Key Takeaways

Naloxone is a life-saving medication used to reverse an opioid overdose, including overdose related to heroin, fentanyl, or prescription opioid medications.
Naloxone is quick, easy to use, safe, and is not addictive.
Anyone can get naloxone from a pharmacy, online retailer, or local organization.

What is naloxone?

Naloxone is a life-saving medication used to reverse an opioid overdose, including overdose related to heroin, fentanyl, or prescription opioid medications. Naloxone is most commonly given in the form of a nasal spray (spray in the nose). Other methods include an injectable (shot) or auto-injector into the outer thigh or another major muscle. Naloxone is safe and easy to use, works almost immediately, and is not addictive. Naloxone has very few negative effects, and has no effect if opioids are not in a person’s system.

Who should carry naloxone?
Why carry naloxone?
Where can you get naloxone?
How do you store and dispose of naloxone?
Naloxone training
Laws and regulations
Resources

Naloxone nasal spray and injectable

Who should carry naloxone?

Anyone can carry naloxone, especially:

People who have an opioid use disorder;
People taking opioid medications prescribed by a doctor;
People who use opioids and benzodiazepines together;
People who use drugs; and
Anyone who is around people who are in the groups mentioned above.

California’s Good Samaritan law protects those giving emergency medical care at the scene of a medical emergency, including giving naloxone.

Why carry naloxone?

Naloxone is a life-saving medication that can reverse an opioid overdose. Carrying naloxone provides an extra layer of protection for those at a higher risk for overdose. Although most professional first responders and emergency departments carry naloxone, they may not arrive in time to reverse an opioid overdose. Carry naloxone, use it on someone having an overdose, and potentially save a life.

Bystanders are present at almost half of all fatal overdoses in California. Because you cannot use naloxone on yourself, let others know you have it in case you experience an opioid overdose.

How to recognize an opioid overdose:

Recognizing the signs of an overdose can save a life. Signs of an opioid overdose may include:

Small, constricted “pinpoint pupils”
Falling asleep or losing consciousness
Slow, weak or no breathing
Choking or gurgling sounds
Limp body
Cold and/or clammy skin
Discolored skin (especially in lips and nails)

How to respond to an opioid overdose:

It may be hard to tell if someone is experiencing an opioid overdose. If you are not sure, treat it like an opioid overdose—you could save a life. With a fentanyl overdose, two or more doses of naloxone may need to be given.

Give naloxone and call 911
Keep the person awake and breathing
Lay the person on their side to prevent choking
Stay with the person until 911 responders arrive

Where can you get naloxone?

Pharmacies and online retailers

Anyone can buy naloxone over the counter from a pharmacy or through an online retailer. Visit the Over the Counter (OTC) Naloxone webpage to learn more.

California residents can now visit the CalRx website to purchase an individual twin-pack of naloxone HCL 4 mg nasal spray at the cost of $24 plus tax and shipping fees.

Local organizations and syringe services programs

Naloxone is also available for free or low-cost at local organizations that have a naloxone distribution program, such as a local opioid or overdose safety coalition or a syringe services program.

The Naloxone Finder below, from the National Harm Reduction Coalition, provides information on how to locate naloxone in the community.

People who use drugs: mail-based distribution programs

If you are a person who uses drugs and you do not have a resource in your community, you may be able to access mail-based naloxone through Next Distro.

Qualified organizations: Naloxone Distribution Project

The California Department of Health Care Services (DHCS) provides naloxone to qualified organizations to distribute naloxone within communities. Learn more by visiting the Naloxone Distribution Project.

How do you store and dispose of naloxone?

Naloxone storage

Follow manufacturer instructions for storing naloxone. Storage instructions may be different.
Keep naloxone in its box until ready for use.
Protect from light.
Store at room temperature below 77°F (25°C).
Do not freeze or expose to heat above 104°F (40°C).
Store in a safe location.

Naloxone disposal

Unused naloxone: Dispose of unused naloxone at a local pharmacy or through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. Learn more about safe disposal options.

