Responding to Overdose: How to Administer Naloxone

If you or someone you know is experiencing issues with substance use, call The National Rehab Hotline at 866-210-1303 for help over the phone. Of course, if someone is experiencing an emergency, you need to call 911 immediately and administer naloxone if you have it available.

Time is of the essence when responding to an overdose. Properly administering naloxone to someone experiencing an overdose is critical, especially since the person who is overdosing cannot do this himself or herself. People survive overdoses because others take swift action. If you do happen to have some naloxone on hand, knowing how to properly administer it could save another person’s life. Here is what you need to know about naloxone and how to administer it to someone experiencing an overdose.

What Is Naloxone?

Knowing about naloxone is important. Often referred to by its brand names Narcan or Evzio, naloxone is a pre-filled automatic injection device that counters the effects of many opioids. Although it might not reverse the effects of pentazocine or buprenorphine, an injection of naloxone during an overdose can be life-saving. A second dose might be necessary, but one injection will often help to reverse the effects of the opioids that a person overdosed on.

If you have a naloxone injectable, be sure to keep it with you at all times. If you end up overdosing, first responders will be able to use it to help you. It can also come in handy if you encounter someone else you know is overdosing. Just bear in mind that every dose has an expiration date, which will be printed on it. If an injection is past the expiration date, you should properly dispose of it and get a new one that is not expired.

If you have the automatic injection, it will provide you with an electronic voice system that can give you step-by-step instructions about how to inject the dose in case of an emergency. Of course, technology is susceptible to errors, so knowing beforehand how to use it can come in handy and can shave precious time off of your response.

Assessing for Overdose Signs

Not all overdoses are obvious. If you aren’t sure whether someone has overdosed, call 911, and follow the instructions that the dispatcher gives you. The operator will likely ask you to assess for signs of an overdose, which include:

• Constricted or “pin-pointed” pupils
• Falling asleep or losing consciousness
• Choking or gurgling sounds coming from the throat
• Breathing that is slow and shallow
• Pale, cold skin that is bluish-gray
• A limp body

Stimulating the Individual

You will need to try to stimulate the person before administering naloxone. If he or she is unconscious, you need to try to bring the individual to consciousness, first verbally and then potentially physically.

Verbal Stimulation

First, try to call the person’s name. If you don’t know the individual well, check for identification that will tell you the name and that will possibly inform you about whether he or she has any known health conditions. You can also say, “I am going to administer naloxone,” or “I am going to dial 911,” to arouse the person.

Physical Stimulation

If verbal stimulation does not work, you might have to physically stimulate the individual. First, make a fist, and rub your knuckles into the center of the chest where the ribs join, which is known as the sternum. Next, rub your knuckles on the upper lip. If that does not work, try pinching the back of the arm.

Getting the overdosed person to speak to you is essential. If you are able to wake the individual up, get him or her to focus. If he or she is having trouble responding, you need to dial 911. Keep an eye on the individual’s condition until first responders arrive. If the person cannot be stimulated, or if his or her condition seems to be deteriorating, treat this as an emergency situation. Do not try any other form of resuscitation before calling for help.

Putting the Individual Into the Recovery Position

If you need to leave the person for a moment to make a 911 call, you will need to put him or her into the recovery position. Gently lay the person on the side with the top knee bent. Turn the face to the side that matches the direction that the top knee is pointing. If the person throws up, he or she will projectile onto the floor and not choke on the vomit.

What to Do If You Can’t Call 911

Calling 911 might not always seem like an option if you are tending to the person. If you are not able to call, try to get someone who is nearby to make the call for you. If you have to do rescue breathing, administer the naloxone and get the person into the recovery position before you can flag down help, then you might have to do just that. Tend to the direst needs first.

How to Administer Naloxone

Administering naloxone is only recommended for opioid overdoses. If you know that this person has overdosed on opioids, you may proceed with the injection or nasal spray.

Administering Nasal Spray Naloxone

To administer the nasal spray form of naloxone, you need to pull or pry off the yellow caps and then the red cap. Next, grip the clear plastic wings, and gently screw the naloxone capsule into the syringe’s barrel. Insert the white cone first into the nasal cavity; start with either nostril. Give one short, hard push on the capsule’s end to spray the naloxone into the person’s nose. Half of the capsule should be sprayed into each nostril.

