Harm Reduction Narcan (naloxone) available OTC in most US states

[tathra]

i'm quite shocked that there isn't already a stickied thread for this, but Narcan (naloxone) can be acquired over the counter in most states in the US. everyone who uses opioids or knows anyone that uses should absolutely have naloxone onhand and know how and when to administer it, and should also inform everyone who knows of their use how and when to administer it (breathing rate at <10 breaths per minute).

in states where naloxone doesnt require a prescription, its literally available over the counter, but plenty of states do require a prescription for it - in those states, the respective pharmacies have established a standing prescription order with a physician where you will be prescribed it on the spot when you ask for it at the pharmacy, no questions asked, no dirty looks, nothing, just walk in and get your naloxone (your insurance will most likely cover it too).

please spread the word. its unbelievable that this program has been going for so long but there are still so few people who know about it.

 

[kleinerkiffer]

It's not a stickied thread because sourcing/vendor discussion, including otc stuff and stuff like naloxone is against the rules

 

[tathra]

last i knew, harm reduction supplies were exempt from that. but then that was forever and ever ago. is it acceptable to say that its available OTC without the store names, such that a google search can do the rest?

 

[kleinerkiffer]

They have been added before my time, I think 1-2 years ago
Yeah, imo that should work

 

[tathra]

excellent. perhaps this can be expanded into a naloxone/opioid antagonist-type megathread? when in doubt, call emergency medical services of course, but having naloxone onhand already and understanding when to administer it can prevent very expensive ambulance rides and police involvement. the second-to-last thing somebody wants after falling out from too large a shot (next to never waking up, of course) is waking up to precipitated withdrawal and then being handcuffed and dragged off to jail, or being kicked out of a moving car at the doors of the ER because your "friends" are terrified of getting arrested. having this life-saving medicine onhand will prevent all of those troubles and hassles.

and when you pick up some, make sure that you inform all your user friends that you have it - you never know when you might get a random call to go somewhere and save a life.

 

[OpioidphanatiC]

does over the counter Naloxone come in an "IV" form?

 

[subotai]

You don't have to IV Naloxone you just administer an IM injection and it will work

that would some cruel irony right there. Trying to save an addicts life with Naloxone and thinking you have to IV it but you can't get a vein to hit and they die anyway

 

[[email protected]]

This is good info. Why not keep some onhand if there's a chance you might encounter someone OD'ing? Thanks.

 

[tathra]

does over the counter Naloxone come in an "IV" form?

You can either get it in a syringe (no needle, just the syringe part) or as a nasal spray. The nasal spray-type would be best for amateurs and people who don't know anything about opioids or drugs; pretty sure the nasal spray type is properly measured at one spray per dose.

Certain clinics are starting to prescribe naloxone as well any time opioids are prescribed, including bupe and methadone for maintenance programs. VA clinics prescribe these awesome idiot-proof autoinjectors that have a little speaker attached to them that will walk you through the process, just like AEDs (automated external defibrillators) do, whenever you open them and prep them for use.

 

[kleinerkiffer]

Just don't forget that the half life of naloxone is really small, meaning that if someone OD'ed on an opioid with a long half life one shot will keep him from the OD for some time, but once the naloxone is metabolized he'll slip intop the OD again

 

[tathra]

Just don't forget that the half life of naloxone is really small

an excellent point. the halflife of naloxone is only about 30-60 minutes, so you cant necessarily just administer it once and forget it in case of overdose, you have to keep an eye on them still. its also important to know that buprenorphine (suboxone/subutex) has a higher receptor affinity than naloxone, meaning that it will have little to no effect on a bupe overdose, so if somebody is dying from taking too much bupe there's little you can do for them. it still has some effect, but for a bupe overdose that has put them at <8 breaths per minute you should immediately call EMS and perhaps consider giving rescue breaths until they arrive.

while on the subject of naloxone, i've personally confirmed that at single-digit microgram doses (ultra-low dose naloxone, or ULDN) it can be used as a potentiator to make your dope several times stronger. add about 4-6ug of naloxone to your dose and whoooo boy. the suppression of tolerance and dependence doesnt seem to work as expected in my experiences, but ULDN will easily give a 2-3x boost and do away with cravings entirely.

i also have a friend who uses low dose naltrexone (LDN) by itself for chronic pain management; his experience is that it is far superior to every full agonist he's tried in every way and is basically responsible for giving him his life back - excellent pain management, increased energy and testosterone levels, no having to worry about ever-increasing tolerance and decreased effect or the dreaded opioid-induced disphoria.

opioid antagonists are far more interesting than simply being an overdose antidote, but that one effect is so critically important that its a must-have for any user's emergency/first aid kit.

