Naloxone is an opioid antagonist, meaning that it is formulated to stop an overdose in its tracks by interfering with the activity of opioid molecules. 

More than 100 people in Mercer County have died from suspected overdose deaths each year from 2017 through 2021, the last year for which complete statistics are available.¹ As horrific as those numbers are, they might be as much as five times higher were it not for naloxone, a life-saving drug administered more than 500 times in the county in each of those years.¹

Naloxone is an opioid antagonist, meaning that it is formulated to stop an overdose in its tracks by interfering with the activity of opioid molecules. Nationwide, acute administration of naloxone by people using heroin and other opioids, paramedics, police officers and emergency department physicians has saved tens of thousands of overdose victims since the drug’s approval 50 years ago, federal health officials report. Based on that track record, state and local governments have been increasing access to naloxone to help stem the rising tide of opioid fatalities.

“Naloxone is highly effective at saving lives by reversing the respiratory depression associated with opioid intoxication and overdose,” said David DeCamp, a patient navigator for the New Jersey Division of Mental Health and Addiction Services (DMHAS) Mercer County Opioid Overdose Recovery Program (OORP). “It has been proven to reverse the respiratory depression effects associated with opiates of all types, including fentanyl.”

The agent, delivered as a nasal spray or injection, is given during an acute overdose episode, when a person may be delirious, unconscious, struggling to breathe or not breathing. If administered promptly, naloxone can restore breathing and prevent long-term overdose effects, such as brain damage, medical experts say.

If the person is not breathing independently after a severe opioid overdose, cardiopulmonary resuscitation and rescue breathing can be used in conjunction with naloxone to restore respiration, DeCamp added.

Naloxone, delivered as a nasal spray or injection, is given during an acute overdose episode, when a person may be delirious, unconscious, struggling to breathe or not breathing.

The Life Story of A Lifesaving Drug

First developed in the early 1960s, naloxone was approved in 1971 by the U.S. Food and Drug Administration (FDA) for emergency reversal of an opioid overdose.

For many years thereafter, naloxone was used primarily by paramedics and hospital staff to treat opioid overdoses, and was administered exclusively as an intramuscular injection. But over the past decade, naloxone use has become more widespread by law enforcement and the lay public, as state and local agencies have moved toward a “harm reduction” approach designed to keep persons addicted to opioids as safe as possible until they are ready to seek substance use treatment.

Hand in hand with the harm reduction movement, the FDA in 2015 approved an easier-to-use nasal spray formulation of naloxone (sold under the brand name Narcan). The compact spray bottle is prefilled with a single dose of naloxone that is sprayed into a nostril. Several generic-brand naloxone nasal sprays also are available.

In May 2018, then-U.S. Surgeon General Jerome Adams, MD, MPH, called for naloxone to be made more accessible to persons misusing oral or injectable opioids, those persons’ family and friends, and health care providers. “Knowing how to use naloxone and keeping it within reach can save a life,” Dr. Adams said.

A higher-dose naloxone nasal spray (brand name Kloxxado) was approved by the FDA in 2021 specifically to treat overdoses of fentanyl, a synthetic opioid analgesic that according to U.S. Centers for Disease Control and Prevention is up to 50 times more potent than heroin.

“Naloxone is now even effective against fentanyl and other more powerful synthetic opioids if there is a sufficient quantity delivered to the patient quickly enough, before damage occurs due to lack of breathing, heartbeat cessation or other issues,” DeCamp explained.

While naloxone is considered a relatively safe medication, it can exacerbate symptoms of opioid withdrawal, such as nervousness, irritability, body aches, dizziness or weakness, diarrhea, fever, chills, goosebumps, and runny nose and sneezing, according to the U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration.

Still, “The proven effectiveness of naloxone in saving the lives of persons struggling with opioid addiction far outweighs any resulting side effects or discomfort,” says Jasmine Belton, a program navigator for the Hyacinth AIDS Foundation, a non-profit organization that aids people struggling with substance use, medical issues and other challenges in Trenton and other New Jersey cities.

Naloxone stops opioid molecules from working by attaching to the brain’s opioid receptors soon after it is administered.

