Overdose prevention and naloxone planning in NYC

Naloxone and opioid overdose response

Naloxone is a medicine that can reverse an opioid overdose. People who use opioids, take OUD medication or may be around someone at risk should discuss access and learn how to respond. You can also obtain over-the-counter naloxone products without waiting for a clinic appointment. The specific product and dispensing pathway determine whether a prescription is needed.

How naloxone and opioid overdose response works

Naloxone blocks opioid effects and can restore breathing during an opioid overdose. Its effects can wear off before those of the opioid, so emergency assessment is still needed. It does not provide ongoing OUD treatment or directly treat stimulant toxicity. It can be useful when fentanyl is mixed with cocaine, methamphetamine or an unknown pill because an opioid overdose may occur without the person expecting opioid exposure.

Eligibility: Naloxone and opioid overdose response

Discuss naloxone if opioids are used or prescribed, there is a previous overdose, multiple sedating substances are involved, or opioid tolerance may have fallen. Risk can increase after time without use, discharge, a treatment gap or stopping naltrexone. Family, friends and other people who may witness an overdose can also learn the response. The right product and instructions should be reviewed before an emergency.

What to expect: Naloxone and opioid overdose response

Obtain a product and review its instructions

Ask a pharmacist or clinician about OTC and other local access pathways. Confirm the specific device, expiration and storage instructions. Keep it somewhere that the people likely to help can find it promptly. Do not assume instructions for one nasal spray or injectable product match every product.

Recognize a possible overdose

A person who cannot be awakened or has slow, shallow or absent breathing may be having an overdose. Other signs can include choking or gurgling sounds and discolored lips or nails. If uncertain but an opioid overdose is possible, respond promptly rather than waiting for proof of what was taken.

Give naloxone and obtain emergency help

Administer available naloxone according to the product instructions and call 911. Tell the dispatcher what is happening and follow instructions for breathing support or CPR. More naloxone may be needed, especially with fentanyl. Repeat according to the product directions and emergency guidance.

Stay and support emergency assessment

Stay with the person until help arrives. Breathing problems can return after apparent improvement because naloxone may wear off. Do not assume that waking up means emergency care is unnecessary. Once immediate safety is addressed, discuss treatment, access barriers and another naloxone supply.

Preparing for your appointment

Review the device with a pharmacist or healthcare professional and share the plan with trusted people. Check that they know where it is stored. Replace expired, used or damaged products as appropriate. If you live alone, discuss practical ways to reduce overdose risk; carrying naloxone does not guarantee that you can administer it to yourself during unconsciousness.

Risks and when to seek help

Possible overdose is an emergency. Call 911 and use available naloxone. Do not wait for an appointment, insurance confirmation or a prescription. Naloxone may cause sudden withdrawal in a person dependent on opioids, but saving breathing takes priority. Emergency monitoring is required even after an apparent response. It does not make high-risk opioid or sedative combinations safe.

Follow-up and treatment review

After any overdose, obtain medical assessment and review the treatment plan. Discuss what led to the exposure, whether OUD medication is needed or interrupted, and how another supply of naloxone will be obtained. Review lower tolerance and risk after a period without opioids. A naloxone visit should connect to ongoing care when wanted and clinically appropriate, while keeping emergency access straightforward.

Appointments, costs and coverage

Ask a pharmacist about OTC availability or other dispensing pathways and what the actual product costs or coverage may be. Local programs may also provide naloxone, but their availability needs confirmation. Confirm whether the specific service has naloxone available and what it costs. If the clinic does not have it, ask about another verified access source; do not delay responding to an overdose.

Medical sources

• CDC: five things to know about naloxone
• CDC: naloxone FAQs
• DailyMed: Suboxone prescribing information
• VIVITROL: prescribing information
• SAMHSA: types of treatment
• HHS: understanding confidentiality of SUD patient records
• SAMHSA: co-occurring disorders and other health conditions