Naloxone (also known by one brand name Narcan®) is a type of medicine called an “opioid antagonist”.
Naloxone reverses the effects of opioids including heroin and prescription opioids (e.g. painkillers).
Opioids attach to certain ‘receptors’ in the body. In opioid overdose, it is the attachment of the opioids to these receptors that can stop a person breathing.
Naloxone can temporarily knock the opioids off those receptors and restore a person’s breathing.
Naloxone has been used in opioid overdose reversal – including by paramedics – for decades.
Naloxone is now being prescribed and dispensed to people at risk of opioid overdose. Community Overdose Prevention and Education (COPE) programs are now teaching people how to respond to overdose, including when and how to administer naloxone.
Lives are being saved by community members successfully administering naloxone.
How does naloxone work?
Naloxone only works if a person has opioids in their system.
Naloxone knocks the opioids off the receptors for a short time (around 30 to 90 minutes), temporarily reversing an opioid overdose.
This can allow a person to breathe again.
Questions & Answers
Does naloxone reverse non-opioid overdoses?
No. Naloxone only reverses the effects of opioids such as heroin, methadone, morphine, codeine or other commonly used opioid painkillers (eg: fentanyl, MS Contin®, Kapanol® Endone®, OxyNorm®, OxyContin®).
Naloxone does not counter the effects of other types of drugs, such as benzodiazepines including diazepam (eg: Valium®), alprazolam (eg: Xanax®), alcohol or other sedatives.
Naloxone has no impact on stimulants such as methamphetamine, ecstasy or cocaine.
How long does naloxone take to work?
Naloxone (400mcg/1Ml dose) generally begins to take effect within two to five minutes. If the overdosing person does not respond within five minutes, a second 400mcg dose should be given.
Rescue breathing should be carried out while waiting for the naloxone to take effect so the person still gets oxygen to their brain and has less risk of brain injury.
Can naloxone wear off before the drugs that cause the overdose?
Yes. Naloxone usually wears off in 30 to 90 minutes. When this happens, opioids may reattach to receptors in the brain and cause another overdose.
This is especially the case if they have taken other depressant drugs as well as the opioids (such as alcohol or benzodiazepines).
For this reason, it is important to always call 000 so the person can be reviewed and/or taken for medical care.
What formulation of naloxone is suitable?
In Australia, there is a single-use pre-filled syringe formulation of naloxone, known as a Minijet (similar to an Epipen.)
The formulation is 400 micrograms of naloxone in a 1 millilitre solution (400mcg/1Ml).
Doctors can prescribe naloxone which is dispensed by pharmacists. It is also available over the counter at pharmacies without a prescription.
How can you access naloxone?
Your doctor can prescribe naloxone as a Schedule 4 medication. Naloxone is also available over the counter at pharmacies as a Schedule 3 medication. Alternatively, you can visit an alcohol and drug agency that incorporates community based overdose prevention initiatives who can provide education on how to recognise the signs of overdose and facilitate access to naloxone. For more information, contact COPE or view take-home naloxone programs.
What does it cost?
The 400mcg/1Ml naloxone formulation is listed on the Pharmaceutical Benefits Scheme (PBS prescriber code 2192J).
Each prescription (containing five Minijets) has a maximum cost of $37.70. People with a Health Care Card can receive the five Minijets for $6.10.
Where are naloxone programs operating in Australia?
Some small-scale programs operate in Brisbane, Canberra, Perth and Sydney.
Under the Community Overdose Prevention and Education program many services in Melbourne and country Victoria are being educated to provide naloxone education and assist people to access it.
Any doctor – such as your GP – can prescribe naloxone.
How should naloxone be stored?
Manufacturers recommend that naloxone is stored below 25 degrees Celsius. However, naloxone is a very stable drug and remains effective when stored at temperatures above 25 degrees.
Keeping naloxone in the box provided is recommended, to avoid direct sunlight.
What is the shelf-life of naloxone?
Naloxone has a shelf-life of approximately two years. An expiry date can be found on the minijet. The expiry date refers to the last day of the month indicated. A person with ‘expired’ naloxone should ask a doctor for a repeat script, or purchase new naloxone over the counter at a pharmacy.
Are there risks associated with naloxone use?
Naloxone is a very safe drug and has no potential for abuse.
What if children find and use the naloxone? Can it harm them?
Naloxone is not harmful to children. But it is a good idea to keep all medicines out of reach of children.
Can naloxone be addictive?
Naloxone is not addictive in any way.
Can people get a ‘high’ from naloxone?
No. It has no euphoric qualities, meaning that a person cannot get ‘high’ by taking naloxone.
Can naloxone be misused?
There is no use for naloxone other than reversing the effects of opioids.
It has no potential for misuse.
Is naloxone harmful?
No. Naloxone only blocks or reverses opioid effects. It does nothing else.
Can naloxone cause an overdose?
No. It is not possible to overdose on naloxone. If a large dose is given to a person with opioids in their system, they may experience symptoms of withdrawal.
Will naloxone work on a person who has received it before?
Yes. People cannot develop a tolerance to naloxone, so it can be used in every opioid overdose situation, no matter how many times it has been used on a person before.
Who can carry or administer naloxone?
Prescribing and dispensing naloxone is consistent with Australian laws regulating drug prescribing and dispensing. It is legal for a person to carry naloxone.
It is legal for a non-medical (third-party) person to administer naloxone to someone else to reverse an overdose.
Is take-home naloxone controversial?
No. Take-home naloxone is a widely endorsed policy. The United Nations and the World Health Organisation support the availability of naloxone.
Take-home naloxone programs exist in the United Kingdom, Europe, North America, Asia and Russia and, more recently, Australia.
The Australian Medical Association and the Pharmacy Guild of Australia support programs to make naloxone available in the community.
State and Territory Governments that fund naloxone access include the Australian Capital Territory, Queensland, South Australia, Victoria and Western Australia
Is naloxone a “safety net” that encourages people to take more drugs?
Researchers have investigated this. They have found that making naloxone available does NOT encourage people to use opioids more.
The goal of distributing naloxone and educating people about how to recognise, respond to and prevent overdoses is to stop disability and death.
Will a person be angry and aggressive if given naloxone?
Naloxone can result in withdrawal symptoms for some people and this will make them feel uncomfortable or unwell. The lack of oxygen the person has experienced, coupled with the shock of awaking to such scenario, can result in confusion and agitation. However, the naloxone dose (400mcg/IML) contained within UCB minijet is a low dose and much less likely to precipitate withdrawal symptoms. Individuals who have received oxygen during their overdose (either via rescue breaths or from ambulance oxygen apparatus) are less likely to be agitated when they come round than those who have not.
It is also important to note that the person has been unconscious and will not remember the efforts involved to save their life. Most people are extremely grateful later on.
Remember, the benefits of saving a life, or preventing brain damage, are far more important than any concerns regarding upsetting someone.
Is naloxone the same as naltrexone?
Naltrexone is not naloxone. Both are opioid antagonists, and have similar effects in that they both block the effects of opioids. But, naltrexone is given as a tablet, not as injection.
Therefore, naloxone is used to reverse overdose, while naltrexone is not.
It is common for people to confuse the two names. Remember, “nalTREXone is not nalOXone”.