If you have a spare 50 minutes, you should listen to the Addictions Edited podcast episode on naloxone. If you don’t, here are some essential snippets from the conversation between three naloxone experts and podcast host Rob Calder.

Rob: Many people will be aware that naloxone reverses overdoses, but can you give us a bit more detail on how it works?

Rebecca: “Naloxone is an ‘opioid antagonist’, meaning that it blocks ‘opioid agonists’ such as heroin from acting. When a person experiences an opioid overdose, their breathing is suppressed. If naloxone is given in a timely fashion, it can restore breathing and prevent a fatal outcome from the overdose.”

Rob: In the event of an overdose, what does someone need to do in order to administer naloxone?

Martin M: “It’s about recognising the signs of an overdose, and then using naloxone. Most people who use opioids know the signs of an overdose: the person is going to be unconscious; there’s probably going to be signs of drug use around, perhaps a syringe near or still inside the body; potentially blue lips or blue fingertips; and rasping or slow breathing. And, there are two different ways to administer naloxone. With the injectable version, we advise people to inject it into the thigh muscle. With the nasal spray, that obviously goes into the nose.”

Rob: Is nasal naloxone as effective? My assumption, knowing nothing about this, would be that an injection was more effective, but that isn’t necessarily the case, is it?

Martin M: “One method isn’t better than the other, they’re just different. They both work just as quickly – typically in about 1–2 minutes.”

Rob: One of the key aspects of naloxone is that it’s not something you can self-administer. Is this something you cover in training?

Martin S: “Yes, as you said, you need two people present – one is the person who overdosed and may die, and the second is the person who has naloxone, is willing to use it, and has the confidence and skills to use it. We also tell clients that it is important to call an ambulance. If an emergency happens, you always call the ambulance. But if you have naloxone, you can do something more while you are waiting.”

Rob: Are there any common myths you have to explain in training?

Martin M: “Yes, there’s several. I have friends that swear a saltwater injection will reverse an overdose. Other myths are that if you walk a person around, or put them in a cold bath, it will reverse an overdose. All of these are nonsense because they can’t do what naloxone does, which is temporarily block the opiates from sitting on the receptors. But people will still swear by them.”

Rob: I remember attending training where the facilitator emphasised that ‘an overdose is an overdose is an overdose’. If you can wake someone up, it isn’t an overdose.

Martin M: “Yes. But the cool thing about naloxone is that it’s a ‘one trick pony’. If you get it wrong – if it’s not an opiate overdose – you’re not doing any harm. It only works on opiates. If there’s no opiates in that person’s system, it won’t work. And legally you’re covered. Anyone can administer naloxone for the purpose of saving a life.”

Rob: What are some of the barriers to people carrying naloxone?

Rebecca: “There have been some qualitative studies in North America, mostly with people who were abstinent, and they found that some people considered naloxone to be a trigger for returning to using illicit drugs.”

Martin M: “Yes, and I’m sure you would get very different answers from a non-abstinent group. The reason I hear most of the time is, ‘I use alone, so there’s no point in me having it’. Unfortunately, a lot of people who use opioids see an overdose as part of the job description. It’s something that happens a lot.”

Rob: And how about some of the reasons why people may want to carry naloxone?

Martin S: “There was a period of 3 to 4 weeks in Lambeth when a synthetic opioid was available on the ‘black market’, and many of our clients reported that they had witnessed an overdose or had an overdose. Almost on a daily basis we had people on the phone or coming to the service, and they were very stressed and worried. These clients, they knew that they may die or that their friends or someone they know may die, and they were coming here and they were saying, ‘I need naloxone. I need more naloxone because the risk is there. And if I see if I see an overdose, I want to use it’.

“Just thinking about the different groups of people who may use naloxone, I think it is important to mention parents or family members. I have trained parents in how to use naloxone and reverse the overdose, and I think they were grateful that they had some power to do something if an emergency happened. So, you always call the ambulance. But while you are waiting for an ambulance, you are counting the minutes or seconds, and if you have naloxone you can do something more. And I think for these parents, it was important to know that this is what they could do to save the life of their child.”

Rob: What are the next steps for naloxone research?

Rebecca: “One of the things we want to look at is ways to expand naloxone access through non-traditional routes. Some of the foundations for this were probably laid in the early part of the COVID-19 pandemic, when services weren’t necessarily open regular hours. So, things such as mail delivery of naloxone was used more widely, or the provision of multiple kits per person. We also need to get an understanding of what level of coverage of naloxone in a community is needed to bring down mortality rates.”

edited by Natalie Davies

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