will insurance cover the cost of the naloxone (Narcan)?

Insurance may very well cover the cost of the prescription. You can check with your insurance company. If you have Husky C or Medicaid LIA, the cost is covered by these plans.
 
Will naloxone (Narcan) work if the person overdosed on something other than an opioid
Naloxone (Narcan) will only work to reverse the effects of opioids.
 
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 (Narcan) has been given?
Yes. Naloxone does not last very long in the body, only 30 - 90 minutes. If the overdose was the result of a person using an extended release/long acting (ER/LA) opioid, it's possible they could re-overdose without taking additional opioids once the naloxone wears off. The reason is that naloxone does not remove opioids from the body, only from the receptor sites in the brain.

So, if the person who overdosed hasn't had time to metabolize the opioids in their system by the time the naloxone wears off, those opioids could reattach to the brain receptor sites and the person could re-overdose. This is one reason why it is important for people who have overdosed to be checked out at the hospital even if they have been revived already by the naloxone. 

 
Why won't my family doctor prescribe me naloxone?
Many people in our society, including some medical professionals, don't understand the addictive process. They mistakenly assume that an addiction reflects a lack of willpower, a personality defect or a moral weakness. These assumptions are untrue. Any person, under certain circumstances, has the potential to develop an addiction. Opioids are powerful and potentially addictive substances, including those prescribed by a doctor. If your family doctor will not prescribe you naloxone, there are other ways to obtain it. See the answer to Where can I go for naloxone and training?
 
What is fentanyl?
Fentanyl is both an opioid medication that can be prescribed to treat pain (it can be prescribed as a transdermal patch worn on the skin) and an illicitly manufactured opioid that can be created in a lab similar to how methamphetamine is created in “meth labs”. It’s the illicitly manufactured fentanyl that is playing a significant role in the current opioid epidemic. Fentanyl and its many analogues are dangerous because they are much stronger than heroin and can be pressed into pills and passed off as other medications or mixed into heroin without the user’s knowledge. Many overdoses now involve fentanyl or fentanyl analogues.

 

Where can I go for naloxone and training?

At this point in Connecticut, there are several ways to access naloxone and training:

  • Ask your family doctor for a prescription for naloxone, which can be filled at any Connecticut pharmacy
  • Go directly to a pharmacist certified to prescribe and dispense naloxone. You can use this link to find a certified pharmacist near you:  (insert link). The pharmacist will train you on how to use the naloxone.
  • Contact your Regional Behavioral Health Action Organization (RBHAO). These local DMHAS-funded RBHAOs  can provide you with naloxone and training.
  • Utilize the DPH mobile vans that provide sterile syringe exchange as they also have naloxone and can offer training.
  • Use DPH's NORA (Naloxone and Opioid Response App) available for free download at norasaves.com if you need step-by-step instructions on how to use naloxone. It can also help you access naloxone and other helpful resources.