 

[MDPV_Psychosis]

That is interesting tathra, thanks.

I would have expected a 4-6ug dose to practically be a "homeopathic" dose being so small.

 

[subotai]

its also important to know that buprenorphine (suboxone/subutex) has a higher receptor affinity than naloxone, meaning that it will have little to no effect on a bupe overdose

I have often wondered this but never actually looked to deep into it but, wouldn't it make sense in theory then for an IV dose of Suboxone to be able to counteract an opiate overdose?

not sure if spreading this fun fact is good or bad for people but you can still get high on buprenorphine while taking naltrexone (vivitrol).

 

[Slow_Mobius]

Suboxone can help in the case of an overdose. Ive read a couple stories where people have saved lives by administering Suboxone to someone that had ODed.

 

[tathra]

I have often wondered this but never actually looked to deep into it but, wouldn't it make sense in theory then for an IV dose of Suboxone to be able to counteract an opiate overdose?

it doesnt have to be IV (in fact i wouldnt recommend IV bupe at all if somebody is on a full agonist), but yes, you could use bupe to pull somebody out of a life-threatening overdose. i dont know that there's any data on what would be the proper dose, but what i do know is that you can take 2mg sublingually or 0.5mg IV no more than once every 2 hours while high on a full agonist and not get precipitated withdrawal (or only very minor precip), so it would probably need to be a little bit more than that, but certainly dont go giving them a full 8mg pill or a 2mg IV shot. bupe-precip'd wd is 2 hours of hell, and unlike with naloxone its not really as simple as just giving them more dope to ease the precip wd. better to just grab some naloxone and titrate up until their breathing rate is >=10/minute; if you can help it, dont be a dick and force them into wd - the idiot-proof autoinjectors i previously mentioned administer 0.4mg naloxone intramuscularly, so thats probably a good starting point (when i had to use one on somebody it didnt put him into wd, just made him conscious again, and he was very thankful to not get tortured as part of saving his life).

 

[Slow_Mobius]

it doesnt have to be IV (in fact i wouldnt recommend IV bupe at all if somebody is on a full agonist), but yes, you could use bupe to pull somebody out of a life-threatening overdose. i dont know that there's any data on what would be the proper dose, but what i do know is that you can take 2mg sublingually or 0.5mg IV no more than once every 2 hours while high on a full agonist and not get precipitated withdrawal (or only very minor precip), so it would probably need to be a little bit more than that, but certainly dont go giving them a full 8mg pill or a 2mg IV shot. bupe-precip'd wd is 2 hours of hell, and unlike with naloxone its not really as simple as just giving them more dope to ease the precip wd. better to just grab some naloxone and titrate up until their breathing rate is >=10/minute; if you can help it, dont be a dick and force them into wd - the idiot-proof autoinjectors i previously mentioned administer 0.4mg naloxone intramuscularly, so thats probably a good starting point (when i had to use one on somebody it didnt put him into wd, just made him conscious again, and he was very thankful to not get tortured as part of saving his life).

Making sure you save their life is exponentially more important than accidentally sending them into WD.

 

[tathra]

Making sure you save their life is exponentially more important than accidentally sending them into WD.

its not an either/or. if you know so little or are so unsure of what to do that you think that giving them 2 grams of naloxone or 8mg bupe is a good idea, you're better off calling EMS and letting the professionals handle it. the goal here is to give people enough information that they can save a life without inflicting torture.

 

[NeuroNymph]

Would it be ok to post a link to a map that has laws and culpability broken down by state?

 

[tathra]

Would it be ok to post a link to a map that has laws and culpability broken down by state?

figured the current mods would have chimed in and answered this by now. even though i started the thread i feel like i'm doing too much work (ie, all of it). the posting the laws and culpability as they vary by state should be fine, just no direct information about where purchases can be made. the laws and policies at the state-level are relevant and should be static, whereas even if they would be allowed, franchise-level policies would vary by store and possibly even by shift/manager. one of the store franchises in my local-ish area will, for example, allow syringes to be purchased with only showing your ID, as the state law allows, but the same store another town over will not, but other stores that will not sell them in my town will sell them in that other town, reversing their policies and positions entirely.

 

[NeuroNymph]

http://lawatlas.org/datasets/laws-regulating-administration-of-naloxone


There is a Narcan sticky in drug faqs, but some of the information isn't accurate. The map simply provides information about whether or not the pharmacist is required to report you; if the state has default doctors that prescribe it on the spot; and other requirements that don't include actual sourcing information. Basically, it's an easy resource to check the local availability of a possible legal lifesaver. I didn't see any franchise information, but you're definitely correct about how different they can be individually.