Naloxone is called an opioid receptor antagonist. What does that mean? Well, it binds to opioid receptors in the brain and blocks incoming drugs, or it can also dislodge opioids that got to a receptor before naloxone was administered.
Quite simply, naloxone restores the brain and normal breathing. Opioids suppress bodily functions, including breathing. Somebody suffering an overdose can pass out as respiration grows slow and shallow. Naloxone reverses that in just two to five minutes.
So those videos you see of people being rapidly revived — that's naloxone working.
Naloxone wears off after 30-90 minutes, so patients need to be monitored afterward. If they are heavy users or took an especially potent opioid, another dose might be necessary — sometimes more than one.
Naloxone can be injected with a syringe, administered with an auto-injection device sold under the brand name Evzio or given by nasal spray, which is sold under the brand Narcan.
The cost of naloxone is spiking. A vial of generic naloxone used by medical professionals that cost about $4 in 2009 is now about $16. A two-dose auto-injector package that was introduced at $690 in 2014 climbed as high as $4,500 last year, though it was priced at $4,100 more recently.
There are other concerns. One is that naloxone is no match for more potent opioids like fentanyl and carfentanil. And that has drug companies and researchers working on alternatives. One, which is similar to naloxone, would last four times longer.
Another concern: Does naloxone make the opioid crisis worse? That's unclear. Some first responders say it increases opioid use because it reduces the fear of dying. Dayton, Ohio, police have revived one overdose patient 20 times. Middletown, Ohio, is considering limiting Narcan resuscitations to two per person because of the number of repeat offenders.
Maine's Gov. Paul LePage vetoed legislation in 2016 that would have made naloxone available without a prescription. He wrote: "Naloxone does not truly save lives; it merely extends them until the next overdose." A version of the bill passed a year later anyway.
Detractors might see naloxone as a crutch. Advocates call it a life-saver. One thing is certain: It saves lives in the short-run. The ultimate effect remains to be seen.
Editor's note: This story has been updated to clarify that while the Evzio product reached a price of $4,500 in 2017, it's currently priced lower.
