Naloxone: The Psychology Behind Safety Nets

More than 70,000 people died from a drug overdose in the United States in 2017. Sixty-eight percent were from opioid overdoses, as reported by the U.S. Centers for Disease Control and Prevention. 

Imagine if one of those deaths was someone you knew and loved, and their death could have been prevented with a dose of naloxone?

Naloxone is a drug that was approved in 1971 by the U.S. Food and Drug Administration (FDA) for the reversal of an opioid overdose. It was created in the 1960s by a man who died before seeing it work on his stepson and before he could see how successful it is. 

It was first issued to first responders to use. Now, it can be sold to people affected by someone who uses opioid medication or abuses illicit opioids, such as heroin. It is sold in 48 U.S. states and the District of Columbia without a prescription.

Many people are under the impression that naloxone gives people abusing opioids the opportunity to get as high as possible, knowing that naloxone becomes a “safety net” if they overdose. News organizations, local, state, and regional health and law enforcement departments also believe this theory.

A layperson may think that having naloxone handy could compel more opioid drug use. This would be a misinformed opinion. Some people think that naloxone can be abused, too. This is also a misconception about the drug.

The fact is that naloxone is a lifesaver when someone has overdosed on opioids.  Read more about the psychology of naloxone safety nets.

Narcan Parties

The stories relayed about so-called “Narcan parties” abound. They are described as a gathering of people abusing opioids to get high knowing they will be “saved” by a naloxone product should they overdose. This causes consternation about the users and misinforms the general public about the effectiveness of Narcan and naloxone products.

As one person wrote for Vice, naloxone reverses an opioid overdose immediately and restarts a person’s breathing. It often quickly brings on opioid withdrawal symptoms. Withdrawal symptoms can be physically demanding on the body and mind, and equally dangerous, also. 

As the writer explains, “It began as a wave of anxiety, so heavy and intense it crashed over my body like a physical force. I had also taken Xanax, a benzodiazepine that enhances the depressant effects of opioids and can inhibit the production of memories, and I don’t remember too much. I do remember shaking violently. It was the shaking of someone who had relinquished control of her body, and was succumbing to the force of precipitated withdrawal.”

How Naloxone Works

Naloxone can be injected or inhaled. Three forms of naloxone are prescribed or sold:

• Injectable – First responders only can obtain this form of naloxone. It comes in a vial and must be injected by a trained medical professional.
• Auto-injectable – This is a pre-filled injectable form of naloxone which is injected into the thigh. It is sold to families and first responders. It is sold under the brand name Evzio® and comes in a two-pack.
• Prepackaged nasal spray – This product, sold under the brand name Narcan ®, comes in a two-pack. It is a nasal spray.

The two-packs are prescribed or sold in case the person receiving the dose does not respond after two to three minutes. A second dose would then be needed.

What Does Naloxone Do?

The National Institute on Drug Abuse (NIDA) says that naloxone reverses an overdose from opioids only. It does not work for other drugs.

It is an opioid receptor antagonist, meaning it binds to the opioid receptors and blocks or reverses other opioids from clinging to them. Naloxone immediately reverses the effects of opioids and restores normal breathing.

It is active in the body for only 30 to 90 minutes. Emergency help should be called immediately. 

The naloxone recipient must be monitored for up to two hours after receiving a dose.

Naloxone might produce opioid withdrawal symptoms for some people. 

These are:

• Nausea
• Vomiting
• Headaches
• Changes in blood pressure
• Sweating
• Rapid heart rate
• Tremors

The Pros of Naloxone

There are pros and cons to everything one can think of. As for naloxone, the pros are:

• It’s easy to obtain and relatively inexpensive.
• Over-the-counter naloxone is easy to administer.
• It revives the overdosed individual immediately and restores normal breathing.
• It’s not an addictive medication.
• It can save someone’s life.

The Cons of Naloxone

And the cons of this medication are:

• Withdrawal symptoms that arise from naloxone use can be mild to severe. This means it might cause the recipient to use the opioid drug again so as not to feel uncomfortable.
• A two-pack of the naloxone nasal spray or auto-injectable can cost $125 without insurance.
• Someone who has taken an opioid laced with fentanyl will need more than one dose.
• It is not a permanent solution for opioid addiction.

Can Naloxone Give Someone a Rush?

This is one of the untruths about naloxone. This mistruth was relayed from a New England first responder to a local news station and then spread on the internet. Naloxone does not give someone a rush. In fact, it does the opposite; it immediately puts the person in withdrawal, in which agonizing symptoms are felt.

Other myths about naloxone are that it prolongs addiction. The fact is that addiction is a chronic disease of the brain, and not getting help to overcome it prolongs addiction.

The Psychology of Safety Nets

Is naloxone a safety net for someone in the throes of an opioid overdose? Yes, it is. Usually, one dose of any form of it will bring the overdosing person back to life almost immediately. There are not many people who want to die from an opioid overdose. Certainly, their loved ones do not want that either.

Psychologically, it is always better to save the life of someone who could die from an overdose than not to give them naloxone. Not giving a dose of it to someone who needs it is, more or less, allowing them to suffer and die. No matter how someone feels about people with opioid use disorder (also called opioid addiction), naloxone is a safety net that is needed.

Sources

US Centers for Disease Control and Prevention. Opioids Portal. from https://www.cdc.gov/opioids/index.html

HuffPost. Who Invented Naloxone?. Castillo, T. December 15, 2015. Updated November 30, 2015. from https://www.huffpost.com/entry/meet-jack-fishman-the-man_b_6329512

The Atlanta Journal-Constitution. Narcan parties becoming disturbing trend, police say. WPXI.com. April 27, 2017. from https://www.ajc.com/news/national/narcan-parties-becoming-disturbing-trend-police-say/2dEFxaNfqAO68mHD64cVsJ/

Vice. Heroin Overdose Parties Are a Dehumanizing Myth. Brisco, E. May 16, 2019. from https://www.vice.com/en_us/article/qv7jmp/heroin-overdose-parties-are-a-dehumanizing-myth

Partnership for Drug-Free Kids. How to Use Naloxone to Reverse Opioid Overdose and Save Lives. Retrieved September 2019. from https://drugfree.org/article/overdose-response-treatment/

National Institute on Drug Abuse. Opioid Overdose Reversal with Naloxone (Narcan, Evzio). Mayh 2018. from https://www.drugabuse.gov/related-topics/opioid-overdose-reversal-naloxone-narcan-evzio

RxList.com. Narcan. from https://www.rxlist.com/narcan-side-effects-drug-center.htm

Time Magazine. The Surgeon General Says More People Should Carry Naloxone, the Opioid Antidote. Here's Where to Get It and How Much It Costs. Adams, A. April 5, 2018. from https://time.com/5229870/naloxone-surgeon-general-cost-where-buy/