How Learning About NARCAN Can Help Your Community

Disclaimer: If you or someone you know is suffering from a potential opioid overdose, call 911 or your local emergency services department immediately. 

There are many misconceptions around opioid use, addiction and overdoses. These range from socioeconomic circumstances to age, occupation, gender and marital status, with the common thread that opioid overdoses only happen in rural or underserved communities and populations. The truth is, opioid use is prevalent in every aspect of society, at all economic levels and among people ranging from teenagers to those in their sixties. 

In recent years, naloxone (commonly referred to as NARCAN) has become society’s greatest tool in preventing opioid overdoses and deaths. It’s a readily available drug and, when administered properly, extraordinarily effective. Dr. Kimberly Levin is an Aspen Valley Health emergency medicine physician and Pitkin County Medical Officer with a passion for cultivating a thriving community here in the Roaring Fork Valley—one based on public health access and education. Central to that philosophy is access to NARCAN, including how to use it in a way that will save lives.

Understanding NARCAN and How it Works

You might have heard of NARCAN recently. To better understand what it is and how it works, it’s important to first understand how an overdose happens. Dr. Levin explains, “Opioids bind to a specific receptor in the body called the mu-opioid receptor (MOR). In an overdose, the effects cause respiratory depression, sedation and can lead to death.” NARCAN, or naloxone, is a medication that works as an opioid antagonist to reverse opioid toxicity. “When administered, naloxone actually displaces the opioid from this binding site and reverses its effects, restoring breathing and consciousness and effectively saving someone’s life.” 

The medication is available to the public in the U.S. over-the-counter at pharmacies in the form of a nasal spray, while EMS and emergency departments can administer it intravenously or intramuscularly. The results are rapid. The nasal spray typically takes effect in 3 to 10 minutes and lasts 30 to 60 minutes, which can require repeated doses as most opioid effects extend beyond the 60-minute timeframe. Intravenous and intramuscular methods produce effects within two minutes. For non-medical bystanders and family members, the nasal spray is easy to use and access and is very effective. The drug is non-addictive and has a high safety profile, meaning it does not pose any harm to those administering it.

The Scope of Opioid Overdoses in Communities

Current statistics tell us opioid overdose deaths and emergency calls in communities have been on an alarming rise in Colorado in recent years. Says Dr. Levin, “There was a sharp increase in opioid overdose deaths in the state starting in 2019, and peaking in 2023. According to the Colorado Department of Public Health and Environment (CDPHE), there were 349 deaths in 2018, which rose dramatically to 1,273 in 2023.”

Pointing to the prolific nature of opioid overdose deaths, Dr. Levin continues, “Many different demographics in our population are affected by opioid overdoses. In Colorado, we see them in all age categories, predominantly among 25 to 64-year old’s, with the highest rate in those 35 to 44.” Additionally, twice as many males as females die from opioid overdoses, and a higher number of single people versus those who are married are victims. While the common misconception is opioid deaths mostly occur among people experiencing homelessness, they only account for about 15% of deaths from opioid toxicity. 

Most deaths occur in private spaces, such as the victim’s home, making it imperative for friends and family members of those battling opioid addiction to be familiar with NARCAN, have some on-hand and understand how to administer it effectively, with the optimum window of efficacy being within 2 to 5 minutes of when a person overdoses.

Breaking Down Barriers to Community Access

This short administration window makes having NARCAN on-hand the biggest step toward preventing an opioid overdose, and remember, this can happen to anyone who has access to opioids. “The biggest barriers preventing community members from accessing and using naloxone are having it readily and easily available in the moment of an overdose to save a life, as well as education and how to administer it. The intranasal formula is very easy to use. Since 2017, it has been available over-the-counter at local pharmacies in Colorado.”

For those worried about cost, you might want to get a prescription from your doctor. Continues Dr. Levin, “While a prescription isn’t necessary to secure doses of naloxone, in some cases it might be cheaper with insurance coverage.” 

