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General Ways to Use Naloxone Safely

Simply having Narcan, Evzio, or generic injectable naloxone kits around isn’t good enough when it comes to effectively responding to opioid overdoses. Rather, the effective administration of naloxone in cases of likely or certain opioid overdose is more about being educated about such.

In my personal experience, drug users across Northwest Tennessee (NWTN) are typically not aware of what naloxone or Narcan is, let alone how to use it effectively.

As with everything else on this website, this publication is not meant to be perused or referenced as an authoritative source. You should use your judgement in determining to what degrees I’m correct, reasonable, incorrect, and unreasonable.

Without further ado, here are a few ways to use naloxone safely and derive more utility — “utility” refers to happiness or use people get out of things — from educating others about best practices in naloxone administration for opioid overdose and actually carrying out the procedure in real-life yourself.

Naloxone-Reversed Opioid Overdoses Cause Immediate Withdrawal

Opioid withdrawal syndrome, a medical term that might be referred to as being sicker-’n’-shit, is how a rural Tennessean might describe the opioid withdrawal experience.

If you’re not familiar with how opioid withdrawal syndrome plays out, symptoms gradually show up and slowly get worse from roughly 12 to 18 hours after one’s most recent opioid use and typically peak by the third or fourth day of withdrawals.

This type of opioid withdrawal, which occurs naturally, is medically known as spontaneous opioid withdrawal. The “spontaneous” in the phrase refers to the spontaneous cessation of opioid use.

The opposite of this natural, gradual accumulation of symptoms is known as precipitated withdrawal and is caused when opioid-dependent patients are administered a sufficient dose of naloxone.

One time, I overdosed on a heroin-fentanyl mixture and was brought back with 0.16 mg of naloxone or less. Despite the fact I should have experienced mild withdrawal symptoms after being revived with naloxone, I didn’t.

I understand drugs from a real-world perspective shaped by my tenure as a long-term drug user, having grown up with a super-problematic drug user for a mother, and my experience from having served Northwest Tennessee as an active advocate for harm reduction. I say this because you might pharmacologically understand opioids, opioid dependence, and naloxone use in opioid-dependent persons in response to opioid overdose symptoms — that’s something I don’t understand at all!

However, Usually Only If It’s in Doses That Are Small Enough

Picture of Narcan nasal spray.
Narcan nasal spray

Traditionally, generic vials of naloxone, Narcan, and Evzio have carried various naloxone dosages. Generic naloxone vials typically carry 0.4 milligrams. Narcan nasal spray carried 4 milligrams of naloxone per dose. The rarely-used voice-assisted auto-injector known as Evzio contains either 0.4 or 2 milligrams.

Evzio auto-injector

All of these doses are high in terms of what’s typically required to reverse opioid overdose in typical modern cases. A recent study carried out by the American College of Emergency Physicians reported that, when median intravenous doses of 0.08 mg naloxone administered in just short of 10 separated bursts in stop-and-go fashion, it was easier to not overdo it on naloxone, resulting in more favorable outcomes, often entirely avoiding opioid withdrawal symptoms — this was even true for opioid-dependent persons.

Which one is better:

• (1) Using just enough naloxone to bring someone back from an opioid overdose without causing precipitated withdrawals, though with higher risks of death?

• (2) Or using plenty of naloxone despite patients almost certainly suffering precipitated opioid withdrawal for about two hours — as far as naloxone administration is concerned?

I think we’d much rather have better outcomes if we stuck with number two. However, opioid use scenarios that are more controlled and better supervised, especially in the presence of a confident, experienced, and well-researched partner.

Also, as far as reliable-and-gentle average intranasal naloxone doses go — including both Narcan and with atomizer-equipped syringes filled with injectable naloxone — ideal doses have been shown to usually be around 2 milligrams naloxone administered intranasally. In such cases, per the aforementioned American College of Emergency Physicians study, researchers have found an 83% successful response rate with this dosing approach.

Knowing About It Isn’t Enough; Trainees Need Practice

Most people aren’t required to take prescription medicine that necessitates the use of syringes and injections into muscles, veins, or under the skin. Further, most people also aren’t intravenous drug users.

Generic, vialed naloxone must be injected either directly into a vein, which requires skill to do quickly, a muscle, or under the skin — respectively known as intravenous (IV), intramuscular (IM), and subcutaneous (SC) use.

