COVID-19: Potential Implications for Individuals with Substance Use Disorders

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As people across the U.S. and the rest of the world contend with coronavirus disease 2019 (COVID-19), the research community should be alert to the possibility that it could hit some populations with substance use disorders (SUDs) particularly hard. Because it attacks the lungs, the coronavirus that causes COVID-19 could be an especially serious threat to those who smoke tobacco or marijuana or who vape. People with opioid use disorder (OUD) and methamphetamine use disorder may also be vulnerable due to those drugs’ effects on respiratory and pulmonary health. Additionally, individuals with a substance use disorder are more likely to experience homelessness or incarceration than those in the general population, and these circumstances pose unique challenges regarding transmission of the virus that causes COVID-19. All these possibilities should be a focus of active surveillance as we work to understand this emerging health threat.NIH has posted a compilation of updates for applicants and grantees, including a Guide Notice on administrative flexibilities and accompanying FAQs.

SARS-CoV-2, the virus that causes COVID-19 is believed to have jumped species from other mammals (likely bats) to first infect humans in Wuhan, capital of China’s Hubei province, in late 2019. It attacks the respiratory tract and appears to have a higher fatality rate than seasonal influenza. The exact fatality rate is still unknown, since it depends on the number of undiagnosed and asymptomatic cases, and further analyses are needed to determine those figures. Thus far, deaths and serious illness from COVID-19 seem concentrated among those who are older and who have underlying health issues, such as diabetes, cancer, and respiratory conditions. It is therefore reasonable to be concerned that compromised lung function or lung disease related to smoking history, such as chronic obstructive pulmonary disease (COPD), could put people at risk for serious complications of COVID-19.

Co-occurring conditions including COPD, cardiovascular disease, and other respiratory diseases have been found to worsen prognosis in patients with other coronaviruses that affect the respiratory system, such as those that cause SARS and MERS. According to a case series published in JAMA based on data from the Chinese Center for Disease Control and Prevention (China CDC), the case fatality rate (CFR) for COVID-19 was 6.3 percent for those with chronic respiratory disease, compared to a CFR of 2.3 percent overall. In China, 52.9 percent of men smoke, in contrast to just 2.4 percent of women; further analysis of the emerging COVID-19 data from China could help determine if this disparity is contributing to the higher mortality observed in men compared to women, as reported by China CDC. While data thus far are preliminary, they do highlight the need for further research to clarify the role of underlying illness and other factors in susceptibility to COVID-19 and its clinical course.

Vaping, like smoking, may also harm lung health. Whether it can lead to COPD is still unknown, but emerging evidence suggests that exposure to aerosols from e-cigarettes harms the cells of the lung and diminishes the ability to respond to infection. In one NIH-supported study, for instance, influenza virus-infected mice exposed to these aerosols had enhanced tissue damage and inflammation.

People who use opioids at high doses medically or who have OUD face separate challenges to their respiratory health. Since opioids act in the brainstem to slow breathing, their use not only puts the user at risk of life-threatening or fatal overdose, it may also cause a harmful decrease in oxygen in the blood (hypoxemia). Lack of oxygen can be especially damaging to the brain; while brain cells can withstand short periods of low oxygen, they can suffer damage when this state persists. Chronic respiratory disease is already known to increase overdose mortality risk among people taking opioids, and thus diminished lung capacity from COVID-19 could similarly endanger this population.

A history of methamphetamine use may also put people at risk. Methamphetamine constricts the blood vessels, which is one of the properties that contributes to pulmonary damage and pulmonary hypertension in people who use it. Clinicians should be prepared to monitor the possible adverse effects of methamphetamine use, the prevalence of which is increasing in our country, when treating those with COVID-19.  

Other risks for people with substance use disorders include decreased access to health care, housing insecurity, and greater likelihood for incarceration. Limited access to health care places people with addiction at greater risk for many illnesses, but if hospitals and clinics are pushed to their capacity, it could be that people with addiction—who are already stigmatized and underserved by the healthcare system—will experience even greater barriers to treatment for COVID-19.  Homelessness or incarceration can expose people to environments where they are in close contact with others who might also be at higher risk for infections. The prospect of self-quarantine and other public health measures may also disrupt access to syringe services, medications, and other support needed by people with OUD.  

