Nasal Naloxone 101
PUBLISHED ON 09/24/24
Overdoses can happen anywhere and to anyone. Knowing what to do during a possible overdose can be the reason that person survives. Naloxone is an opioid antagonist that blocks opioid receptors, which are some of the same parts of the brain that control your breathing. By blocking the opioid receptors in the brain, the effects of opioids are reversed. This allows the individual to regain the ability to breathe on their own again. There are several different routes of administration for naloxone. The two most popularly used are nasal naloxone and intramuscular naloxone. This document will outline how to properly administer nasal naloxone, what is an appropriate dose of naloxone to administer, and what are the general steps to follow during a possible overdose.
Symptoms of a possible opioid overdose: • • • • • • •
Blue, gray, or purplish fingernails, lips, or face Unresponsiveness to painful agitation, like rubbing knuckles on the sternum or shin Snoring, rattling, gurgling sounds Rigidity/stiffness: indicative that fentanyl is involved Pinprick pupils Slowed, shallow, erratic, or stopped breathing Awake but unable to speak
Appropriate Dosing Because of how naloxone works, it’s possible to send opioid dependent people into precipitated withdrawal. Precipitated withdrawal is very uncomfortable and usually painful for folks who use opioids. This can cause a negative experience for both the person who has experienced the overdose and the person providing naloxone. We go into precipitated withdrawal, its negative effects, and how to care for individuals after an overdose in our Post-OD Care Plan. Administering microdosed intramuscular naloxone has successfully reversed overdoses without putting the individual into withdrawal. Unfortunately, with the nasal formulation there is no way to measure out a microdose. We recommend administering one full nasal spray and performing rescue breaths. Most times, one dose of nasal spray naloxone combined with rescue breathing is more than enough to bring someone out of an overdose. If the individual has not begun to breathe again on their own and you have waited a full five minutes since the first dose, another dose of nasal naloxone should be given. With the rise of xylazine in the drug supply, opioid overdoses have changed. People who overdose from an opiate containing xylazine are more likely to remain unresponsive even if they’ve regained the ability to breathe on their own. Once someone is breathing on their own, please try to avoid oversaturating them with more nasal naloxone, as it can cause negative and sometimes dangerous side effects.
How to properly administer nasal naloxone: Nasal naloxone is absorbed into the bloodstream through the lining of the nose. Because of this, it’s important to work with gravity when administering it. Ideally, the overdosed person can easily be placed on their back (preferably on a solid surface in the event that CPR is needed), given a chin lift (depicted below), and then given nasal naloxone.