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Naloxone (Narcan)

Orlando

Bluelighter
Joined
Feb 26, 2002
Messages
277
What is naloxone?
Naloxone hydrochloride is an opioid antagonist that is used to treat overdoses. It is commonly found under the brand name Narcan.

What does it look like?
It is almost always found dissolved in a liquid and packaged in ampoules. Although it is available in a variety of strengths and quantities, the most common (used by hospitals, emergency medical personnel, etc) is either 0.4mg/ml or 1mg/ml concentrations in 0.4, 0.8, 1 or 2mg doses.

Is it legal?
Naloxone is legal to possess with a prescription. In the past, this has generally meant that unless you worked at a hospital or had an amazing hookup, the only way you were going to see naloxone was when you woke up next to a medic with empty ampoules.

In the past few years, this has changed. Some in the medical community have loosened their grip on naloxone and are now prescribing it to opioid users. Harm reduction organisations are also working towards this end, and some needle exchange programs are distributing naloxone. Also, online pharmacies have made naloxone easier to acquire.

Where can I get some?
If you don’t have a doctor who can hook you up and there are no groups in the area that distribute naloxone, you’re pretty much limited to trying to get it through an online pharmacy. As per the Bluelight User Agreement, sources won’t be posted here.

How effective is it?
Naloxone only works against opioids.
Lycaeum’s list of opioids.


Against opioids, naloxone is devastatingly effective. It takes effect within 2-3 minutes of IM administration. Naloxone will reverse respiratory and CNS depression, hypotension, sedation, anaesthetic effects – everything.

However, it will also produce dose-dependent and user-dependent withdrawal symptoms. This is covered in greater depth during the next section.

How does it work?
The overwhelming majority of evidence suggests that naloxone works by filling in opioid receptor sites in the brain. The extent to which the sites are blocked depends on the amount of naloxone administered. In almost all cases, a 2mg dose is sufficient.

Naloxone fills these sites with absolute precedence over other opioids. That is to say, naloxone will occupy a receptor site before anoether opioid will. Not only does it fill the receptor sites, but it will unseat opioids that are already occupying the sites. Some people like to say that naloxone “competes” for receptor sites. There is no competition - naloxone pretty much storms your brain and owns the opioid receptor sites.

The catch is that since the opioids are no longer having an effect, you may experience withdrawal symptoms. The severity of the symptoms will vary depending on your level of addiction.

How is naloxone administered?
Professional medics will usually administer naloxone via an IV injection. If you have the requisite proficiency and confidence, IV is the way to go. However, for personal user-on-user employment of naloxone, IM is usually a better route of entry for several reasons:
  • IM is easier and less problematic than IV
  • IM injections can usually be given more quickly than IV injections
  • You may be nervous, frightened, or apprehensive when giving the injection – this is not the time to go poking around for a vein.
  • Not everyone has administered an IV injection, and this is not the time to teach yourself how to do it.

What will happen after naloxone is administered?
After naloxone has been administered, the victim will not immediately snap out of the overdose. It will take 2-3 minutes for the naloxone to take effect. When it does, the victim will come to very rapidly.

During this 2-3 minute window, it is necessary to perform rescue breathing on the victim.

Note - When they come to, bear in mind that this person has just been rocketed back into consciousness and may be experiencing withdrawal symptoms. Be prepared for the worst (confusion, violence, etc)!

If victim has not come to after 2 minutes, another 1-2mg dose of naloxone will usually be administered. This pattern will normally be allowed to continue until 10mg have been given.

How long does naloxone last?
Depending on the dose, naloxone will usually last for 30-75 minutes. After this time, it may be necessary to administer another dose of naloxone if the user displays overdose symptoms again.

Naloxone has a shelf-life of three years.

How do emergency room doctors and first responders use naloxone?
Doctors and emergency medical technicians frequently give doses of 2mg. If the initial treatment is not effective, they will usually be willing to continue dosing until 10mg has been administered.

The medical community has come under fire for this, with opponents saying that such large doses are given in an attempt to punish drug users by causing severe withdrawal symptoms. While perhaps golden hearted, this claim is largely baseless. Even if their aim was to cause the onset of withdrawal symptoms, a 10mg dose would not necessarily do this any better than a 2mg dose.

What are the side effects of naloxone use? Is it possible to OD on naloxone?
Naloxone’s only contradiction is that it may initiate withdrawal symptoms. It is safe to administer regardless of age, physical health, or medications.

Extremely high doses (~30mg or more) may cause memory impairment, dysphasia, hypertension, and disorientation.

It is basically impossible to OD on naloxone. The LD50s for rats and mice were more than 100mg/kg, which is ridiculously far beyond what would be administered in anything but a study to determine the LD50.


Naloxone Related Links
Medsafe Naloxone Page
InChem Naloxone Page
Some adverse effects
A study using VERY high doses of naloxone
Protocol for medical personnel
Naloxone according to rxlist.com
Overdose treatment
 
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