Naloxone Saves Lives

Intranasal vs Intramuscular Naloxone

Naloxone comes in two forms: intranasal and intramuscular. Intramuscular naloxone is preferred because it has a higher bioavailability when injected, the route of administration may increase the speed in which the medication works, and the dosage of the medication is more controlled. However, if you are unfamiliar or uncomfortable giving an intramuscular injection we recommend using intranasal naloxone . 

Brands of Naloxone

Naloxone is the generic name of the medication, with the most common brand being Narcan. We distribute RiVive Naloxone because it has a lower (more tolerable dose) and it is manufactured by a nonprofit pharmaceutical company funded by the Opioid Settlements. Padagis naloxone is a brand frequently distributed at naloxone boxes around campus, chosen because it is less expensive and easier to access. 

RiVive, Narcan, and Padagis are the exact same medication and have the same administration (intranasal). Narcan and Padagis brand both contain 4 mg of Naloxone. We advocate against using brands with more than 4 mg of naloxone like Kloxxado and we prefer to distribute 3 mg RiVive. 

Why a Lower Dose is More Compassionate

We prefer a lower dose because higher doses of naloxone can send chronic opioid users into withdrawal which can be extremely painful and in some cases, dangerous to the person's health. Higher doses of naloxone are linked to worsened withdrawal symptoms. In the majority of cases, 3 mg of naloxone is plenty to reverse an overdose but if it isn’t, the box comes with two doses. 

• Absent or slowed breathing

• Cold, clammy, or discolored skin (blue lips or fingernails in lighter skinned individuals and grey lips or fingernails in darker skinned individuals)

• Constricted (small) pupils. This is a response specific to opioids that may not be seen in other life threatening emergencies.

• Snoring or gurgling sounds

• Unresponsiveness. To test for responsiveness you can deliver a painful (but not harmful) stimulus including a sternum rub, or a pinch on the shoulder above the collarbone.

Do not give naloxone to someone who is unresponsive but just high without their consent!

Follow directions on naloxone packaging. For intranasal naloxone, insert the device into the persons nostril and direct it backwards (as if you are giving them a COVID test). Press the plunger firmly once. Do not attempt to slowly give the dose as it will not spray properly. 

Only give a second dose after 3 minutes. Naloxone can take this long to work and giving someone several doses in a row can lead to intense discomfort for chronic opioid users. 

One you’ve identified that a person is experiencing a drug overdose, either call 911 or if there is someone close by, ask them to call 911. The most important thing is getting someone naloxone, so prioritize that.

When calling 911, it is often best to avoid mentioning that the individual is using drugs as police may be sent in addition to EMS which can be traumatizing for some individuals and can lead to stigmatized care.

When speaking to the 911 operator, it’s best to say, “My friend is unconscious and is not breathing.” If they ask whether you know what happened, you can say that you aren’t sure or just describe their physical symptoms and ask for care advice.

When EMS arrives make sure to let them know that you have given the person naloxone.

Rescue breaths are vital for someone experiencing an opioid overdose. This is because opioids suppress respiration and the person is not getting enough oxygen.

CPR is good if you are uncertain how long someone has been without breathing. If you see someone overdose, their heart is likely still beating and CPR is probably not needed.

Steps for giving rescue breaths

• Tilt the head back and make sure nothing is blocking the airway

• Pinch the persons nose

• Take a deep breath

• Exhale into the persons mouth

• Watch for their chest to rise

• Repeat

Make sure to give one breath every five seconds: you can think “a breath for you, a breath for me.”

Many people who are revived using naloxone do not realize that they have overdosed and they may be confused or upset. Naloxone gets rid of someone's high and can send them into withdrawal which can be extremely uncomfortable and even dangerous for a chronic opioid user. This is part of why it’s important to call 911.

Make sure that the person does not try to use anymore drugs as they might go back into the overdose. Additionally, naloxone wears off after 30-90 minutes and it is possible for the person to go back into an overdose. Respect autonomy if they want to leave but try to stay with them until EMS arrives. If they want to go, offer them another dose of naloxone.

Take care of yourself and try to get support. Responding to an overdose can be scary.