How Naloxone Works 

Opioids bind to receptors in the brain in a way that interrupts pain-signaling pathways. While this mechanism of action makes opioid-based medications valuable for treating people who have experienced traumatic injuries or who are recovering from surgery, opioids also boost feelings of pleasure, making them dangerously addictive. Additionally, opioids act on brain receptors that regulate breathing, so an overdose can lead to uneven breathing, shortness of breath or even cessation of breathing.

Naloxone stops opioid molecules from working by attaching to the brain’s opioid receptors soon after it is administered. The fast-acting agent can restore breathing within two to three minutes, according to the CDC.

However, naloxone also has a short duration of action, staying active in the body for only 30 to 90 minutes. And because opioids are longer-acting, an acute overdose episode could outlast naloxone’s effectiveness. So, if you are assisting an overdose victim, keep monitoring the patient until emergency help arrives and be prepared to administer a second naloxone dose if the patient again struggles to breathe, the National Institute on Drug Abuse (NIDA) suggests.

Although the agent’s spray bottle is easy to use, NIDA strongly urges relatives and friends of an opioid user to receive training on how to use naloxone in an overdose crisis.

Naloxone’s National Track Record — and Distribution in Trenton

While the CDC reported an estimated 109,000 overdose deaths nationwide for the 12-month period ending in March 2022, national and state statistics suggest the death toll would be even higher if not for naloxone.

Pennsylvania, which like other states is battling rising opioid addiction rates, has reported an 80% opioid overdose survival rate since 2018, in part because of increased access to naloxone, according to a 2022 study in the journal “Drug and Alcohol Dependence.”

Meanwhile, a naloxone distribution program implemented in 19 Massachusetts communities decreased opioid-related deaths in those towns by 11%, according to NIDA.

Closer to home, the Rescue Mission of Trenton regularly deploys its county-funded Mobile Harm Reduction Unit to areas of Trenton where illicit drug use is common, distributing naloxone nasal spray to anyone who requests it. Rescue Mission workers staffing the van also provide information on obtaining treatment for substance use disorder and accessing social services and medical care.

“They (chronic drug users) all know where the naloxone is,” said Rescue Mission CEO Barrett Young. “If they use it and run out, they know where to get it from the van. That’s a step toward them saying ‘OK, these folks are here to help me, and if and when I’m ready for help, they’re going to be here to help me,’ ” he added, noting that in recent months, nine people served by the van have entered treatment programs because of the rapport Rescue Mission staffers developed with them, one conversation at a time.

In addition to the naloxone distribution efforts spearheaded by the Rescue Mission of Trenton, the New Jersey Harm Reduction Coalition will provide free naloxone to anyone in New Jersey who needs it. For information, call 1-877-4NARCAN.

Reference: NJCares.gov. Suspected drug related deaths, naloxone administrations and PMP data by county. Available at njoag.gov/programs/nj-cares/nj-cares-data-by-county. Accessed Jan. 10, 2023.

Who Should Obtain Naloxone and Learn How to Use It?

The federal Department of Health and Human Services recommends that people should obtain naloxone and learn how to use it in an emergency if they, a family member or friend:

• is receiving high-dose opioids (50 morphine milligram equivalents [MME] per day or greater);
• is at high risk of an overdose from heroin or illicit synthetic opioids, or is misusing prescription opioids;
• uses other illicit drugs, such as methamphetamine and cocaine, either of which could be contaminated with fentanyl or other synthetic opioids;
• is being treated for opioid use disorder, including medication-assisted treatment with methadone, buprenorphine or naltrexone;
• has previously misused opioids or was recently released from incarceration or another controlled setting where tolerance to opioids may have been lost;
• uses opioids and has a respiratory condition, such as chronic obstructive pulmonary disease or obstructive sleep apnea (regardless of opioid dose);
• uses opioids and has been prescribed Valium (diazepam), Klonopin (clonazepam) or a similar tranquilizer (regardless of opioid dose);
• has a non-opioid substance use disorder, uses alcohol excessively or has a mental health disorder (regardless of opioid dose).

Source: U.S. Department of Health and Human Services  

To learn more about how harm reduction tools can help Mercer County residents manage substance use disorder, watch this informative video replay of a NJ.com-hosted webinar featuring a coalition of Mercer County thought leaders from several local organizations. This virtual event was presented by Trenton Health Team and was designed to shed light on the number of resources available in Mercer County, New Jersey. Featured topics included information on how Trenton-area residents who use drugs can draw on local resources that help to reduce the risks of substance use and increase their quality of life.