We know very little right now about COVID-19 and even less about its intersection with substance use disorders. But we can make educated guesses based on past experience that people with compromised health due to smoking or vaping and people with opioid, methamphetamine, cannabis, and other substance use disorders could find themselves at increased risk of COVID-19 and its more serious complications—for multiple physiological and social/environmental reasons. The research community should thus be alert to associations between COVID-19 case severity/mortality and substance use, smoking or vaping history, and smoking- or vaping-related lung disease. We must also ensure that patients with substance use disorders are not discriminated against if a rise in COVID-19 cases places added burden on our healthcare system. 

As we strive to confront the major health challenges of opioid and other drug overdoses—and now the rising infections with COVID-19—NIDA encourages researchers to request supplements that will allow them to obtain data on the risks for COVID-19 in individuals experiencing substance use disorders.

Finland Ends Homelessness

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In Finland, the number of homeless people has fallen sharply. The reason: The country applies the “Housing First” concept. Those affected by homelessness receive a small apartment and counselling – without any preconditions. 4 out of 5 people affected thus make their way back into a stable life. And: All this is cheaper than accepting homelessness.

Finland is the only country in Europe where homelessness is in decline

In 2008 you could see tent villages and huts standing between trees in the parks of Helsinki. Homeless people had built makeshift homes in the middle of Finland’s capital city. They were exposed to harsh weather conditions.

Since the 1980s, Finnish governments had been trying to reduce homelessness. Short-term shelters were built. However, long-term homeless people were still left out. There were too few emergency shelters and many affected people did not manage to get out of homelessness: They couldn’t find jobs – without a housing address. And without any job, they couldn’t find a flat. It was a vicious circle. Furthermore, they had problems applying for social benefits. All in all, homeless people found themselves trapped.

But in 2008 the Finnish government introduced a new policy for the homeless: It started implementing the “Housing First” concept. Since then the number of people affected has fallen sharply.

Finland has set itself a target: Nobody should have to live on the streets – every citizen should have a residence.

And the country is successful: It is the only EU-country where the number of homeless people is declining.

How everyone is given residence in Finland

It is NGOs such as the “Y-Foundation” that provide housing for people in need. They take care of the construction themselves, buy flats on the private housing market and renovate existing flats. The apartments have one to two rooms. In addition to that, former emergency shelters have been converted into apartments in order to offer long-term housing.

“It was clear to everyone that the old system wasn’t working; we needed radical change,” says Juha Kaakinen, Director of the Y-Foundation.

Homeless people turn into tenants with a tenancy agreement. They also have to pay rent and operating costs. Social workers, who have offices in the residential buildings, help with financial issues such as applications for social benefits.

Juha Kaakinen is head of the Y-Foundation. The NGO receives discounted loans from the state to buy housing. Additionally, social workers caring for the homeless and future tenants are paid by the state. The Finnish lottery, on the other hand, supports the NGO when it buys apartments on the private housing market. The Y-Foundation also receives regular loans from banks. The NGO later uses the rental income to repay the loans.

“We had to get rid of the night shelters and short-term hostels we still had back then. They had a very long history in Finland, and everyone could see they were not getting people out of homelessness. We decided to reverse the assumptions.” (Juha Kaakinen, Director of the Y-Foundation)

That’s how the “Housing First” concept works

The policy applied in Finland is called “HousingFirst”. It reverses conventional homeless aid. More commonly, those affected are expected to look for a job and free themselves from their psychological problems or addictions. Only then they get help in finding accommodation.

“Housing First”, on the other hand, reverses the path: Homeless people get a flat – without any preconditions. Social workers help them with applications for social benefits and are available for counselling in general. In such a new, secure situation, it is easier for those affected to find a job and take care of their physical and mental health.

The result is impressive: 4 out of 5 homeless people will be able to keep their flat for a long time with “Housing First” and lead a more stable life.

In the last 10 years, the “Housing First” programme provided 4,600 homes in Finland. In 2017 there were still about 1,900 people living on the streets – but there were enough places for them in emergency shelters so that they at least didn’t have to sleep outside anymore.

