What is the treatment for someone suspected of having an opioid overdose using Narcan (naloxone)?

Treatment of Suspected Opioid Overdose with Naloxone

For a suspected opioid overdose, immediately activate the emergency response system, provide high-quality CPR (compressions plus ventilation) if the person is unresponsive and not breathing normally, and administer naloxone. 1

Initial Assessment and Response Algorithm

1. Identify suspected opioid overdose:

   • Unresponsiveness
   • Respiratory depression (slow, shallow, or absent breathing)
   • Pinpoint pupils (miosis) - though this may not always be reliable
   • Evidence of opioid use nearby

2. Immediate actions:

   • Activate emergency response system (call 911) 1
   • Do not delay emergency activation while waiting for response to naloxone 1
   • Assess breathing and responsiveness

3. Response based on breathing status:

   • If not breathing or breathing abnormally (gasping):

     • Begin high-quality CPR (compressions plus ventilation) 1
     • Administer naloxone while continuing resuscitation efforts 1

   • If breathing but unresponsive:

     • Place in recovery position
     • Administer naloxone
     • Monitor closely

Naloxone Administration

• Route of administration: Intranasal or intramuscular routes are both effective 2, 3

  • Higher-concentration intranasal naloxone (2 mg/mL) has similar efficacy to intramuscular naloxone 3
  • Intranasal administration avoids needles and risk of needle-stick injuries 2

• Dosing: Follow package instructions for specific formulation

  • Repeat doses may be necessary if no response in 2-3 minutes
  • More than 20 studies demonstrate naloxone is safe and effective for treating opioid-induced respiratory depression 1

• Continue resuscitation: Do not stop CPR while waiting for naloxone to take effect 1

  • Naloxone should not delay components of high-quality CPR 1

Post-Administration Management

• After return of spontaneous breathing:

  • Continue to monitor the patient closely 1
  • All patients should be observed in a healthcare setting until risk of recurrent opioid toxicity is low 1
  • The patient's level of consciousness and vital signs should normalize before discharge 1

• Watch for recurrence of overdose:

  • The duration of action of naloxone may be shorter than the respiratory depressive effects of opioids, particularly long-acting formulations 1
  • Repeated doses or an infusion of naloxone may be necessary if opioid toxicity recurs 1

• Transport to healthcare facility:

  • All patients should be transported to a healthcare facility for observation 1
  • Patients who refuse transport should be evaluated according to local protocols for capacity to refuse care 1

Important Considerations and Pitfalls

• Safety profile: Naloxone has an excellent safety profile and is unlikely to be harmful if given to a person with respiratory depression who does not have an opioid overdose 1

• Common pitfalls to avoid:

  • Delaying CPR while waiting for naloxone to take effect
  • Failing to activate emergency services immediately
  • Assuming a single dose of naloxone will be sufficient, especially with long-acting opioids
  • Discharging patients too early after naloxone administration
  • Failing to recognize that naloxone's duration of action may be shorter than the opioid's effects 4

• Potential adverse effects:

  • Acute withdrawal syndrome (vomiting with risk of aspiration) 4
  • In patients treated for severe pain, high-dose or rapidly infused naloxone may cause catecholamine release leading to pulmonary edema and cardiac arrhythmias 4

By following this algorithm, first responders and healthcare providers can effectively manage suspected opioid overdoses, potentially saving lives while minimizing risks associated with naloxone administration.