From the Research
Sublingual naloxone (Narcan) is not recommended as an effective route of administration for opioid overdose emergencies. Naloxone should be administered via intranasal spray, intramuscular injection, intravenous injection, or subcutaneous injection, but not sublingually. The standard dose for opioid overdose is 0.4-2 mg, which may need to be repeated every 2-3 minutes until the person responds or emergency services arrive. For intranasal administration, the prefilled device delivers 4 mg per spray into one nostril. For injectable forms, 0.4 mg/mL or 1 mg/mL solutions are typically used. Sublingual administration would be ineffective in emergency situations because naloxone needs to reach the bloodstream quickly to reverse life-threatening respiratory depression, and absorption under the tongue would be too slow and incomplete. Additionally, during an overdose, the person is often unconscious and unable to cooperate with keeping medication under their tongue. Always position the person on their side after administration to prevent aspiration if vomiting occurs, and call emergency services immediately even if the person responds to naloxone, as its effects wear off faster than many opioids.
Some key points to consider when administering naloxone include:
- The most effective route of administration is one that allows for rapid absorption into the bloodstream, such as intranasal or intravenous routes 1, 2.
- The dose and frequency of administration may vary depending on the severity of the overdose and the individual's response to treatment 3, 4.
- It is essential to prioritize the person's airway, breathing, and circulation (ABCs) and provide supportive care, such as oxygen therapy, as needed 5.
- Naloxone is not a substitute for medical attention, and emergency services should be called immediately, even if the person responds to treatment.
In terms of the evidence, the most recent and highest-quality study on this topic is from 2023, which highlights the limitations of naloxone in reversing opioid-induced respiratory depression and preventing cardiac arrest 4. However, this study does not address the specific question of sublingual naloxone administration. The 2019 study on evidence-based guidelines for EMS administration of naloxone provides conditional recommendations for the route of administration, but does not support sublingual administration 1. Overall, the evidence suggests that sublingual naloxone is not an effective or recommended route of administration for opioid overdose emergencies.