Providing people with apartments is cheaper than leaving them on the street

Creating housing for people costs money. In the past 10 years, 270 million euros were spent on the construction, purchase and renovation of housing as part of the “Housing First” programme. However, Juha Kaakinen points out, this is far less than the cost of homelessness itself. Because when people are in emergency situations, emergencies are more frequent: Assaults, injuries, breakdowns. The police, health care and justice systems are more often called upon to step in – and this also costs money.
In comparison, “Housing First” is cheaper than accepting homelessness: Now, the state spends 15,000 euros less per year per homeless person than before.

No miracle cure – but a high success rate

With 4 out of 5 people keeping their flats, “Housing First” is effective in the long run. In 20 percent of the cases, people move out because they prefer to stay with friends or relatives – or because they don’t manage to pay the rent. But even in this case they are not dropped. They can apply again for an apartment and are supported again if they wish.

Of course, there is no guarantee for success. Especially homeless women are more difficult to reach: They conceal their emergency situation more often: They live on the streets less frequently and rather stay with friends or acquaintances.

Original Source/Author:  Kontrast.at/Kathrin Glösel 

Know the Risks of Marijuana

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Marijuana use comes with real risks that can impact a person’s health and life.

Marijuana is the most commonly used illegal substance in the U.S. and its use is growing. Marijuana use among all adult age groups, both sexes, and pregnant women is going up. At the same time, the perception of how harmful marijuana use can be is declining. Increasingly, young people today do not consider marijuana use a risky behavior.

But there are real risks for people who use marijuana, especially youth and young adults, and women who are pregnant or nursing. Today’s marijuana is stronger than ever before. People can and do become addicted to marijuana.

“Approximately 1 in 10 people who use marijuana will become addicted. When they start before age 18, the rate of addiction rises to 1 in 6.”

Know the risks before you use.

Marijuana Risks

Marijuana use can have negative and long-term effects:

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Brain health: Marijuana can cause permanent IQ loss of as much as 8 points when people start using it at a young age. These IQ points do not come back, even after quitting marijuana.

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Mental health: Studies link marijuana use to depression, anxiety, suicide planning, and psychotic episodes. It is not known, however, if marijuana use is the cause of these conditions.

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Athletic Performance: Research shows that marijuana affects timing, movement, and coordination, which can harm athletic performance.

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Driving: People who drive under the influence of marijuana can experience dangerous effects: slower reactions, lane weaving, decreased coordination, and difficulty reacting to signals and sounds on the road.

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Baby’s health and development: Marijuana use during pregnancy may cause fetal growth restriction, premature birth, stillbirth, and problems with brain development, resulting in hyperactivity and poor cognitive function. Tetrahydrocannabinol (THC) and other chemicals from marijuana can also be passed from a mother to her baby through breast milk, further impacting a child’s healthy development.

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Daily life: Using marijuana can affect performance and how well people do in life. Research shows that people who use marijuana are more likely to have relationship problems, worse educational outcomes, lower career achievement, and reduced life satisfaction.

Medical Marijuana Update

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According to the National Institutes of Health, people have used marijuana, or cannabis, to treat their ailments for at least 3,000 years. However, the Food and Drug Administration have not deemed marijuana safe or effective in the treatment of any medical condition, although cannabidiol, a substance that is present in marijuana, received approval in June 2018 as a treatment for some types of epilepsy.

This tension, between a widespread belief that marijuana is an effective treatment for a wide assortment of ailments and a lack of scientific knowledge on its effects, has been somewhat exacerbated in recent times by a drive toward legalization.

Twenty-nine states plus the District of Columbia have now made marijuana available for medical — and, in some states, recreational — purposes.

A recent study published in the journal Addiction also found that use of marijuana is increasing sharply across the United States, although this rise may not be linked to the legalization of marijuana in participating states. Nevertheless, this rise in use is prompting major public health concerns.

In this article, we look at the scientific evidence weighing the medical benefits of marijuana against its associated health risks in an attempt to answer this simple question: is marijuana good or bad?

What are the medical benefits of marijuana?

Over the years, research has yielded results to suggest that marijuana may be of benefit in the treatment of some conditions. These are listed below.

Chronic pain

Last year, a large review from the National Academies of Sciences, Engineering, and Medicine assessed more than 10,000 scientific studies on the medical benefits and adverse effects of marijuana.

One area that the report looked closely at was the use of medical marijuana to treat chronic pain. Chronic pain is a leading cause of disability, affecting more than 25 million adults in the U.S.