Six-panel infographic with written instructions about using naloxone for opioid overdose.
Harm Reduction Coalition

Although both SC and IM administrations are easier and straightforward, people are prone to experiencing issues when administering naloxone without having physically practiced the motions of intramuscular, subcutaneous, or intravenous use. This is even true for naloxone kits that contain step-by-step, picture-based charts that inform people how to use naloxone to bring people back from excessive opioid doses as they read it — not requiring prior experience for most people, that is.

Get your hands on sterile water or, if that’s not available, cold tap water that has been boiled for 5 to 10 minutes immediately preceding its use.

Now, you’ll need to find one or more guides or other information sources for intramuscular administration. Peruse their steps, make mental run-throughs of carrying them out, and practice at least two intramuscular injections before considering yourself or someone else as being able to carry out the administration of naloxone for opioid overdoses. Also, since you should have more than plenty of vials of naloxone in your possession just to be on the safe side, you should be able to burn through anywhere from two to a few vials of naloxone in practicing how to draw up solutions into syringes from vials.

Real-world practice and having an army of tips built up from many academic sources form the ideal combination to serve as the foundation that supports the home of reversing opioid overdoses with naloxone.

Check Out This Unconventional Concern to Consider Regarding Injection Naloxone Use

The Internet is packed to the brim with helpful content regarding harm reduction and staying safe while using opioids.

However, one thing that I picked up from the real world that I’ve never seen mentioned online is that injectable naloxone is prone to causing syringes’ needles to break of as the result of opioid overdosers’ having regained consciousness. To better explain, as you might know, people brought back from opioid overdoses are often confused and sometimes don’t take well to waking up to being essentially pinned down and hovered over by one or more people who are usually strangers (e.g., emergency medical technicians).

Since you’ll never know exactly how people will respond to understandably-disorienting naloxone-aided opioid overdose reversals, intranasal uses of naloxone are safer than those involving syringes because of their potential spread of blood-borne diseases from getting poked by the syringe used to administer naloxone or the possibly-yet-unlikely incidence of hypodermic needles breaking off inside people’s bodies.

Should this be a central reason in determining best practices for naloxone?

No! It’s more of a novel, though very real, practically-minded idea that was presented to me by Melesa Lassiter, Tennessee’s Region 6N — Region 6N is one of 13 regions that the state’s 21 Regional Overdose Prevention Specialists are assigned to — Regional Overdose Prevention Specialist. She covers all of Northwest Tennessee, a nine-county area home to roughly 250,000 people.

I haven’t since heard or seen this idea anywhere else and, although it shouldn’t be a central factor in determining how we use naloxone, I feel responsible for fleshing it out for the World Wide Web to see.

Always Use Around Others

Without being supervised by someone who fits all three of the categories below, you’re setting yourself up for an increased risk of suffering permanent damage or death as a result of opioid overdose:

• Aware of your opioid use.
• Trained in administering naloxone during opioid overdose.
• Well-versed in spotting opioid overdose very quickly after happening.

Unfortunately, not all of us are actually able to regularly use opioids around someone else. Some of us are forced to use without hardly ever being supervised by someone who knows what’s going on.

Others, especially in NWTN, where stigmas are high and people are particularly incentivized to retain information regarding their drug among themselves and keep it away from most others, are able to regularly consume opioids around other people except those people aren’t trained in the use of naloxone or spotting opioid overdoses, let alone being aware when their drug-using counterparts consume opioids.

Another important part of responding to opioid overdoses is performing CPR, or, at the very least, rescue breathing until paramedics arrive, You’re not able to perform these basic medical procedures on yourself — while it’s possible for people to self-administer naloxone successfully in the prevention of imminent opioid overdoses, it’s actually physically impossible to be able to perform CPR or rescue breathing on yourself.

Of course, this is another important reason why you should avoid using opioids without active, ample supervision.

Just a Few

Depending on how you classify things, this text covers either four or five tips — just a select few — for using naloxone in response to opioid overdose. Either way, there are many other tips worth reading that will improve various factors regarding this application of naloxone — in other words, this article just scratches the surface.

If you learned something, carry it with you and try to spread the word to other people. Even if you didn’t, being exposed to how different people explain things is a good way to improve your efforts in educating others about harm reduction.

By Daniel Garrett

I'm a self-employed writer, long-term drug user, and resident of rural Tennessee. Find me on Twitter at @DanielGarrettHR or email me at danpgarr@ut.utm.edu.

1 reply on “General Ways to Use Naloxone Safely”

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