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U.S. Department of Health and Human Services
Opioid Stewardship in the Indian Health Service

Naloxone

Narcan box

Naloxone is a prescription medication that can temporarily reverse opioid overdose and can save lives. Naloxone is an opioid antagonist that reverses the depression of the central nervous and respiratory systems after an overdose of prescription opioids or heroin. This medication can quickly be administered by several easy to use devices. Family members, caregivers, and emergency responders should be trained to administer naloxone to populations at risk for opioid overdose. Below is an overview of the available formulations:

Intranasal Naloxone: Narcan® Nasal Spray 4mg

This naloxone device is a prepackaged, ready-to-use, plastic unit that is given up the nose. The dose can be repeated every 2-3 minutes until initial response.

Evzio Injector

Naloxone Auto-Injector

Evzio® is a ready-to-use auto-injector that delivers the naloxone dose intramuscularly. For children under the age of 1 year the Evzio® should be administered subcutaneously. Key features of the device include voice instructions, ability to be administered through clothing, and automatic needle retraction following administration.

How to Use the VA Auto-Injector Naloxone Kit Exit Disclaimer: You Are Leaving www.ihs.gov  Training Video

Early access to the opioid reversal agent naloxone through community-based models has demonstrated positive outcomes during its use in the last decade. Patients at risk for overdose and their loved ones can be educated on opioid overdose symptoms and administration of naloxone in the community setting. Prescribers and pharmacists can be trained to identify patients at high risk for overdose. In some states, pharmacists can independently prescribe naloxone or can enter into collaborative practice agreements with prescribers to increase access to this life-saving medication. Co-prescribing has benefits for both chronic pain patients as well as patients with opioid use disorders.

Consider co-prescribing naloxone in these situations:

  • Recently rotated to a new opioid
  • Prescribed morphine equivalent daily (MED) dose of 50mg or more
  • On long-acting opioids particularly if in conjunction with short-acting opioids
  • Poly-opioid use
  • Prescribed opioids greater than 30 days
  • Over the age of 65 years
  • Households with people at risk of overdose such as children or someone with a substance abuse disorder
  • Patients who have difficulty accessing emergency medical services (distance, remoteness, lack of transportation, homelessness, and/or without phone services)
  • Recent mandated substance use treatment, incarceration, or period of abstinence with history of drug abuse
  • Concurrent prescription or over-the-counter medications
    • Benzodiazepines
    • Antipsychotics
    • Antiepileptics
    • Muscle relaxers
    • Hypnotics
    • Antihistamines

Training Videos

Two IHS Naloxone training videos on opioid reversal and law enforcement are available.

Resources