Naloxone Administration

To prevent fatal overdose on-site at all NKY Health Locations and syringe access exchange sites.

NKY Health provides harm reduction services to individuals who use opioids and other substances. Recent data indicate that many, if not most substances are unknowingly laced with Fentanyl, a powerful synthetic opioid that increases the risk for potential overdoses. While waiting for emergency services to arrive, there are interventions that trained staff can do for the individual. Having access to naloxone, that temporarily reverses an opioid overdose, can aid in saving a life while waiting for emergency services to arrive.

It may be hard to tell whether a person is experiencing an overdose. If you are not sure, treat it like an overdose - you could save a life. Signs and symptoms to look for include:

● Small constricted “pinpoint pupils”

● Falling asleep or losing consciousness

● Slow, weak or no breathing

● Choking or gurgling sounds

● Limp body

● Cold and/or clammy skin

● Discolored skin (especially in lips and nails)

1. If a person appears to be unresponsive and/or unconscious, try to wake them by calling their name or talking to them loudly. If they do not respond, try waking them with a pain stimulus like pinching the ear or rubbing their sternum.

2. Assess surroundings during the response process:

   • Ask questions of bystanders such as “Does anyone have information on what happened?”

   • Directly observe the person - look for signs of injections on the skin or other opioid use

   • Observe the surroundings - look for medication bottles or signs of other opioid use.

3. Check breathing and responsiveness; if they are not breathing and are unresponsive immediately call for assistance, give a location of the emergency and have someone call emergency services (911) and get the AED and naloxone as described in the AED policy.

4. If a pulse is present and the person remains unconscious, trained staff can administer naloxone to the unresponsive person. If a pulse is not present, staff will use the AED machine or initiate CPR and give naloxone as soon as possible, but not to delay CPR. (See the AED policy). Do not wait for emergency workers to arrive.

5. Administer naloxone.

1.    Intranasal Instructions -For the Narcan nasal spray 4mg dose: Peel back the tab with the circle to open the Narcan nasal spray. Hold the Narcan nasal spray with your thumb on the bottom of the plunger and your first and middle fingers on either side of the nozzle. Tilt the person’s head back and provide support under the neck with your hand. Gently insert the tip of the nozzle into one nostril, until your fingers on either side of the nozzle are against the bottom of the person’s nose. Press the plunger firmly to give the dose of Narcan nasal spray. Remove the Narcan nasal spray from the nostril after giving the dose.

2.    Multi-Dose Vial Instructions - Draw up a full vial of 0.4mg (1mL) naloxone with the syringe supplied with the naloxone (1 inch needle). Administer naloxone in the victim’s deltoid (shoulder muscle), outer thigh muscle, or upper and outer quadrant of the buttocks. Clothing does not need to be removed to administer this injection.

3.    Auto-Injector (Evzio) Instructions - Pull auto-injector from the outer case. Pull off the red safety guard. Place the black end against the middle of the patient's outer thigh, through clothing (pants, jeans, etc.) if necessary, then press firmly and hold in place for 5 seconds. Injector should make a click and a hiss if activated correctly.

6. Utilizing naloxone in the event of a suspected overdose is a temporary treatment. More than one dose might be needed   under some circumstances.

7. If the person is still unresponsive after giving naloxone, and has a pulse, wait between 2 to 3 minutes before administering a second dose of naloxone. If the person no longer has a pulse, apply AED pads or initiate CPR. (See AED policy).

8. When the individual begins breathing on their own, lay them on their side in the recovery position and monitor breathing and pulse.

9. Upon awakening, try to keep the person awake and breathing.

10. Stay with the person until emergency assistance arrives.

11. After the person is transported to a medical facility, document situation and response on the appropriate forms. 

05/24/2023

• Updated purpose to include all NKY Health locations, relocated signs of an overdose to policy section, updated process to be in-line with updated CPR instructions and in a sequential order of the steps to respond in an overdose situation, and updated language throughout.