Naloxone (Narcan): Background information when reading Rough Sleepers

Naloxone (Narcan)

This article relates to Rough Sleepers

In Tracy Kidder's Rough Sleepers, the drug naloxone, commonly known by the brand name Narcan, saves the lives of multiple people in the throes of an overdose from opioids like fentanyl and oxycodone.

A relative of morphine, naloxone was first patented in 1961 by American scientists looking for a medication to treat constipation resulting from opioid use. They discovered that the drug could be used to reverse opioid overdoses, and the FDA approved it for such treatment in 1971. As heroin abuse and subsequent overdose deaths increased alarmingly in the 1990s, naloxone became a vital part of emergency medical kits. A nasal spray delivery system was devised in 2012 and given FDA approval in 2015.

Opioids such as morphine, oxycodone and fentanyl activate receptors in the brain that block pain signals. They may also generate a sense of euphoria in users that can lead to misuse, addiction, and/or overdose. Naloxone binds to these receptors and blocks the effects of opioids, stopping an overdose almost immediately. It has very few side effects, although if a person is overdosing on an opioid at the time naloxone is administered they may suffer withdrawal symptoms (nausea, vomiting, sweating, etc.).

According to the Centers for Disease Control (CDC), nearly 50,000 people died in 2019 from opioid-induced overdose, and bystanders were present in more than a third of cases. They therefore recommend that naloxone kits and training in administering the drug be made widely available, particularly to those caring for someone suffering from opioid use disorder (OUD). As of 2022, the medication is available without a prescription in all 50 states and online, although rules and logistics for actually obtaining the drug vary from state to state. Prices vary, but the average out-of-pocket cost for naloxone was $31 in 2018.

Because naloxone is considered safe to use, most believe that if there's any suspicion someone is overdosing, it's better to administer the drug than not. If the person has taken an opioid, the medication very well could save their life, and if they're overdosing from another drug or having a different medical issue, naloxone shouldn't adversely impact their condition.

Symptoms of an overdose include:

• Small "pinpoint" pupils
• Falling asleep or losing consciousness
• Slow, weak or no breathing
• Choking or gurgling sound
• Limp body
• Cold or clammy skin
• Discolored skin, especially nails and lips

The CDC recommends those witnessing a potential overdoes perform the following steps:

• Call 911
• Administer naloxone
• Try to keep the person awake and breathing
• Lay the person on their side to prevent choking
• Stay with the person until emergency help arrives

Naloxone has saved countless lives since its introduction. It's an important tool for those treating or caring for individuals prone to opioid abuse, and there are a number of options for those seeking free or low-cost Narcan to have on hand. If you would like to know more about how to administer naloxone, the Mayo Clinic provides comprehensive information.

Narcan nasal spray, courtesy of UW-Madison Police Department

Filed under Medicine, Science and Tech

This "beyond the book article" relates to Rough Sleepers. It originally ran in February 2023 and has been updated for the January 2024 paperback edition. Go to magazine.