Naloxone: What Every Family Affected by Opioid Use Should Know

A Medication That Saves Lives

Naloxone is a medication that reverses opioid overdose. It is safe, effective, easy to use, and increasingly available without a prescription. It has saved hundreds of thousands of lives. And yet, many families affected by opioid use disorder do not have it — often because they do not know about it, do not know how to get it, or carry the mistaken belief that having it somehow enables drug use.

This article covers everything you need to know about naloxone: what it is, how it works, how to get it, and how to use it. If someone you love uses opioids — whether prescribed or illicit — this information could save their life.

What Is Naloxone?

Naloxone (brand names include Narcan and Kloxxado) is an opioid antagonist — a medication that binds to opioid receptors in the brain and blocks the effects of opioids. When administered to someone experiencing an opioid overdose, it rapidly reverses the overdose, restoring normal breathing within minutes.

Naloxone has no effect on people who have not taken opioids. It is not a controlled substance. It cannot be misused to get high. It is purely a life-saving medication.

Naloxone was approved by the FDA in 1971 and has been used in emergency medicine for decades. In recent years, it has become increasingly available to the general public — in pharmacies, community organizations, and harm reduction programs — as part of the public health response to the opioid crisis.

How Opioid Overdose Happens

Opioids suppress the central nervous system, including the brain's respiratory control centers. In an overdose, breathing slows and eventually stops. Without intervention, the person loses consciousness, their brain is deprived of oxygen, and they die.

The risk of overdose is highest when:

• The person uses a stronger opioid than they are accustomed to (particularly illicit fentanyl, which is 50–100 times more potent than morphine)
• The person uses after a period of abstinence, when tolerance has dropped
• Opioids are combined with other CNS depressants (alcohol, benzodiazepines, sleep medications)
• The person uses alone, with no one present to respond

Recognizing an Opioid Overdose

Knowing the signs of opioid overdose is as important as having naloxone. Signs include:

• Unresponsive or unconscious — cannot be woken up
• Slow, shallow, or stopped breathing (fewer than one breath every 5 seconds)
• Choking or gurgling sounds (sometimes called the "death rattle")
• Blue or grayish lips, fingernails, or skin (cyanosis)
• Pinpoint (very small) pupils
• Limp body
• Pale, clammy skin

If you observe these signs, act immediately. Do not wait to see if the person "sleeps it off." Opioid overdose is a medical emergency.

How to Respond to an Opioid Overdose

1. Call 911 immediately. Naloxone buys time — it does not replace emergency medical care. Call 911 first, or have someone else call while you administer naloxone.
2. Administer naloxone. If you have naloxone nasal spray (Narcan), insert the nozzle into one nostril and press the plunger firmly. If using an auto-injector, follow the device instructions. A second dose can be given after 2–3 minutes if there is no response.
3. Rescue breathing. If the person is not breathing, give rescue breaths while waiting for naloxone to take effect.
4. Place in recovery position. Once the person is breathing, place them on their side (recovery position) to prevent choking if they vomit.
5. Stay with them. Naloxone wears off in 30–90 minutes. If the opioid is still in their system, they may go back into overdose. Stay with them until emergency services arrive.

How to Get Naloxone

Naloxone is now available without a prescription at most pharmacies in the United States. You can ask the pharmacist directly — you do not need to explain why you want it. Many pharmacies stock it behind the counter.

Naloxone is also available free or at low cost through:

• Harm reduction organizations and needle exchange programs
• Community health centers and federally qualified health centers
• Some health departments and public health programs
• NEXT Distro and other mail-based naloxone distribution programs
• Many addiction treatment programs

If cost is a barrier, NEXT Distro (nextdistro.org) and NEXT Harm Reduction can mail naloxone to most states for free.

Addressing the "Enabling" Concern

Some family members worry that having naloxone available sends the message that drug use is acceptable, or that it removes a consequence that might motivate the person to get sober. This concern, while understandable, is not supported by evidence.

Research consistently shows that naloxone availability does not increase drug use. What it does is prevent death. A person who is dead cannot recover. Naloxone keeps the possibility of recovery alive — literally.

Having naloxone is not enabling. It is loving someone enough to keep them alive until they are ready to get help.

After an Overdose: A Window of Opportunity

An overdose is a terrifying experience — for the person who experienced it and for those who witnessed it. It is also, sometimes, a turning point. Research suggests that the period immediately following a non-fatal overdose can be a powerful moment of motivation for treatment.

If someone you love survives an overdose, the days that follow are a critical window. Having a treatment plan ready — knowing the number of a treatment program, having a conversation about medication-assisted treatment, connecting with a peer support specialist — can make the difference between a turning point and a temporary reprieve.