The review found that marijuana, or products containing cannabinoids — which are the active ingredients in marijuana, or other compounds that act on the same receptors in the brain as marijuana — are effective at relieving chronic pain.

Alcoholism and drug addiction

Another comprehensive review of evidence, published last year in the journal Clinical Psychology Review, revealed that using marijuana may help people with alcohol or opioid dependencies to fight their addictions.

But this finding may be contentious; the National Academies of Sciences review suggests that marijuana use actually drives increased risk for abusing, and becoming dependent on, other substances.

Also, the more that someone uses marijuana, the more likely they are to develop a problem with using marijuana. Individuals who began using the drug at a young age are also known to be at increased risk of developing a problem with marijuana use.

Depression, post-traumatic stress disorder, and social anxiety

The review published in Clinical Psychology Review assessed all published scientific literature that investigated the use of marijuana to treat symptoms of mental illness.

Evidence to date suggests that marijuana could help to treat some mental health conditions.

Its authors found some evidence supporting the use of marijuana to relieve depression and post-traumatic stress disorder symptoms.

That being said, they caution that marijuana is not an appropriate treatment for some other mental health conditions, such as bipolar disorder and psychosis.

The review indicates that there is some evidence to suggest that marijuana might alleviate symptoms of social anxiety, but again, this is contradicted by the National Academies of Sciences, Engineering, and Medicine review, which instead found that regular users of marijuana may actually be at increased risk of social anxiety.

Cancer

Evidence suggests that oral cannabinoids are effective against nausea and vomiting caused by chemotherapy, and some small studies have found that smoked marijuana may also help to alleviate these symptoms.

Some studies on cancer cells suggest that cannabinoids may either slow down the growth of or kill some types of cancer. However, early studies that tested this hypothesis in humans revealed that although cannabinoids are a safe treatment, they are not effective at controlling or curing cancer.

Multiple sclerosis

The short-term use of oral cannabinoids may improve symptoms of spasticity among people with multiple sclerosis, but the positive effects have been found to be modest.

Epilepsy

In June 2018, the Food and Drug Administration (FDA) approved the use of a medication containing cannabidiol (CBD) to treat two rare, severe, and specific types of epilepsy — called Lennox-Gastaut syndrome and Dravet syndrome — that are difficult to control with other types of medication. This CBD-based drug is known as Epidiolex.

CBD is one of many substances that occurs in cannabis. It is not psychoactive. The drug for treating these conditions involves a purified form of CBD. The approval was based on the findings of research and clinical trials.

A study published in 2017 found that the use of CBD resulted in far fewer seizures among children with Dravet syndrome, compared with a placebo.

Dravet syndrome seizures are prolonged, repetitive, and potentially lethal. In fact, 1 in 5 children with Dravet syndrome do not reach the age of 20 years.

In the study, 120 children and teenagers with Dravet syndrome, all of whom were aged between 2 and 18, were randomly assigned to receive an oral CBD solution or a placebo for 14 weeks, along with their usual medication.

Research indicates that marijuana could help to treat epilepsy.

The researchers found that the children who received the CBD solution went from having around 12 seizures per month to an average of six seizures per month. Three children receiving CBD did not experience any seizures at all.

Children who received the placebo also saw a reduction in seizures, but this was slight — their average number of seizures went down from 15 each month before the study to 14 seizures per month during the study.

The researchers say that this 39 percent reduction in seizure occurrence provides strong evidence that the compound can help people living with Dravet syndrome, and that their paper has the first rigorous scientific data to demonstrate this.

However, the study also found a high rate of side effects linked to CBD. More than 9 in 10 of the children treated with CBD experienced side effects — most commonly vomiting, fatigue, and fever.

The patient information leaflet for Epidiolex warns of side effects such as liver damage, sedation, and thoughts of suicide.

What are the health risks of marijuana?

At the other end of the spectrum is the plethora of studies that have found negative associations between marijuana use and health. They are listed below.

Mental health problems

Daily marijuana use is believed to exacerbate existing symptoms of bipolar disorder among people who have this mental health problem. However, the National Academies of Sciences, Engineering, and Medicine report suggests that among people with no history of the condition, there is only limited evidence of a link between marijuana use and developing bipolar disorder.

