Naloxone and The Opioid Epidemic

Since 1980, the number of deaths from drug overdose has increased five-fold. In 2009, deaths from drug overdoses outnumbered the deaths due to motor vehicle crashes. Unfortunately, this trend continues to grow.

As the epidemic of prescription drugs and illicit opioids overdoses continues to grow, access to naloxone is being expanded. The general public now has access to naloxone products and can administer them to reverse opioid overdose.

With this increase in access, comes many questions. Fortunately, the University of Texas College of Pharmacy, in collaboration with the School of Social Work and Texas Overdose Naloxone Initiative, is leading efforts to combat the opioid epidemic. Through Operation Naloxone, they provide overdose prevention and response education to students, health professionals and the public.

Naloxone can reverse the effects of an opioid overdose and save a life.

Naloxone is an opioid antagonist that blocks the effects of opioids, including heroin. If someone takes too much of an opioid, they may experience fatal respiratory depression. Naloxone can reverse the effects of opioids and allow an overdose victim to breathe again. Naloxone is not a controlled substance and cannot be abused. If an overdose victim is physiologically dependent on opioids, administering naloxone may precipitate acute opioid withdrawal. Industry experts recommend naloxone be offered to every patient who fills an opioid prescription and pharmacists maintain a stock of naloxone and be prepared to dispense it.

No formulation of naloxone has been proven more effective than another.

Price and ease-of-use vary greatly, and these will likely be the determining factors when you work with a patient to select an appropriate formulation. Some formulations require separate equipment to be dispensed for proper administration.

Reports of ultra-potent, naloxone-resistant opioids are unsubstantiated.

The U.S. is seeing an influx of illicitly-manufactured fentanyls (IMF), some of which exhibit enhanced binding affinity to mu-opioid receptors. There have been isolated reports of IMF overdoses in which several doses of naloxone were administered to resuscitate the victim, but it is not clear that all doses were required. It is hypothesized that high-dose formulations of naloxone may exhibit superior efficacy against IMF, but this has not yet been demonstrated in practice.

State Regulations

As of last Fall, forty-six jurisdictions have laws that address access to naloxone. The laws from state to state vary. Kansas, Missouri, Arizona, Wyoming, and Montana do not have any laws that address access to naloxone. For more information about the laws regarding access to naloxone in your state, refer to the Prescription Drug Abuse Policy System website.

To find naloxone administration videos and other educational resources, be sure to visit OperationNaloxone.org.

Be sure to stay tuned for the release of a comprehensive harm reduction continuing education module developed by The University of Texas at Austin College of Pharmacy. Look out for our upcoming newsletter with exclusive access to this module.


Information and the formulation details below have been provided by Operation Naloxone, an initiative at the University of Texas at Austin.

Dispensing Naloxone

It is generally recommended to dispense two doses in case the first dose is insufficient.

Prescriptions should be issued to the recipient, even if the recipient is not the individual at risk for opioid overdose.

Intranasal

Prefilled Syringe

  1. Naloxone Prefilled Syringe (2mg/2mL), #2 boxes, PRN refills

Directions: Instill 1mL into each nostril as needed for suspected opioid overdose, repeat in 2 minutes if necessary

  1. Mucosal Atomization Device with Luer-lock, #2 devices, PRN refills

Directions: Attach to prefilled naloxone syringe as needed for suspected opioid overdose

Nasal Spray

  1. Narcan Nasal Spray (4mg/0.1mL), #1 two-pack, PRN refills

Directions: Instill 4mg into nostril as needed for suspected opioid overdose, repeat in 2 minutes if necessary

Intramuscular

Vial & Syringe

  1. Naloxone Vial (0.4mg/mL), #2 vials, PRN refills

Directions: Inject 1mL into outer thigh as needed for suspected opioid overdose, repeat in 2 minutes if necessary

  1. IM Needle & Syringe (3mL, 25g, 1ʺ), #2 syringes, PRN refills

Directions: Use to administer naloxone as needed for suspected opioid overdose

Prefilled Syringe

  1. Naloxone Prefilled Syringe (2mg/2mL), #1 box, PRN refills

Directions: Inject 1mL into outer thigh as needed for suspected opioid overdose, repeat in 2 minutes if necessary

  1. IM Needle with Luer-lock (25g, 1”), #2 devices, PRN refills

Directions: Attach to prefilled naloxone syringe as needed for suspected opioid overdose

Auto-Injector

  1. Evzio Auto-injector (2mg/0.4mL), #1 two-pack, PRN refills

Directions: Inject into outer thigh as needed for suspected opioid overdose, repeat in 2 minutes if necessary

  1. Evzio Auto-injector (0.4mg/0.4mL), #1 two-pack, PRN refills

Directions: Inject into outer thigh as needed for suspected opioid overdose, repeat in 2 minutes if necessary


References

  1. Centers for Disease Control and Prevention, “Addressing Prescription Drug Abuse in the United States Current Activities and Future Opportunities” https://www.cdc.gov/drugoverdose/pdf/hhs_prescription_drug_abuse_report_09.2013.pdf. Accessed August 23, 2017.
  2. University of Texas at Austin College of Pharmacy, “Operation Naloxone” http://sites.utexas.edu/naloxone/. Accessed August 23, 2017.
  3. American Journal of Public Health, “Expanded Access to Naloxone: Options for Critical Response to the Epidemic of Opioid Overdose Mortality” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2661437/. Accessed August 23, 2017.
  4. The Policy Surveillance Program, “Naloxone Overdose Prevention Laws” http://lawatlas.org/datasets/laws-regulating-administration-of-naloxone. Accessed May 3, 2017.
  5. Images Courtesy of Pureradiancephoto | Dreamstime https://thumbs.dreamstime.com/b/naloxone-sign-counter-pharmacy-to-let-people-know-over-available-to-help-narcotic-overdose-83267513.jpg. Accessed August 23, 2017.