Drug That Reverses Heroin Overdose

Naloxone can reverse a heroin overdose in seconds. Find out how this drug works and where to get it.

Medically reviewed in August 2021

Heroin and prescription opioid abuse and overdoses have soared in recent years. According to the Centers for Disease Control and Prevention (CDC), almost 2 million people were addicted to prescription opioids in 2014 (the latest year for which data is available.) Heroin overdose deaths nearly quadrupled in a decade, and more than four of five heroin abusers got their start with prescription opioids.

Stemming this tide will require efforts on multiple levels. But in the meantime there is a drug that can almost instantaneously reverse an opioid overdose. It’s naloxone hydrochloride (called, more commonly, naloxone or by the brand name Narcan), and its effects can be sudden and powerful. “I’ve had occasion to give it myself from time to time, and people wake up in seconds,” says Keith Roach, MD, Sharecare’s chief medical officer. “It’s one of the most dramatic things you can see in clinical medicine.”

Today the medication isn’t just reserved for use by paramedics, EMT workers and doctors. There are some states where individuals who think they may need it for themselves, or for someone else at risk of overdosing, can have the medication on hand.

Anatomy of an Overdose
When an opioid is taken, its molecules bind to cell receptors to make users feel euphoric and dull their perception to pain. Those receptors also blunt the body’s ability to regulate breathing. If the opioid dose is high enough, breathing stops entirely. “It’s a powerful effect on the brain itself. The area of the brain that tells you to breathe stops working,” says Dr. Roach. “You die from opiates because you forget to breathe.”

Signs of an opioid overdose include:

  • Unconsciousness
  • Pinpoint pupils
  • Slow, shallow, or no breath
  • Slow heartbeat or low blood pressure

How Naloxone Works
Naloxone molecules bind to the same receptors as opioids. They basically muscle the opioid molecules out of the way, knocking them off the receptors like billiard balls. It allows the person to breathe again – but it may also induce withdrawal symptoms.

“Nobody likes to get naloxone because it’s such an unpleasant wakeup call,” says Roach. “People are not happy about it because for whatever reason they took the opioid in the first place, all of the benefit would go away.” 

How to Use Naloxone
Naloxone is sold as a nasal spray, an auto-injector or a pre-filled syringe. In a hospital, if the drug is given intravenously, it works almost instantly. The auto-injectors and pre-filled syringes are designed to be jabbed into a muscle, which works more slowly than an IV, says Roach. The nasal spray is the slowest, but “the advantage of giving it nasally is anyone can do it,” says Roach.

It’s essential to be trained in the use of naloxone if you’re expecting or expected to have to give a dose, says Roach. That means asking your doctor. “Many communities in most states have the ability for citizens to give it, and have Good Samaritan laws to protect them. But you want to be sure you know exactly how to do it.”

It goes without saying that you should call 911 in addition to administering naloxone in the event of an overdose.  

How to Get Naloxone
All 50 states allow paramedics to carry and use naloxone, which is classified as a prescription drug by the Food and Drug Administration (FDA). An increasing number of states allow EMTs to do the same, while police officers in select communities can carry the drug.

In January of 2017 Kaleo, the company that makes an auto-injector–a product known as Evzio–raised the price of a twin-pack from $690 when the product debut in 2014, to $4,500.

In a rapidly growing number of states, individuals can buy the life-saving medication -- and may not even need a prescription, thanks to what’s called a standing order (and in some states that’s not even needed). This allows a doctor to write a prescription for a pharmacy (not an individual), allowing the pharmacist to sell the medication to anyone who walks in and requests it. But, again, laws vary: In some states it’s only distributed to a prescriber’s patients, or those who are at risk of an overdose, or a family member. Typically a pharmacist dispensing it needs to be trained in its administration and teach the consumer. Currently the pharmacy chains Walgreens and CVS can distribute naloxone without a prescription in some states.

“I think people should be able to get it more easily,” says Roach. “Studies show that in communities with more access, there’s less deaths from opioids. Anything we can do to reduce the number of deaths is a good thing.” 

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