Moderate evidence suggests that regular marijuana users are more likely to experience suicidal thoughts, and there is a small increased risk of depression among marijuana users.

Marijuana use is likely to increase risk of psychosis, including schizophrenia. But a curious finding among people with schizophrenia and other psychoses is that a history of marijuana use is linked with improved performance on tests assessing learning and memory.

Testicular cancer

Although there is no evidence to suggest any link between using marijuana and an increased risk for most cancers, the National Academies of Sciences did find some evidence to suggest an increased risk for the slow-growing seminoma subtype of testicular cancer.

Respiratory disease

Regular marijuana smoking is linked to increased risk of chronic cough, but “it is unclear” whether smoking marijuana worsens lung function or increases the risk of chronic obstructive pulmonary disease or asthma.

A 2014 study that explored the relationship between marijuana use and lung disease suggested that it was plausible that smoking marijuana could contribute to lung cancer, though it has been difficult to conclusively link the two.

The authors of that study — published in the journal Current Opinion in Pulmonary Medicine — conclude:

“There is unequivocal evidence that habitual or regular marijuana smoking is not harmless. A caution against regular heavy marijuana usage is prudent.”

“The medicinal use of marijuana is likely not harmful to lungs in low cumulative doses,” they add, “but the dose limit needs to be defined. Recreational use is not the same as medicinal use and should be discouraged.”

So, is marijuana good or bad for your health?

There is evidence that demonstrates both the harms and health benefits of marijuana. Yet despite the emergence over the past couple of years of very comprehensive, up-to-date reviews of the scientific studies evaluating the benefits and harms of the drug, it’s clear that more research is needed to fully determine the public health implications of rising marijuana use.

More research is needed to confirm the harms and benefits of marijuana use.

Many scientists and health bodies — including the American Cancer Society (ACS) — support the need for further scientific research on the use of marijuana and cannabinoids to treat medical conditions.

However, there is an obstacle to this: marijuana is classed as a Schedule I controlled substance by the Drug Enforcement Administration, which deters the study of marijuana and cannabinoids through its imposition of strict conditions on the researchers working in this area.

If you happen to live in a state where medical use of marijuana is legal, you and your doctor will need to carefully consider these factors and how they relate to your illness and health history before using this drug.

For instance, while there is some evidence to support the use for marijuana for pain relief, you should certainly avoid marijuana if you have a history of mental health problems.

The Risks of Meth Usage

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Methamphetamine (meth) is a powerful, highly addictive drug that causes devastating health effects, and sometimes death, even on the first try.

Meth is easy to get addicted to and hard to recover from. Meth is a dangerous, synthetic, stimulant drug often used in combination with other substances that can be smoked, injected, snorted, or taken orally. Someone using meth may experience a temporary sense of heightened euphoria, alertness, and energy. But using meth changes how the brain works and speeds up the body’s systems to dangerous, and sometimes lethal, levels—increasing heart rate, blood pressure, body temperature, and respiratory rate. Chronic meth users also experience anxiety, confusion, insomnia, paranoia, aggression, visual and auditory hallucinations, mood disturbances, and delusions.

The Rise of Meth Use in the United States

The number of fatal overdoses involving meth has more than tripled (PDF | 336 KB) between 2011 and 2016, according to the CDC. Use is also on the rise between 2016-2018 for most age groups. In 2018, more than 106,000 adults aged 26 or older used meth—a 43 percent increase over the previous year.

Short-term Effects of Meth

Even taking small amounts of meth, or just trying it once, can cause harmful health effects, including:

  • Increased blood pressure and body temperature
  • Faster breathing
  • Rapid or irregular heartbeat
  • Loss of appetite, disturbed sleep patterns, or nausea
  • Bizarre, erratic, aggressive, irritable, or violent behavior

Long-term Health Risks of Meth

Chronic meth use leads to many damaging, long-term health effects, even when users stop taking meth, including:

  • Permanent damage to the heart and brain
  • High blood pressure leading to heart attacks, strokes, and death
  • Liver, kidney, and lung damage
  • Anxiety, confusion, or insomnia
  • Paranoia, hallucinations, mood disturbances, delusions, or violent behavior (psychotic symptoms can sometimes last for months or years after quitting meth)
  • Intense itching, causing skin sores from scratching
  • Severe dental problems (“meth mouth”)

Need Help?

