Naloxone FAQ

What is naloxone?

Naloxone is a fast-acting medication that can quickly reverse the effects of an opioid overdose. It can be administered as an injection in muscle or a spray through the nose. Naloxone is also known as Evzio or Narcan.

How does naloxone work?

Opioids can be illicit drugs such as heroin, or prescription drugs like oxycodone and morphine. In any setting opioids can be dangerous if not managed properly. The overdose reversal medication naloxone is able to work by blocking the access of opioids to receptors in the brain that opioids once occupied. Opioids attach to brain receptors to relax the body and essentially slow the body down. Unfortunately, that can slow down breathing and the heart to the point of oxygen deprivation. Naloxone has a stronger affinity to the opioid receptors than opioid drugs, so it is able to temporarily knock the opioid off of the receptor. This allows the person to begin breathing again.

Is naloxone safe?

  • Naloxone is safe and easy to use.
  • It can be safely administered to pregnant women and children.
  • It has no effect if a person has not used opioids.
  • The main adverse effect associated with its use is the precipitation of acute opioid withdrawal, which is not fatal.

What is a Standing Order prescription for naloxone

The Maryland State Standing Order prescription for naloxone is a blanket prescription for naloxone that makes naloxone available essentially over the counter.

You can go to the pharmacy and get naloxone without carrying a prescription or overdose response training certificate.

Statewide Naloxone Standing Order 5.31.17

Where can I learn to recognize and respond to an opioid overdose with naloxone?

The Baltimore City Health Department’s Community Risk Reduction Services and other Overdose Response Programs in Baltimore City will continue to offer public overdose response training for anyone who wants to learn to use naloxone. Below links the complete list of public trainings:

www.dontdie.org/public-trainings-schedule/

Am I protected from liability when I use naloxone?

Under the Good Samaritan law under the state of Maryland, a person who administers naloxone to an individual who is or is believed to be experiencing an opioid overdose is immune from liability for their actions.

https://bha.health.maryland.gov/OVERDOSE_PREVENTION/Pages/Good-Samaritan-Law.aspx

How do I pay for naloxone?

Private coverage

Naloxone reimbursement may vary by insurance provider. Under state law, insurance providers may implement prior authorization requirements for naloxone but only if there is at least one formulation that does not require a prior authorization.

Medicaid

Naloxone formulations that fall under the Maryland Medicaid Preferred Drug List are available with a $1 co-pay. The 2017 list includes Narcan®  Nasal Spray and 2 mg/2 mL Luer-lock injection dispensed with intranasal mucosal atomizer device.

Evzio auto-injector will require prior authorization for Medicaid coverage.

What happens during an opioid overdose?

During an overdose, a person’s body becomes so relaxed that they stop breathing sufficiently to provide the oxygen their body needs. A person who is experiencing an overdose may exhibit several characteristic signs, including:

  • Unresponsiveness to verbal cues or sternal rub
  • Fingertips or lips turning blue or gray
  • Breathing that is slow, shallow or stops
  • A gurgling or snoring sound
  • Pinpoint pupils
  • Seizures
  • Unusual sleepiness
  • Low or slow heartbeat
  • Cold or clammy skin

What should I do if I think a person may be experiencing an opioid overdose?

  1. Attempt to wake the person
  2. Call 911 and stay with the person until first responders arrive
  3. Administer naloxone and additional doses if needed

Even if the person wakes up in opioid withdrawal, they should not take more opioids as another overdose could occur

People at higher risk of an opioid overdose include:

  • Those who take prescription opioids (such as oxycodone, or fentanyl), especially those taking higher doses
  • Taking opioids in combination with other substances such as alcohol or sleep medications known as benzodiazepines (which include Ativan®, Xanax®, and Valium®)
  • People with medical conditions such as depression, HIV, or lung/liver disease
  • Household members of people in possession of opioids (including prescription opioids)

Others who may be at a higher risk include:

  • Those who have a reduced tolerance of opioids following detoxification or incarceration
  • Those with a suspected or confirmed history of substance abuse, dependence, or nonmedical use of prescription or illegal drugs such as heroin or fentanyl