Naloxone and Other Opioid Overdose Reversal Medications

Opioids are a class of drugs derived from substances found in the opium poppy plant. They can also be created synthetically. Examples of opioid drugs range from prescription pain medication to illegal drugs.

Opioids in any form are addictive. They trigger the release of endorphins in the body. These endorphins boost feelings of pleasure and make it less likely that you'll feel pain. The euphoric feeling produced by opioids is powerful, but does not last long. As opioid use continues, the body can build up tolerance to the drug so that larger and more frequent doses are required to get that same euphoric feeling. This often leads to opioid use disorders. The use of opioids, either alone or with other drugs, is a major factor in drug overdoses in the United States. In particular, the use of benzodiazepines such as Xanax and Ativan increases the risk of opioid overdose.

Opioid overdose reversal medications (OORM) are lifesaving medications approved by the Food and Drug Administration (FDA) to reverse an opioid overdose. Opioid overdoses are commonly associated with recreational drug use, but can also occur in situations involving legitimate opioid use, such as when opioid-based medications like Oxycodone or Morphine have been prescribed to those dealing with intense, chronic pain.

An opioid overdose can happen when:

  • A patient misunderstands the directions for use, or accidentally takes an extra dose.
  • A person takes opioid medication prescribed for someone else.
  • Opioid medications are mixed with alcohol or over-the-counter drugs.
  • A person takes illegal drugs made with opioids.

Signs of opioid overdose include:

  • Breathing is very slow or has stopped.
  • Lips and nose are bluish in color.
  • The person is unresponsive.

Having OORMs on hand has unfortunately been stigmatized as a sign of illicit drug use, and is often viewed as a tool intended only for law enforcement officials or other first responders. In fact, OORMs are now available to the general pubic, and should be viewed as an important tool to have on hand for anyone using opioids for any reason.

Common Types of OORMs

Naloxone

Naloxone is considered an opioid antagonist. When administered, it binds to your body's opioid receptors. Receptors are the parts of your body that turn energy into electrical impulses. Receptors are utilized by the body in many different ways --- some are located in the skin and are responsible for the sense of touch; others mass together to form sense organs like eyes and ears. When naloxone binds with the receptors converting the opioid's "energy" into electrical impulses, it quickly blocks and reverses the drug's effects.

Naloxone should be given to any person exhibiting signs of opioid overdose. The FDA has approved two forms of naloxone:

  • Injectable --- This type of naloxone, available under a variety of brand names, can be injected with a needle into the muscle, into a vein, or under the skin. The majority of injectable forms of naloxone come in a vial, and the proper dosage has to be drawn up with a needle. The FDA has also approved a single-dose, prefilled syringe available under the brand name of Zimhi™.
  • Prepackaged Nasal Spray --- Available in prefilled, needle-free devices, this form of naloxone is sprayed into one nostril while the person lays on their back. It is available as the generic naloxone, or under the brand names Narcan® and Kloxxado®.

Some dosages of naloxone spray are available to the general public without prescription. However, some dosages may only be available with a prescription, and some insurance companies may require a prescription in order to cover the purchase of naloxone. For more information on obtaining naloxone in Alabama, and for available training in the use of naloxone, visit ADPH's Pharmacy Division

Nalmefene

This OORM is also an opioid antagonist, working in much the same way as naloxone. Nalmefene is available by prescription only, and is intended for use in health care and community settings for individuals 12 years of age and older. Common candidates for nalmefene include:

  • Those taking high doses of opioids for chronic pain management.
  • Those undergoing rotating opioid medication plans.
  • Those who have been discharged from emergency medical care following opioid poisoning or intoxication.
  • Those taking extended-release or long-acting opioid medication.
  • Those who have had a period of abstinence from opioid use, including those recently released from incarceration.

The following video from the Substance Abuse and Mental Health Services Administration (SAMHSA) gives an overview of the steps one should follow in attempting to reverse and opioid overdose.


Side Effects of OORM Use

Like most medications, OORMs can have side effects, including allergic reactions such as swelling the face, lips, or throat. The use of OORMs causes symptoms of opioid withdrawal, which may include:

  • Feeling nervous, restless, or irritable.
  • Dizziness, weakness, fever, or chills.
  • Body aches, diarrhea, stomach pain, or nausea.

Always seek medical assistance as soon as possible after a dose of OORM has been administered or received.

Additional Resources