If the person does not become responsive in five minutes or less, administer the second dose. If the second dose does not work, it could be that the heart has stopped pumping, that the person does not actually have opioids in his or her system, or that the individual has taken very strong opioids. Fentanyl, for example, will likely require more than one dose and possibly more than two.

Administering Injectable Naloxone

Injectable naloxone comes in two different dosages as a multi-dose 10-mililiter vial and single-dose 1-mililiter vial with a top that pops off. Naloxone should never be stored under light and should not be used past its expiration date. If you are using injectable naloxone, follow these steps to administer it:

1. If the person is not breathing, quickly provide a few resuscitation breaths.
2. Use an intramuscular needle, which is typically 1 to 1.5 inches long and which can be acquired at a local pharmacy. If this needle isn’t available, you can use a smaller needle and inject under the skin.
3. Pop the orange top off of the vial.
4. Draw 1cc, 1mL, or 100u of naloxone into the syringe.
5. Choose a muscle that is easy to get to, such as the thigh, shoulder or upper outer buttock quadrant. Inject the naloxone straight in to ensure that you get it into the muscle.
6. Continue providing rescue breathing for two to three minutes after the injection.
7. If the person is not responsive after three minutes, provide a second dose, and continue to breathe for the individual. Should the person still not respond, his or her heart might have already stopped, or he or she might require even more naloxone due to the strength of the opioids.

Naloxone only lasts for about 30 to 90 minutes, and opioid effects can last much longer. An overdose can still occur after the naloxone has worn off. It also has some seriously uncomfortable withdrawal symptoms since it blocks the way that opioids act on the brain. Some people might want to use opioids again immediately afterward because the withdrawal symptoms are downright unpleasant. This is why it is crucial that someone stays with the person after naloxone is administered. This person needs to be monitored since an overdose can occur again soon after receiving naloxone.

How to Perform Rescue Breathing

Being able to perform rescue breathing is essential when dealing with a person who has overdosed. If someone is experiencing shallow, short breaths once every five to 10 seconds or has stopped breathing entirely, rescue breathing needs to start immediately. The fastest way to revive someone in this state is to use your own breath.

Start rescue breathing by doing the following:

1. Place the person flat on his or her back.
2. Tilt the chin skyward, and make sure the airways are open.
3. Look inside of the mouth and see if anything, such as gum or even the tongue, is blocking the airway. You might even find a cheeked fentanyl patch inside of the mouth. All types of items have been found inside the mouths of those who have overdosed, so checking before you start breathing for the person is essential.
4. Once the airway is clear, plug the nose with one hand and give two evenly spaced, regular breaths. You want to get enough air into the other person’s lungs to cause the chest to rise. If the chest does not rise, tilt the head back, and make sure the nose is tightly plugged. Then, try your rescue breathing again.
5. Administer one regular breath every five seconds.

What About CPR?

Cardiopulmonary resuscitation, or CPR, is not recommended for someone experiencing an overdose. This type of response is best used for someone going into cardiac arrest. Those who have overdosed are typically dealing with respiratory depression and not cardiac arrest. Therefore, they require rescue breathing without hands-on chest compressions.

Divide Up the Duties

If you are not the only person there with the individual who has overdosed, then you and your companions need to decide quickly how to divide up your duties. One of you can call 911 for help while the other gets the person into the rescue position and grabs the naloxone kit. It is even better if a third individual can step in to help take turns with the rescue breathing. Rescue breathing can be taxing on the rescuer, so dividing up that duty can be helpful.

What to Do Afterward

A person who has overdosed will need good aftercare no matter what. That person could experience sickness due to the naloxone counteracting the opioids trying to act on the brain. Stay with the person, and do your best to gently offer help. He or she might not take your assistance, but it is important that you are supportive and understanding.

Naloxone can work immediately, but it sometimes takes up to eight minutes to kick in, and it only lasts for 30 to 90 minutes. A person is likely to overdose again depending on how well his or her liver is processing things, the half-life of the drug taken, how much of the drug was taken, and whether he or she decides to use again.

A person who cannot walk or talk after being given naloxone needs to get to a hospital immediately. Stay with him or her until first responders arrive and are able to load the individual onto a stretcher. Keep talking with the person; the goal is to get him or her alert and oriented. Of course, staying with the overdose victim also shows your compassion in a time of need.

In an emergency, it’s best to call 911 for help. However, if you’re in a non-emergency situation and you need help dealing with your own or a loved one’s addiction, call The National Rehab Hotline at 866-210-1303 to learn about resources near you.