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Description
Steps for Administering Naloxone Nasal Spray (4mg):
1. Identify Overdose Signs:
- Unresponsiveness
- Slow or no breathing
- Blue or purple fingernails or lips
- Pinpoint pupils
2. Call for Emergency Help:
- Dial 911 or your local emergency number immediately before administering naloxone.
3. Administer the Nasal Spray:
- Prepare the Person: Lay the person on their back to ensure the airway is open.
- Open the Nasal Spray: Remove the nasal spray device from its packaging.
- Position the Device: Hold the device with your thumb on the bottom of the plunger and your first and middle fingers on either side of the nozzle.
- Insert the Nozzle: Tilt the person’s head back and insert the tip of the nozzle into one nostril. Your fingers should be against the bottom of their nose.
- Administer the Dose: Press the plunger firmly to release the entire dose into the nostril.
4. Provide Supportive Care:
- Rescue Breathing or CPR: If trained, provide rescue breathing or CPR if the person is not breathing or has a weak pulse.
- Monitor the Person: Watch for improvement in breathing and responsiveness.
5. Administer a Second Dose if Needed:
- Check for Response: After 2-3 minutes, if the person does not wake up or respond to the first dose, administer the second dose.
- Second Dose: Use the second nasal spray device and repeat the steps, inserting the nozzle into the other nostril and pressing the plunger.
6. Stay with the Person:
- Continue monitoring the person until emergency help arrives. Naloxone can wear off in 30-90 minutes, so they may need another dose.
- Be prepared for withdrawal symptoms such as agitation, nausea, vomiting, and sweating.
Important Tips:
- Stay Calm: Keep calm and speak reassuringly to the person.
- Post-Administration Care: Once the person is responsive, keep them comfortable and ensure they do not take more opioids.
- Training: Familiarize yourself with the naloxone nasal spray device beforehand, and consider taking a training course if available.
Administering naloxone nasal spray promptly can save a life. Your readiness and calm demeanor in such situations can make a critical difference.
- Who should carry naloxone?
- Why carry naloxone?
- Where can you get naloxone?
- How do you store and dispose of naloxone?
- Naloxone training
- Laws and regulations
- California’s statewide standing order for naloxone
- Naloxone Grant Program
- Resources
Who should carry naloxone?
- Family and friends: If you or someone you know is at increased risk for opioid overdose, especially those with opioid use disorder (OUD), you should carry naloxone and keep it at home.
- People who are taking high-dose opioid medications (greater or equal to 50 morphine milligram equivalents per day) prescribed by a doctor, people who use opioids and benzodiazepines together, and people who use drugs, should all carry naloxone. Because you cannot use naloxone on yourself, let others know you have it in case you experience an opioid overdose.
Why carry naloxone?
Carrying naloxone provides an extra layer of protection for those at a higher risk for overdose. Although most professional first responders and emergency departments carry naloxone, they may not arrive in time to reverse an opioid overdose. Anyone can carry naloxone, give it to someone having an overdose, and potentially save a life. Bystanders such as friends, family, non-health care providers and persons who use drugs can reverse an opioid overdose with naloxone.
How to recognize an opioid overdose:
Recognizing the signs of an overdose can save a life. Signs of an overdose may include:
- Small, constricted “pinpoint pupils”
- Falling asleep or losing consciousness
- Slow, weak or no breathing
- Choking or gurgling sounds
- Limp body
- Cold and/or clammy skin
- Discolored skin (especially in lips and nails)
How to respond to an opioid overdose:
It may be hard to tell if someone is experiencing an overdose. If you are not sure, treat it like an overdose – you could save a life. With a fentanyl overdose, two or more doses of naloxone may need to be given.
- Call 911 and give naloxone
- Keep the person awake and breathing
- Lay the person on their side to prevent choking
- Stay with the person until 911 responders arrive
Naloxone storage
- Follow manufacturer instructions for storing naloxone. Storage instructions may be different.
- Keep naloxone in its box until ready for use.
- Protect from light.
- Store at room temperature below 77°F (25°C).
- Do not freeze or expose to heat above 104°F (40°C).
- Store in a safe location.
Naloxone disposal
Unused naloxone: Dispose of unused naloxone at a local pharmacy or through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. Learn more about safe disposal options.
Used naloxone:
- Nasal spray, such as Narcan®: Put the used naloxone nasal spray back into its box. Dispose of it in solid waste trash.
