Naloxone to Reverse Opioid Overdose
What is naloxone?
Naloxone is a “rescue” drug that quickly and safely reverses opioid overdose. It is available as an injectable solution and as a nasal spray. Naloxone works by blocking the effects of opioids in the body.2 Virtually all opioid overdose deaths are preventable if naloxone is administered in time.
A person who has overdosed cannot administer naloxone to themselves — it must be administered by someone else nearby. The most effective way to prevent fatal opioid overdose with naloxone is to prioritize naloxone distribution to people who use drugs3,4 (for example, through harm reduction and syringe services programs) as this group is the most likely to witness an overdose.5,6
Other new and innovative methods for naloxone distribution include:
- Publicly accessible “NaloxBoxes,”9
- Vending machine distribution,10
- Naloxone distribution by mail11 and
- Naloxone leave-behind programs led by Emergency Medical Services (EMS) professionals.12
“Focus on things that actually work: medications, providing naloxone and syringe service programs.”
– Michael Botticelli, Director of the Office of National Drug Control Policy, 2014-20171
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Hear from individuals and families about the importance of naloxone.
What evidence supports naloxone to reverse opioid overdose?
NALOXONE SAVES LIVES Opioids produce their effects on the body (including pain relief and slowed breathing) by attaching to and activating certain receptors in the brain.13 Naloxone is able to reverse opioid overdose by blocking those receptors and preventing opioids from attaching.2
NALOXONE EFFECTIVELY BLOCKS ALL OPIOIDS Although certain opioids, like fentanyl, produce stronger effects on the body, they do not require more naloxone to counteract.14,15 Multiple studies have demonstrated that the same amount of naloxone works to reverse opioid overdose regardless of fentanyl exposure.16,17
NALOXONE ACCESS SAVES LIVES Between 1996 and 2014, syringe services programs across the U.S. distributed over 150,000 naloxone kits, resulting in tens of thousands of opioid overdose reversals by community members.18 The reach of naloxone access programs has since expanded. For example, North Carolina received reports of 4,152 successful community overdose reversals with naloxone in the year 2021 alone.19
NALOXONE DOES NOT WORSEN SUBSTANCE USE Common myths about naloxone are that it encourages drug use and discourages people who use drugs from seeking treatment.20,21 These claims are untrue; multiple studies have found no association between naloxone access and worsening patterns of substance use.22–25
WHAT ARE NALOXONE ACCESS LAWS? In response to rising overdose rates, states have implemented laws that make it easier for members of the public to access naloxone. State naloxone access laws vary, but many states have established a standing order that authorizes the dispensing of naloxone to persons meeting set criteria.26 Naloxone access laws are associated with lower rates of fatal opioid overdose.7,27–30
Watch a short video about NC Harm Reduction Coalition’s naloxone distribution model.
Are there risks to my community or institution if we don’t support naloxone to reverse opioid overdoses?
NALOXONE ACCESS LAWS DO NOT GUARANTEE NALOXONE ACCESS7 County leaders can help ensure that local residents successfully obtain the naloxone needed to save lives by providing institutional and financial support for naloxone access programs.
WITHOUT NALOXONE NEARBY, THERE MAY BE MORE OVERDOSE DEATHS Though most first responders already carry naloxone,20,31 the fastest way to reverse an overdose is to ensure that the person on scene when the overdose occurs (usually someone else who uses drugs5,6) has naloxone on hand before the overdose occurs.
How much naloxone do we need?
The amount of naloxone each community needs depends on a number of local factors. The website NaloxoneNeededToSave.org provides evidence-based estimates of the quantity of naloxone each state needs to achieve naloxone saturation.
State and federal block grants support the purchase of naloxone by public safety and public health agencies, but this may not be enough. One study compared naloxone access in 12 states and found that only one state met the national target for naloxone access.3
Remedy Alliance for the People is a non-profit organization that negotiates with pharmaceutical companies to provide community-based organizations, health departments and other entities with lower prices for generic injectable naloxone.32
In September 2022, the U.S. Food and Drug Administration issued new guidance that explicitly permits the bulk purchase of naloxone for harm reduction programs regardless of whether or not the purchaser is covered by a statewide standing order or a medical license.33
As of March 29, 2023, nasal spray naloxone (Narcan) is classified by the FDA as an over-the-counter medication.34
What are best practices for supporting or implementing naloxone to reverse opioid overdoses?
- Increase the local supply of naloxone by funding procurement or coordinating local or regional stockpiles.
- Provide funding and voice strong, unambiguous support for programs and sites that distribute naloxone. High-volume distribution though syringe services programs is typically the most effective strategy for preventing overdose death with naloxone.3
- Prioritize naloxone distribution to recently incarcerated persons and their social networks. Recently incarcerated people are at high risk of overdose34,35 and regularly use naloxone to save lives.36,37
- Reduce mandatory training requirements for those who distribute naloxone. About five minutes is all that’s needed to deliver successful and effective naloxone training.38,39
- Educate local pharmacies about naloxone access laws and dispensing naloxone to the community. Despite new regulations allowing pharmacists to dispense naloxone, levels of pharmacy distribution remain low.40 Reasons may include: poor understanding of naloxone access laws; not keeping naloxone in stock; and stigma against naloxone or people who use drugs.41,42
- Support policies that treat naloxone as a public health tool, not drug paraphernalia. Naloxone possession should be encouraged and does not indicate criminal activity.
