What is naloxone and how is it used in the US?

In 2022, opioids were responsible for 81,607 overdose deaths in the US — up from 46,802 in 2018, according to the Centers for Disease Control and Prevention (CDC). During the same period, deaths from fentanyl^[1] and other synthetic opioids rose from 31,335 to 73,654.

However, law enforcement, medical professionals, and everyday Americans can help stop these deaths with Naloxone, a medication designed for rapid mitigation of overdoses caused by opioids.

Are “Narcan” and “naloxone” the same?

Yes. When the Food and Drug Administration (FDA) approved the first prescription naloxone nasal spray in November 2015, its brand name was Narcan. There are now many formulations and brand names, and naloxone is its universal generic name.

How does naloxone work?

Naloxone is an opioid receptor antagonist that reverses and blocks the effects of opioids such as heroin, fentanyl, oxycodone, hydrocodone, codeine, and morphine. It can be given intravenously or as a nasal spray. When administered properly, naloxone can restore normal breathing in someone experiencing an opioid overdose. It has no harmful effects, and the National Institute on Drug Abuse (NIDA) recommends that it be given to anyone who shows signs of an opioid overdose, even when an overdose can’t be confirmed.

Naloxone is active in the body for 30 to 90 minutes and its effects can wear off before those of the opioids causing an overdose, so NIDA cautions continued observation of the person being treated; additional doses could be required.

How is naloxone administered?

Naloxone can be given as an injection or a nasal spray -— the latter of which is easily carried and delivered, even by people without formal medical or emergency training. Both delivery mechanisms are highly effective in reversing an opioid overdose. NIDA is also funding research on longer-acting overdose-reversal medications and wearable technology to automatically administer naloxone at signs of respiratory failure.

What is the federal government’s stance on naloxone?

Increasing naloxone access is a documented “priority” for the US Department of Health and Human Services, with the Surgeon General personally “emphasizing the importance” of the medicine. The White House Office of National Drug Control Policy has also publicly committed to expanding naloxone access.

The FDA has a long history of attempts to increase the availability of naloxone products: It first approved the use of naloxone as a prescription auto-injection in April 2014, and approved the first nasal spray prescription in November 2015. In subsequent years, it also approved generics, higher-dosage offerings, and over-the-counter sales without a prescription.

What are the estimated impacts of naloxone on overdose reduction?

Data on the quantitative impact of naloxone use at the national level is limited, but states and researchers offer some examples of positive results. In Massachusetts, a state distribution program run from 2007 to 2018 gave naloxone rescue kits to 81,000 residents, and reported more than 16,000 rescues by bystanders who administered naloxone to a person overdosing.

NIDA has also cited work by others indicating that naloxone reduces overdose deaths.

What role can bystanders play in naloxone delivery?

Bystanders are a key piece of ensuring access to naloxone at the moment of overdose. The CDC concluded that in nearly two-thirds of overdose deaths in 2021 there was at least one potential opportunity for intervention — and bystanders were present at 46% of overdose deaths.

The CDC reports that, as of February 2022, one naloxone prescription is dispensed for every 70 high-dose opioid prescriptions.

Who can get and carry naloxone?

According to NIDA, all 50 states and Washington, DC, have enacted legislation to increase access to naloxone for everyone. In many of these states, anyone can legally obtain naloxone from pharmacies, including the people who the Substance Abuse and Mental Health Services Administration (SAMHSA) identifies as key in preventing overdoses: community groups, non-medical first responders like police officers, patients prescribed opioid medications, and at-risk individuals and their family members.

Many jurisdictions have also implemented legal protections for naloxone possession and eliminated legal liability for those who administer it, commonly referred to as “Good Samaritan laws”. According to the Government Accountability Office (GAO), 47 states and Washington, DC, now have Good Samaritan and naloxone access laws.

Three states do not have Good Samaritan laws for drug overdoses — but Kansas, Texas, and Wyoming do provide other legal avenues to naloxone access.

The GAO does caution that laws vary by jurisdiction — for example, whether laws exempt people from prosecution for possession entirely or only when immunity applies.

If you or someone you know is in danger or having a medical emergency, call 911 or go to your nearest emergency room. If you or someone you know is struggling with substance misuse or abuse, call the SAMHSA National Helpline, 1-800-662-HELP (4357), a free, confidential, 24/7, year-round treatment referral and information service for individuals and families facing mental and/or substance use disorders.

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