The intranasal formula is simple to use and comes in a package of two so there is an option to repeat doses if necessary. EMS, police and fire departments all carry naloxone and can administer the drug in case of an emergency. For those worried about legal liability when administering naloxone to prevent an overdose death, Dr. Levin assures Colorado’s Good Samaritan law is strong. “Good Samaritan law provides legal protection for any bystander who administers NARCAN for a suspected opioid overdose emergency. In Colorado, these people are well protected under the law, encouraging any bystander and layperson to intervene knowing they do not need to fear legal repercussions.”

Training Programs and Community Education

Recognizing when someone is experiencing an overdose is the first vital step in preventing an overdose death. Signs and symptoms of an opioid overdose can include:

• Slow, shallow breathing
• Extreme sleepiness or unresponsiveness (very difficult or unable to awaken)
• Possible bluish lips, fingernails or skin
• Slow heartrate
• Gurgling noises
• Pinpoint pupils
• Apnea (stopping breathing)
• In severe cases, death

These effects are due to depression of the central nervous and respiratory systems. 

If you find someone experiencing these symptoms, Dr. Levin walks through what to do next:

1. If you have naloxone on-hand, administer it immediately.
2. Always call 911 as soon as possible after the first dose—early activation of emergency services is critical in saving a person’s life.
3. If the first dose of naloxone does not work within 2 to 3 minutes while you’re waiting for emergency services to arrive, give the second dose in the package. 

“Remember, naloxone is very safe and easy for anyone to give, and can rapidly reverse life-threatening effects of opioids. It is also important to avoid mixing opioids with other substances, especially alcohol and/or benzodiazepines, such as Ativan or Xanax, as this combination will create severe risk of sedation and death. Narcan reverses only opioid overdoses, it does not reverse alcohol or other drug overdoses. However, it is always important to give Narcan anytime someone is sedated/unresponsive because it is safe and can still help to save a life even for an unknown or multiple drug ingestion.”

There are a variety of local, state and national organizations that offer community-based naloxone training. Contact your local health department or overdose resource center to learn about those available near you.

Strategic Community Distribution

In order for naloxone to be effective, it has to be accessible at home or where a person has access to opioids, as well as throughout a community. An effective community distribution program incorporates schools, libraries, behavioral health facilities and community centers. Additionally, talk to your human resources department to see if your workplace currently offers a naloxone program, and encourage incorporating one if not. 

If you or someone close to you has access to opioids, train family members and friends on the use of proper naloxone administration, keeping in mind the “it won’t happen to me or someone I know” philosophy does not apply to opioid addiction. Reaching high-risk populations and their support systems is the fundamental way to prevent opioid overdose deaths.

Implementing a Community NARCAN Initiative

According to Dr. Levin, “It is critical for key stakeholders in the community to work together to build partnerships to create a community naloxone program.” These stakeholders include:

• The local public health department 
• Harm reduction organizations
• Health care providers and systems, such as emergency departments, medical clinics, EMS, addiction medicine services and pharmacies
• Law enforcement and first responders
• State and local government
• Schools

Personally, if a physician prescribes you opioids, ask for a naloxone prescription as well, making sure friends and family have two doses of NARCAN readily available.

Long-term Community Benefits

More compassionate, informed communities are better able to combat the opioid epidemic. “Success is easy access to naloxone for all at-risk individuals of all demographics, their families and friends and education on its use resulting in a documented decrease in the number of opioid overdose deaths in a community over time.” 

This requires community members to create conversations about addiction as a health issue. Dr. Levin summarizes the public health importance of NARCAN. “Success depends on shifting community attitudes about addiction and recovery, which requires a multifaceted approach to destigmatization. A reduction in opioid overdose deaths requires community education campaigns that teach opioid use disorder (OUD) is a chronic medical condition that requires medical attention and medications, as well as harm reduction strategies. Normalizing this attitude and the use of naloxone and treatment or OUD is critical to this success.”