What are examples of successful naloxone distribution programs?
The first large scale effort to distribute naloxone to people who use drugs was pioneered by Dan Bigg at the Chicago Recovery Alliance in 1996.43
In Anne Arundel County, Md., the department of health offers free, ongoing trainings to teach community members how to administer intranasal naloxone. Led by the county’s Overdose Response Coordinator, the trainings are held a few times per month and equip each participant with a naloxone kit to take with them into the community.44
In 2022, the San Diego Board of Supervisors unanimously approved a resolution to provide overdose prevention education and naloxone distribution in schools. The Board’s action will educate students and their parents about overdose risks and increase the availability of naloxone among student first responders.45
Rikers Island Correctional Facility, New York City’s jail, distributes naloxone to community members who come to the jail for visitation. In the first six months of this program, 20% of the 226 visitors who received naloxone witnessed an overdose, and most used that naloxone to reverse the overdose and save a life.37
Project DAWN (Deaths Avoided with Naloxone), an initiative coordinated by the Ohio Department of Health, provides naloxone supplies to a diverse network of hundreds of organizations providing overdose education and naloxone distribution in communities.46
Brandeis Opioid Resource Connector
These and many other model programs are described online at the Brandeis Opioid Resource Connector.
Where can I learn more about naloxone to reverse opioid overdoses?
- U.S. Substance Abuse and Mental Health Services Administration’s “Overdose Prevention Toolkit”
- Project Lazarus’ “Project Lazarus Community Toolkit”
- U.S. Bureau of Justice Assistance’s “Law Enforcement Naloxone Toolkit”
- National Harm Reduction Coalition’s “Guide to Developing and Managing Overdose Prevention and Take-Home Naloxone Projects”
- National Harm Reduction Coalition’s “How to Assemble Naloxone Kits”
- RTI International’s “Overdose Education and Naloxone Distribution: Best Practices for Syringe Services Programs”
- Prescription Drug Abuse Policy System’s “Naloxone Overdose Prevention Laws”
- The Network for Public Health Law’s “Legal Interventions to Reduce Overdose Mortality: Naloxone Access Laws”
- Overdose Lifeline’s web-based “Layperson Naloxone Administration” CE/trainer course
- Get Naloxone Now’s web-based “Opioid Overdose Prevention” training
- National Harm Reduction Coalition’s “Opioid Overdose Basics: Responding to Opioid Overdose”
Where can I find support or technical assistance for scaling up naloxone to reverse opioid overdoses in my county?
Remedy Alliance for the People is a non-profit organization that negotiates with pharmaceutical companies for lower prices on generic injectable naloxone. Remedy Alliance also offers technical assistance for establishing and scaling up a naloxone distribution program. Technical assistance may be requested directly through their website.
The NHRTAC was established by the U.S. Centers for Disease Control and Prevention and the U.S. Substance Abuse and Mental Health Services Administration to provide free assistance to those implementing harm reduction services in their community. Technical assistance for implementing naloxone distribution programs may be requested through the NHRTAC website.
NASTAD provides technical assistance for the implementation of naloxone distribution programs to health departments and community-based organizations. They also provide regional harm reduction support through a network of professional consultants working across the United States.
State-specific Technical Assistance Programs
Many U.S. states and territories fund robust technical assistance providers to assist communities in implementing naloxone distribution programs. Examples include:
- The Overdose Prevention Team at the North Carolina Division of Public Health Injury and Violence Prevention Branch.
- The Opioid Overdose Reduction Technical Assistance Center at the University of Pittsburgh School of Pharmacy’s Program Evaluation Research Unit.
The two largest opioid settlements include requirements on how funds can be spent. Learn more about approved uses of the funds that are high-impact and under county authority.
Syringe Services Programs (SSPs) provide low-barrier access to sterile supplies for safer substance use, naloxone and overdose prevention tools like fentanyl test strips and drug checking services.
Medication-assisted treatment is considered the “gold standard” of care for opioid use disorder (OUD). The FDA has approved three medications for treating OUD: methadone, buprenorphine and naltrexone.
During pregnancy, the evidence-based standard of care for opioid use disorder (OUD) is treatment with methadone or buprenorphine.
Opioid Solutions Center
NACo's Opioid Solutions Center empowers local leaders to invest resources in effective treatment, recovery, prevention and harm reduction practices that save lives and address the underlying causes of substance use disorder.
On November 13, members of NACo's Commission on Mental Health and Wellbeing sent a letter to the U.S. Senate Committees on Finance and Health, Education, Labor and Pensions. The Commission called on Congress to support counties in delivering high-quality, assessible mental health services to address residents' comprehensive behavioral health needs in any mental health legislation package.
Every other week, NACo’s County Countdown reviews top federal policy advocacy items with an eye towards counties and the intergovernmental partnership.
Senators launch the Bipartisan Mental Health Caucus, a promising partner for NACo's Commission on Mental Health and Wellbeing in advancing crucial mental health policy.
NACo submits comments on the proposed Mental Health Parity rule, championing mental health coverage, supporting fair treatment limits and robust data collection and requesting consideration of county health plan administration.
Guilford County, N.C. is aiming to reduce its racial disparity in infant mortality by 50% in five years and eliminate it completely within the next decade.
About the Brief
Jennifer J. Carroll, PhD, MPH
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