With the right treatment plan, recovery is possible. If you, or someone you know, needs help with a substance use disorder, including meth use, call SAMHSA’s National Helpline at 1-800-662-HELP (4357) or TTY: 1-800-487-4889, or use SAMHSA’s Behavioral Health Treatment Services Locator to get help.

How to Use Naloxone to Reverse Opioid Overdose and Save Lives

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NALOXONE SAVES LIVES

A variety of drugs and drug combinations carry the risk of fatal overdose. Emergency protocol for any suspected overdose includes calling 911. However, in the case of opioids, which includes heroin and prescription pain medications like Vicodin, OxyContin and Percocet, naloxone (also known by the brand name Narcan) can reverse an overdose, potentially saving a loved one’s life.

What Puts One at Risk for Overdose?

Anyone using opioids, whether for recreational purposes or otherwise, can be at risk for overdose. Other risk factors include:

  • Using or taking drugs alone
  • Mixing opioids with other drugs like alcohol, benzodiazepines (e.g., Xanax and Ativan) and prescription stimulants (e.g., cocaine and Adderall)
  • Having lower tolerance due to recent detox/drug treatment, incarceration or illness
  • Not knowing what drugs one is consuming (e.g. using heroin cut with fentanyl)

Know the Signs of an Overdose

An overdose can happen when the amount ingested causes suppressed breathing in a way that oxygen can’t reach vital organs, and the body begins to shut down. It’s important to note that an overdose can occur anywhere from 20 minutes to 2 full hours after drug use. Signs of an overdose include:

  • Face is clammy to touch and has lost color
  • Blue lips and fingertips
  • Non-responsive to his/her name or a firm sternum rub using the knuckles
  • Slow or erratic breathing, or no breathing at all
  • Deep snoring or a gurgling sound (i.e. what would be described as a “death rattle”)
  • Heartbeat is slow or has stopped

What To Do if You Suspect an Overdose

1. Call 911

If you suspect an overdose and your loved one is unresponsive, call 911. If you must leave the person alone to make the call, put them in the recovery position — on their side with the bottom arm under the head and top leg crossed over the body (see image below). This is to avoid aspiration if he or she vomits. Give the address or location and as much information as you can (i.e., unconscious, not breathing, drugs used if known, etc.).

how to administer auto-injector naloxone for opioid overdose
2. Administer Naloxone

Note that naloxone is only effective in the case of an opioid overdose. However, if you are unsure of the substance(s) involved, it’s best to err on the side of caution and administer it. Naloxone is not known to cause any harm in the case of a non-overdose.

3. Conduct Rescue Breathing

If the person has labored breathing or is not breathing at all, it is vital to conduct rescue breathing. Tilt the head back, pinch the nose closed and give one slow breath every 5 seconds until the person resumes breathing on their own or until the paramedics arrive. Watch to see that their chest rises and falls with each breath.

4. Comfort and Support

Once the person is breathing on their own, place them in the recovery position until paramedics arrive. Comfort the person as he or she may be confused, upset and going through withdrawal (feeling sick from a lack of opioids if their body is dependent on them) when revived. Do not allow him or her to use drugs.

5. Aftermath of an Overdose

Once your loved one has been stabilized, this may be an opportunity to suggest detox and treatment. Contact the Partnership for Drug free Kids free Parent Helpline at 1-855-378-4373 to speak with a trained counselor and begin getting the help your family needs.

How to Administer Naloxone

Naloxone is administered as a nasal spray or via injection, depending on which of the following devices it has been prepared for and packaged with.

1. Evzio auto-injector

With U.S. Food and Drug Administration (FDA) approval in 2014, this was the first auto-injector approved for non-clinical settings. The auto-injector administers a single dose of naloxone with a retractable needle, avoiding accidental needles sticks and any additional assembly. To use, place the black end against the middle of the person’s outer thigh, through clothing (pants, jeans, etc.) if necessary, then press firmly and hold in place for 5 seconds. For extra reassurance, the device has a voice recording that provides step-by-step instructions as you go, including letting you know once it’s OK to stop applying pressure and remove from the person’s thigh.

