How a Nasal Spray Can Bring Someone Back from the Brink of an Opioid Overdose
My friend, Amanda Cowan, is the Narcan fairy. Whether someone is going to a bachelor party, attending a festival or using drugs in any capacity she’s the first to insist we carry Narcan - a life-saving drug designed to bring people back from overdose. Small enough to carry in your pocket, Narcan is a nasal spray containing Naloxone that is simply sprayed into the nostril of someone experiencing symptoms of an overdose from opioids.
Opioids, also known as narcotics, are a broad group of pain-relieving drugs that work by interacting with opioid receptors in your cells (more on this later). These can include drugs such as ketamine, heroin, fentanyl, and prescription medications. Even if you don’t intend to use opioids other substances such as cocaine, MDMA, speed, or other drugs may be cross-contaminated with opioids and have been linked to opioid overdoses.
“The concrete life saving act of administering naloxone and restoring breath is also a symbolic act of friendship, of connection, and of a radical refusal to allow someone to die alone, of a preventable death. The act of restoring life to a friend, a family member, a stranger- this has deep ripples outward, re-envisioning the way we treat each other, and the ways in which we see each other and value the lives of people who use drugs.”
how does Narcan work?
Similar to the way an EpiPen combats the effects of a severe allergic reaction if given early enough, Narcan reverses the impact of certain drugs on the body. Naloxone cannot be misused to get intoxicated, it’s safe for all populations - this includes pregnant people and even little bitty babies. Naloxone will only work if a person has opioids in their system; the medication has no effect if opioids are not.
An overdose occurs when too much of an opioid substance attaches to specific receptors in the brain that are responsible for our breathing. Narcan’s active ingredient Naloxone works by nudging the opioid off its receptor in your brain and instead taking up the space with its harmless presence. This blocks the effects of opioids on the brain to counteract life-threatening depression of the central nervous system and respiratory system, allowing an overdosing person to breathe normally. Having worked in the harm reduction space for over15Years, Amanda is all too familiar with overdoses and how they occur indiscriminately, impacting everyone from cliched coke-bumping CEOs, to molly-popping clubbers, at-risk homeless populations, and people managing chronic pain with opioid prescriptions. Deaths from drug overdoses are avoidable, preventable and survivable with the right tools. As Executive Director of the Community Health Project Los Angeles Amanda shared with us how to use Narcan and save a life.
getting the goods
There are a few ways you can get Narcan. Each box contains two one-time-use nasal sprays.
Free Narcan (naloxone) kits may be available from your local health department, or at local nonprofits and harm reduction groups.
If you have insurance you can also get Narcan at a pharmacy with a $0-$50 copay (check goodrx for your best options). You don’t need a prescription but you will need to ask the pharmacist the same way you would get the morning-after pill or pseudoephedrine.
You can even order them online and get them sent for free from nextdistro.org website.
Don’t have it on you in advance but need it now? Some bars, music venues, police, and other spaces have it, so ask!
You can also check drugs for the presence of fentanyl by using testing strips. You can get these from places such as: DanceSafe - order online here
how to tell if someone is having an overdose & what to do
Unfortunately, if you are overdosing you won’t be able to administer Narcan to yourself. The good news is it’s so easy to administer that anyone can do it for you, provided they recognize the symptoms in time. Experts in harm prevention stress you don’t take drugs alone, have a buddy system or download the canary app that monitors and alerts help if needed or call/text the never use alone hotline on 800-484-3731.
The CDC says overdose symptoms show up as:
Excessive constriction of the pupil. Also known as “pinpoint pupils”
Falling asleep or losing consciousness
Slow, shallow or no breathing (Adults normally breathe 15-20 times per minute so anything less than 8 breaths per minute)
Heartbeat has slowed or stopped. Adults have a normal heartbeat between 60-100 beats per minute.
Gurgling or choking sounds
A limp body
Clammy skin or discolored skin (especially in lips and nails).
When you see these signs it’s time to take action. Try calling their name, state “I am going to give you Narcan”, shake them, pinch their lips, rub your knuckles hard & fast up and down their breastbone for 5-10 seconds, press hard into their nail bed at the cuticle to try to elicit a response.
If they are unresponsive It’s time to call 911 & administer Narcan
how to use narcan
Put the tip of the Narcan spray in the nostril (just the same way you would use a regular allergy nasal spray). Push it in until your fingers touch the bottom of the person's nose. (Do not prime or "test" the spray before using as this will waste the medicine). Press the plunger in firmly and spray once.
Wait 2-3 minutes and see if the person responds to it, If there is no improvement, take a second kit and spray again in the other nostril. You can repeat this step again if you need to.
Lay the person on their side to avoid choking and stay with them until help arrives.
If they aren’t breathing and they don’t have a pulse and you know CPR you can try to administer it or a 911 operator will help guide you through what to do next.
Naloxon is fast acting but temporary, it only lasts 30-90 minutes on the brain receptors, while the effects of opioids last a long time. That’s why it’s important to call for assistance because a person may be at risk of overdosing again after the Naloxone wears off. Most states have good samaritan laws that protect both the person overdosing and the person who called for help from legal trouble for possessing illegal substances or drug paraphernalia. You can check your state laws here.
After Narcan is administered, a person will go into withdrawal (if they are opioid dependent). This can be confusing, disorienting and scary; with some people believing they did not overdose. Treat the individual kindly with dignity and respect. It is essential you remain calm, state what happened and, if you can, provide them reassurance about their belongings or that they are safe (ie- you were there, they were not assaulted, etc). This is not the time to plan an “intervention”. If the individual refuses to go with the EMS, encourage them to stay with someone for at least 2-4 hours and not to use any further drugs during this time.
what not to do
Put them in a shower as it can cause drowning or change their core temperature pushing the body into shock.
Do not give the person something to drink—s/he could throw up.
Do not induce vomiting as it can cause choking.
Do not try to stimulate the person in a way that could cause harm.
Do not inject them with anything (saltwater, cocaine, milk)—it will not work any better than physical stimulation and can waste time or make things worse depending on what you inject.