Used naloxone:

Nasal spray: Put the used naloxone nasal spray back into its box. Dispose of it in solid waste trash.
Injectable naloxone: Put the used injectable naloxone back into its original container/box. Used injectable naloxone is considered medical waste and must be disposed of in a sharps disposal bin, such as at a local pharmacy. Do not throw away used injectable naloxone in solid waste trash.

Expired naloxone

Expired naloxone is better than no naloxone: If you have expired or soon-to-expire intranasal or injectable (intramuscular) naloxone that has been properly stored, contact a local syringe services program about donating the naloxone. If you have a large amount (10+ doses), you can contact NEXT Distro about donating the naloxone.

Narcan® nasal spray shelf-life extension: The U.S. Food and Drug Administration (FDA) has approved an extended shelf-life for the nasal spray formulation of naloxone (Narcan®) from two years (24 months) to three years (36 months).

Naloxone training

An important part of a naloxone distribution program is to provide training to individuals who may give naloxone. Listed below are training resources:

Administering Naloxone - Training Video (You Tube)
Administración de Naloxona: video de capacitación en español (YouTube)
Naloxone Training for Health Care Providers: Centers for Disease Control and Prevention (CDC) offers several naloxone training modules for health care providers. Earn continuing education credits (CE) after completing the full module.
Overdose Education and Naloxone Distribution (webinar recording): Training for professionals who will be responsible for educating laypersons about opioid overdose and distributing naloxone in their community.
Implementing Naloxone Distribution Systems (webinar recording): Training for program managers and others responsible for the implementation of community naloxone distribution programs.

Laws and regulations

California laws protect persons who give naloxone and make naloxone more readily available.

Good Samaritan Law

A person cannot be liable for any civil damages that result from providing emergency care, if:

The person acted in good faith, and not for compensation;
The person provided either emergency medical care or nonmedical care; and
The care was provided at the scene of an emergency.

Learn more on the Good Samaritan Law’s webpage.

Drug Overdose Treatment Liability Law

The Drug Overdose Treatment Liability Law eliminates civil and criminal liability for:

Licensed health care providers that prescribe naloxone and issue standing orders for the distribution of naloxone; and
Individuals that administer naloxone to someone suspected of experiencing an overdose after receiving it along with required training.

Learn more on the Drug Overdose Treatment Liability Law webpage.

Resources

Family Members and Caregivers

Resources for People Who Use Drugs: This webpage contains tips and resources for safer use and treatment, as well as resources for harm reduction or acting in alliance with people who use drugs.

Local Organizations

The California State Public Health Officer issued a statewide standing order to increase access to naloxone. Review the Naloxone Standing Order FAQ (PDF) andterms and conditions to determine if your organization should apply using the Naloxone Standing Order Application.
Naloxone Grant Program (2017–2019) Final Report (PDF): The California Legislature allocated funding in the Budget Act of 2016 to support this program through June 30, 2019. The goal was to reduce the number of fatal opioid overdoses in California from opioid drugs, including prescription opioids and heroin, by increasing access to naloxone.

Clinicians

When to Offer Naloxone to Patients (CDC, PDF): This fact sheet outlines factors that can put patients prescribed opioids or who use illicit opioids at a higher risk for opioid-related harms.
When to Offer Naloxone to Patients in the Emergency Department (CDC, PDF): This fact sheet described for emergency department staff when to offer naloxone and highlights factors that can put patients at a higher risk for overdose.
Talking About Naloxone with Patients Prescribed Opioids (CDC, PDF): This guide offers tips to help providers communicate the benefits of naloxone to patients, family members and caregivers.

Healthcare Administrators

Increase Naloxone Prescribing in your Health System (CDC, PDF): This fact sheet focuses on the role healthcare executives play in supporting training and education for clinicians on naloxone and opioid use disorder. Offers strategies to increase naloxone prescribing.

Pharmacists

The Pharmacists’ Role in Naloxone Dispensing (CDC, PDF): This fact sheet focuses on the role of pharmacists in naloxone dispensing including when to offer naloxone to patients.

Sources

CDC: Lifesaving Naloxone

Narcan® is a registered trademark of Emergent Operations Ireland Limited.

For questions, please contact us at opi@cdph.ca.gov.

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