Education

The Basics
What is naloxone?

  • Naloxone is a medication that quickly reverses the effects of an opioid overdose, usually within 1-3 minutes. It can be injected under the skin or into muscle or a vein. A nasal spray version of naloxone is also available. Naloxone does not have harmful side effects, get people “high,” or reverse overdoses caused by substances other than opioids.

Naloxone, Narcan, Naltrexone, Suboxone… What’s the difference?

  • Naloxone is the generic name for the medication
  • Narcan is one brand name of a naloxone product
  • Suboxone is the brand name for buprenorphine + naloxone (prescribed as Medication Assisted Treatment for opioid use disorder)
  • Naloxone ≠ naltrexone (longer-acting opioid antagonist for alcohol use disorder treatment and relapse prevention in opioid use disorder)

A history of naloxone:

  • In the past, naloxone could only be given at the hospital or by professionals working with ambulance services.
  • Today, most states allow for legal administration of naloxone from medically trained and non-medically trained individuals (including law enforcement and laypersons).
    * For more information by state, visit the Network for Public Health Law
  • Take home naloxone rescue kits are now increasinglyavailable for individuals that may  experience or witness an overdose event. Most naloxone distribution efforts are based in community harm reduction settings for people who actively use drugs or are in recovery from drug use.
  • Across the US, providers have begun to prescribe naloxone to high-risk patients, and in many US states, naloxone is available at pharmacies without an outside prescription (including MO as of August, 2016).
  • From 1996 – June 2014, layperson naloxone administration has saved more than 26,000 lives (CDC, 2015)

Missouri Naloxone Legislation:

  • Statute Section 190.255.1, HB 2040, enacted August 28th, 2014.
    Relevant topics covered by this bill:
    – Allows first responders to obtain, carry and administer naloxone
  • House Bill No. 1568. Enacted August 28, 2016.
    Relevant topics covered by this bill:
    – Pharmacy availability (without a prescription)
    – Pharmacist criminal and civil immunity
    – Criminal and civil immunity for any person administering naloxone “in good faith”
    – Immunity from disciplinary action from licensing boards
    – Right to store/dispense for free if acting under a standing order from a health care professional


History of OEND programs/Harm reduction philosophy and effectiveness:

Naloxone distribution initiatives have traditionally aligned with the Harm Reduction strategies.

Harm Reduction Philosophy:

  • The goal of harm reduction is to use practical strategies intended to reduce negative consequences that result from drug use. Additionally, the harm reduction movement has pushed for social justice for the rights of individuals who use drugs.
    *For more information about harm reduction, please visit here.

Overdose Education and Naloxone Distribution (OEND) Effectiveness:

Below are descriptions and links to a small subset of the research conducted on the effectiveness and impact of OEND initiatives (For a more comprehensive reference list, please visit here):

  • Those who received naloxone rescue kits as part of OEND had higher rates of calling 911, administering naloxone, and staying with the victim until help arrived than those who did not receive naloxone (Dwyer et al., 2015)
  • Providers/staff have a generally positive reception of the program (Samuels, 2014), which is a shift compared to past surveys (Beletsky et al., 2007).
  • Community naloxone distribution reduces overdose at a population level, increases preparedness to respond effectively (Walley et al., 2013), but does not increase levels of drug use (e.g., Dwyer et al., 2015).
  • Conducting OEND with chronic paint patients on opioids reduces opioid-related ER and hospital visits and overdose events at 6 months and 1 year post intervention, with opioid dosage levels remaining stable(Coffin et al., 2016)

Fentanyl

What is fentanyl?

Fentanyl is a powerful synthetic (manufactured) opioid prescribed by physicians to treat patients with severe pain, such as post-surgical or cancer pain. Legally prescribed fentanyl generally comes in the form of a patch, nasal spray, lozenge, injection, tablets or films. However, illegally manufactured fentanyl can be found in a powdered form and is frequently used to “cut” heroin or in counterfeit prescription pills (including fake opioids and benzodiazepines).

Why is fentanyl so dangerous?

Fentanyl is 50-100 times more potent than morphine and is often added to drugs without the user’s knowledge. This places users at a higher risk for overdose since a dose that appears safe may actually be lethal. Most users try to actively avoid fentanyl but are often unable to detect its presence.

What does a fentanyl overdose look like?

The onset of an overdose caused by fentanyl can occur at a much quicker rate (sometimes within seconds) than heroin and may take multiple doses of naloxone to counteract due to the potency of fentanyl.  In the majority of cases, fentanyl overdoses appear very similar to other opioid overdoses. However, atypical overdose symptoms due to fentanyl have been reported, including:

  • Immediate blue or grey lips
  • Body stiffening/seizure like activity
  • Foaming at the mouth
  • Confusion before becoming unresponsive

How do I respond to a fentanyl overdose?

Fentanyl overdoses are often indistinguishable from overdoses caused by any other opioids and should be responded to similarly beginning with administering naloxone, calling 911, and starting rescue breaths (see above).

Where can I go for additional information?

For additional information and current reports on fentanyl, visit: