What is Naloxone?
Naloxone is a medication that reverses an opioid overdose if administered quickly. It works by blocking the effects of opioids and reversing overdose symptoms such as respiratory depression. Naloxone can be administered by intranasal spray (into the nose), intramuscular (into the muscle), subcutaneous (under the skin), or intravenous injection (into the bloodstream).
Dr. Alexander Walley is a Professor of Medicine and an addiction expert at Boston Medical Center and Chobanian and Avedisian School of Medicine, focused on the medical complications of substance use, specifically HIV and overdose. He explains that “Naloxone is a key part of the overdose reduction strategies of major public health organizations, including the World Health Organization, the U.S. Department of Health and Human Services, the Centers for Disease Control and Prevention (CDC), and the U.S. Food and Drug Administration.”
While naloxone is highly effective in reversing opioid overdose, its effects are temporary, and individuals who have been administered naloxone should still seek emergency medical care to address the underlying overdose and prevent relapse into respiratory depression. “Time is a very important factor with naloxone administration, especially in the setting of Fentanyl,” emphasized Dr. Walley. “It used to be that we had minutes to hours to administer naloxone, and it could still be in time after somebody used an opioid like heroin or oxycodone, but with fentanyl, we need to administer naloxone within seconds to minutes after they take the drug that's causing the overdose.”
The History of Naloxone
First synthesized by researchers in 1961, medical professionals began administering naloxone to individuals experiencing opioid-related respiratory depression, effectively restoring normal breathing and consciousness. Its rapid action and minimal side effects have made it a cornerstone of emergency medical care for opioid overdoses. Naloxone distribution has expanded beyond medical settings to include first responders, harm reduction organizations, friends, and family members, empowering communities to respond swiftly to overdose emergencies.
Walley shared background on the history of naloxone expansion into communities: “In
1996, the Chicago Recovery Alliance, a harm reduction organization in Chicago that works with and among people who use drugs, began distributing naloxone directly to their community beginning the world's first coordinated naloxone distribution program. This effort was really underground, and many people thought illegal, but over the next 20 years it became mainstream and the cornerstone of overdose prevention and harm reduction. People have reported using naloxone to revive friends, peers, partners, bystanders, neighbors, and family members.”
What is Overdose Education and Naloxone Distribution (OEND)?
Overdose education and naloxone distribution (OEND) includes education about overdose risk factors and how to recognize and respond to an overdose, as well as how to administer naloxone and provide naloxone or full rescue kits. Overdose prevention education and broad community access to naloxone is associated with reduced opioid-involved overdose deaths. Effective nationwide naloxone distribution programs provide training and distribute doses to first responders, community-based organizations, public health departments, people who use drugs and their caregivers, employers, school systems, transportation partners, and jails and prison systems. Community-level implementation of OEND has been associated with reduced opioid overdose mortality.
Addressing Naloxone Myths
One common myth surrounding naloxone and its safety is that providing the medication to individuals will encourage substance use. However, research has shown that naloxone distribution programs do not increase drug use.
Dr. Walley addressed naloxone myths: “Moral hazard and risk compensation are terms for the belief or concern that giving people safety tools will make them take greater risks. In public health these concerns do not play out – the benefit of safety tools outweighs any riskier behavior that may occur. Examples of these concerns that have been debunked include the idea that seat belt laws result in riskier driving and more deaths in car crashes. The result of seat belt laws are that fewer people die from car crashes. There have been arguments that vaccination and condom distributions increase sexually transmitted infections, when strong controlled trial evidence from multiple studies in multiple venues has demonstrated that they reduce sexually transmitted infections. Distributing syringes to people who inject drugs decreases HIV transmission. It does not increase HIV transmission.”
This myth related to naloxone claims that people who use opioids will use more opioids or be less likely to seek treatment if they have access to naloxone. Dr. Walley uses the example of a fire extinguisher when educating community members. “When people ask, ‘Does naloxone increase drug use?’ it's like asking, “Does a fire extinguisher cause fires?’ A fire extinguisher does not cause fires and naloxone does not increase drug use. We put fire extinguishers where we think fires might occur, like kitchens, in case we need them. We should be giving naloxone to people who we think may witness an overdose, in case they need it. This has been looked at in multiple studies including a meta-analysis and the results found no evidence that take-home naloxone was associated with increased opioid use or overdoses.”
Types of Naloxone Distribution
The numerous models of naloxone distribution programs fall into two main categories – active and passive distribution.
Active Distribution - Strategies provide proactive distribution of overdose education and naloxone to at-risk populations and critical professionals and stakeholders. Examples include harm reduction programs handing out naloxone to at-risk clients, hospitals or emergency departments providing naloxone to patients admitted for substance use disorders (SUD), naloxone distribution to individuals released from prison and jail, and physicians co-prescribing naloxone with prescription opioid medications. Dr. Walley shared: “Active OEND increases OEND or naloxone distribution for high-risk populations and their social networks or venues where high-risk populations were likely to be found. Examples of active OEND included distributing naloxone at syringe service programs, in criminal legal settings, and through peer outreach.”
Passive Distribution - Passive distribution strategies focus on making naloxone available to those who seek it out on their own. Examples of passive distribution include making naloxone available at pharmacies without a prescription (referred to as a “standing order”) and in public areas such as restrooms and vending machines. In March 2023, the FDA approved Narcan® nasal spray for purchase over-the-counter (OTC) in places like drug stores, convenience stores, grocery stores, gas stations, and online. “Passive naloxone distribution examples include making naloxone available in retail pharmacies and naloxone boxes to host naloxone in areas where overdoses are likely to occur,” noted Dr. Walley.
Access the Ask the Expert interview with Dr. Walley here.
About the HEALing Communities Study
The HEALing Communities Study is a multi-site research study to test the integration of prevention, overdose treatment, and medication-based treatment in select communities hard hit by the opioid crisis. HEALing Communities is funded by the National Institutes of Health (NIH) Helping to End Addiction Long-term (HEAL) Initiative®.