Editor’s note: Names have been changed to preserve confidentiality.
When Adam Sutherland got out of bed one night to check on his 21-year-old son, Kyle, he had good reason to be concerned.
Kyle, a heroin addict several weeks out of rehab, had been showing subtle signs of a relapse. Adam and his wife, Lynette, wanted to believe Kyle’s unusually upbeat and chatty mood was merely a side-effect of sobriety, but they feared that assumption was naïve. There had been too many false starts, too many disappointments. That’s why Adam and Lynette had been taking turns looking in on Kyle at their Massachusetts home, as if he were still an infant. The difference was that the Sutherlands now owned an overdose rescue kit containing Narcan, a brand name for the drug naloxone.
Naloxone kit basics
An opioid antagonist, naloxone reverses the effects of narcotics such as heroin, morphine and oxycodone. Kits like the Sutherlands’ have been available to EMS responders, law enforcement officers and private citizens for several years. Although a standard configuration seems to be emerging, there are still variations and caveats to consider when planning a purchase:
- What naloxone does: Naloxone preferentially occupies opiate receptors in the brain, thereby resolving life-threatening respiratory depression caused by an overdose of narcotics.
- What naloxone doesn’t do: Naloxone isn’t a cure or even treatment for addiction. Temporarily blocking the effects of opiates and opioids doesn’t address any of the psychological issues associated with substance abuse. Also, naloxone alone won’t reverse a cardiac arrest.
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Delivery devices: There are two broad categories of naloxone delivery systems for BLS and non-medical personnel: a pre-filled syringe with an adapter for nasal administration and an auto-injector for intramuscular or subcutaneous dosing. The device most commonly found in kits is the same two-milligram container of naloxone carried by ALS providers for intravenous use.
Beware of kits manually assembled with ordinary 3 mL or 5 mL syringes; either naloxone will have to be drawn into the syringe from a vial at the time of use – an awkward process for lay responders – or the preloaded syringe’s exposed plunger will make the unit vulnerable to accidental discharge.
- Shelf life: Expect to replace sealed naloxone vials every two-to-three years per stamped expiration dates.
- Packaging: Glass vials of naloxone can break even when boxed. Zippered bags or pouches don’t add as much protection as hard-shell containers.
- Cost: Boxed, prefilled naloxone syringes cost $40-50 each. Add $5 for a nasal adapter and about $15 per bag. Prices for naloxone auto-injectors are still in flux; right now they’re at least $250 and as much as $825 per unit.
- Training: In almost all U.S. EMS systems, only ALS providers are routinely taught to administer medication using the kinds of vials and syringes found in most naloxone kits. For many BLS responders, including most police officers, single-role firefighters and lay rescuers, naloxone kits will be their first exposure to syringe assembly and use. Training should include introduction of that psychomotor skill, in addition to naloxone indications, contraindications and dosing.
- Program administration: James Garside, a Suffolk County (N.Y.) police officer and AEMT, suggests tracking distribution of naloxone through serial numbers stamped on kits after purchase. “It’s more about collecting data than controlling distribution,” Garside said. “Ideally, we should be following up on both short-term and long-term outcomes.”
Short-term success, maybe more
The Sutherlands’ naloxone kit became a lifesaver when Adam discovered Kyle apneic – not breathing – in bed after Kyle self-administered a dose of heroin. Adam shouted for Lynette, who assembled the pre-filled syringe of naloxone and sprayed one milligram into each of Kyle’s nostrils while Adam called 911.
The antidote restored Kyle’s respiratory drive and kept him alive. After additional treatment by EMS, Kyle recovered at a nearby hospital.
Naloxone did its job; the rest is up to Kyle.