2. Narcan Nasal Spray

Narcan Nasal Spray is the most recent FDA approved naloxone product. It is very easy to use. There is nothing to assemble and each package comes with two devices prefilled with a single dose each. Simply hold the device with your thumb on the bottom and your first and middle fingers on either side of the nozzle. Gently insert the nozzle into one nostril until your fingers on either side of the nozzle are against the bottom of the person’s nose. Once in place, press the plunger firmly to spray the entire dose of Narcan into one nostril. There is no need to spray into both nostrils.

3. Injection via syringe

Injecting into the muscle of the upper thigh or upper arm with a syringe is also a very common way to administer naloxone. Many naloxone kits come with a syringe and a vial or a pre-filled cartridge of naloxone. The shot can be administered through clothes.

Talk to your pharmacist about the proper dose for naloxone. 0.4 mg/mL is commonly recommended. A second dose of 0.4 mg/mL is sometimes needed, however, if the first dose does not reverse the overdose and restore breathing.

Frequently Asked Questions

Where can I get naloxone?
In addition to some independent drugstores, Walgreen’s, CVS, Rite Aid, Target and Wal-Mart are providing naloxone in many states through their pharmacies without requiring a prescription. You can also find training programs and naloxone here.

Will naloxone help if the person overdosed on drugs other than opioids?
No, it only works to reverse an overdose involving opioids.

If I don’t know what the person used, should I administer naloxone anyway?
Yes, naloxone is a very safe drug and will not adversely impact someone who has overdosed on other drugs or alcohol.

I’ve heard friends say that a cold shower, coffee or other stimulants can help with an overdose. Should I try that?
No, if someone is in respiratory distress the best course of action is to call 911 and administer naloxone along with rescue breathing.

If the person begins breathing on their own after giving them naloxone, why should I bother calling 911?
Naloxone only last for 30 to 90 minutes so it’s possible that the person could go into respiratory arrest again due to the opioids still in their system. Medical professionals can help provide the necessary treatment to prevent respiratory failure.

I’ve heard that fentanyl is so powerful that 1 or 2 doses of naloxone may not be enough. Is that true?
Yes, overdoses involving fentanyl may require repeated administrations of naloxone to restore breathing.

My son is in rehab and I expect that he will be committed to recovery when he gets out, so why do I need to get a naloxone kit?
The relapse rate associated with opioid use has been estimated to be as high as 90 percent. 1 As a precautionary measure, it’s important to have naloxone in the home. Just as you don’t anticipate having a fire, you probably have a smoke detector in the home – this is the same kind of precautionary measure that you hope you never have to use.

Won’t the person who overdosed be arrested for possession and potentially other charges if 911 is called and the police arrive?
Many states have passed overdose prevention laws, which support treatment instead of arrests. Check your state’s laws.

What legal protections are there for the person administering the naloxone so that if something goes wrong, they aren’t held responsible?
Most states have passed Good Samaritan Laws for the protection of the person administering the naloxone. Check your state’s laws.

If I don’t have any naloxone and someone has overdosed, what should I do?
Call 911 and perform rescue breathing until the paramedics arrive.

What’s the price and availability of Naloxone?
Price and availability vary. However, some formulations, including the most expensive, are increasingly covered by insurance policies. In some states, insurers still only cover naloxone for patients — people who are taking/using opioids. In other states, insurance will also cover naloxone for third parties (e.g. concerned family or community members). Contact your insurer, pharmacist or Health Department to find out what is covered in your state.

Even when insurance is not available, some manufacturers will provide naloxone at no charge for people who cannot purchase it through insurance or other means if requested by their physician. Contact the manufacturer’s website – such as Evzio or Narcan – for information on these programs.

Does naloxone expire?
There is an expiration date on naloxone, however research indicates that it can be effective well beyond the expiration date on packaging; in some cases months and years later. The safest practice is to get a replacement (setting a reminder on your phone’s calendar) but in the case of an emergency, it’s better to use an expired dose than to not administer anything.

Will naloxone go bad if it is stored in a place that’s too hot or cold?
Yes, check the packaging to see what temperature range is recommended. Generally, room temperature is advised.

If I keep naloxone in the house, won’t my child think that he or she can use more drugs because there’s an antidote available?
There are no studies that indicate increased usage due to having naloxone available. Think of having Naloxone around as you would a first-aid kit. It’s always best to err on the safe side and be prepared in case of emergency.