- Injectable naloxone: Put the used injectable naloxone back into its original container/box. Used injectable naloxone is considered medical waste and must be disposed of in a sharps disposal bin, such as at a local pharmacy. Do not throw away used injectable naloxone in solid waste trash.
Expired naloxone
Expired naloxone is better than no naloxone: If you have expired or soon-to-expire intranasal Narcan® or injectable (intramuscular) naloxone that has been properly stored, contact a local syringe services program about donating the naloxone. If you have a large amount (10+ doses), you can contact NEXT Distro about donating the naloxone.
Narcan® nasal spray shelf-life extension: The U.S. Food and Drug Administration (FDA) has approved an extended shelf-life for the nasal spray formulation of naloxone (Narcan® [PDF]) from two years (24 months) to three years (36 months).
Naloxone training
An important part of a naloxone distribution program is to provide training to individuals who may give naloxone. Listed below are training resources.
- Naloxone Training for Health Care Providers: Centers for Disease Control and Prevention (CDC) offers several naloxone training modules for health care providers. Earn continuing education credits (CE) after completing the full module.
- Administering Naloxone – Training Video (You Tube)
- Administración de Naloxona: video de capacitación en español (YouTube)
- Overdose Education and Naloxone Distribution (webinar recording): Training for professionals who will be responsible for educating laypersons about opioid overdose and distributing naloxone in their community.
- Implementing Naloxone Distribution Systems (webinar recording): Training for program managers and others responsible for the implementation of naloxone distribution systems/OEND in their community.
Laws and regulations
California laws protect persons who give naloxone and make naloxone more readily available.
Good Samaritan Law
A person cannot be liable for any civil damages that result from his or her providing of emergency care, if:
- The person acted in good faith, and not for compensation;
- The person provided either emergency medical care or nonmedical care; and
- The care was provided at the scene of an emergency.
Drug Overdose Treatment Liability Law
Eliminates civil and criminal liability for:
- Licensed health care providers that prescribe naloxone and issue standing orders for the distribution of naloxone; and
- Individuals that administer naloxone to someone suspected of experiencing an overdose after receiving it along with required training.
California’s statewide standing order for naloxone
The California State Public Health Officer has issued a CDPH statewide standing order to increase access to naloxone. Review the FAQs (PDF) and terms and conditions to determine if your organization or entity should apply here:
Naloxone Grant Program
California Senate Bill (SB) 833 (Chapter 30, Statutes of 2016) added Part 6.2, Section 1179.80 to the California Health & Safety Code to require the California Department of Public Health (CDPH) to establish the Naloxone Grant Program. The goal of the program was to reduce the number of fatal overdoses in California from opioid drugs, including prescription opioids and heroin, by increasing access to the life-saving drug naloxone. The California Legislature allocated a one-time appropriation of $3 million from the General Fund in the Budget Act of 2016 to support this program through June 30, 2019. See the Naloxone Grant Program Final Report (PDF).
Resources
Clinicians
- When to Offer Naloxone to Patients (CDC, PDF): This fact sheet outlines factors that can put patients prescribed opioids or who use illicit opioids at a higher risk for opioid-related harms.
- When to Offer Naloxone to Patients in the Emergency Department (CDC, PDF): This fact sheet described for emergency department staff when to offer naloxone and highlights factors that can put patients at a higher risk for overdose.
- Talking About Naloxone with Patients Prescribed Opioids (CDC, PDF): This guide offers tips to help providers communicate the benefits of naloxone to patients, family members and caregivers.
Healthcare Administrators
- Increase Naloxone Prescribing in your Health System (CDC, PDF): This fact sheet focuses on the role healthcare executives play in supporting training and education for clinicians on naloxone and opioid use disorder. Offers strategies to increase naloxone prescribing.
Pharmacists
- The Pharmacists’ Role in Naloxone Dispensing (CDC, PDF): This fact sheet focuses on the role of pharmacists in naloxone dispensing including when to offer naloxone to patients.
Family Members and Caregivers
- What you Need to Know about Naloxone (CDC, PDF): This fact sheet provides general facts about naloxone including where to get it and how to prevent an overdose.
- How and When to Use Naloxone for an Opioid Overdose (CDC, PDF): This fact sheet discusses how to identify an overdose and use naloxone, and includes the side effects of naloxone.
- How to Save a Life with Naloxone (CDC, PDF): This guide offers examples to help you start a conversation with a clinician or pharmacist about how to obtain naloxone, when to use it and where to find training on giving naloxone.
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