The US Surgeon General issued a rare advisory telling Americans to carry a lifesaving drug overdose treatment — here’s how to use it

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We asked a former paramedic what it's like to administer naloxone, the lifesaving drug overdose reversal medication that the US Surgeon General recently advised friends and family members of people at risk for drug overdose to carry.
The drug can be administered as a nasal spray or a shot that's injected into the muscle and goes into effect within minutes.
Here's how naloxone works and what you should know about how to use it.

Former New York City paramedic Alex Pollack can't wipe the vision from his memory: A young woman at a concert had gone down. She was on the floor, barely breathing, a circle of worried strangers closing in around her. Thanks to his 18 years taking 9-1-1 calls, Pollack knew what to do. He took out a container of Narcan, the brand name for the fast-acting drug that can help to reverse an opioid overdose, and administered it. In seconds, the girl was awake and breathing normally.

"It's amazing to see how well it works," Pollack told Business Insider. "You take someone who's almost not breathing, you think they’re dead, you give them this and they pop up."

On Thursday, US Surgeon General Jerome Adams issued a rare national health advisory — the first of its kind in 13 years — telling Americans who know people at risk of drug overdose to carry the overdose-reversal medication naloxone. Dr. Adams said that increasing access to naloxone is key to curbing the rising tide of deaths from drug overdoses involving opioid painkillers, as well as fentanyl and heroin.

Most opioid overdoses happen outside of a hospital, clinic, or other medical setting. That underscores the need to make lifesaving interventions like naloxone more readily available to people across the US, Dr. Adams said.

“Each day we lose 115 Americans to an opioid overdose — that’s one person every 12.5 minutes,” Dr. Adams said in a statement. “It is time to make sure more people have access to this lifesaving medication."

Where to get naloxone and how to administer it to someone in need

The nasal spray formulation of naloxone, sold under brand name Narcan, is available at pharmacies without a doctor's prescription in all but two US states — Nebraska and Michigan. Still even in the 50 states where it can be purchased from a pharmacy, it can be expensive if you don't have insurance, costing anywhere from $130 to $150. Some insurance plans will pay for most of that, however, in some cases curbing the sticker price to about $20.

Many emergency medical facilities and most hospitals carry the drug, which is available either as a nasal spray or an injectable shot. When it comes to price, the formula matters: one version of naloxone, an auto-injector formula sold under the brand name Evzio, has skyrocketed 680% to $4,500 in the last three years.

Naloxone works by counteracting the effects of opioids, which are powerful sedatives. They slow down our breathing and make us feel sleepy. If someone takes too many or too high a dose of a drug like fentanyl, their breathing may stop, along with their heart, killing them.

Naloxone blocks the brain receptors that opioids latch onto to produce their effects, thereby stopping or reversing sedation. Naloxone is temporary — its effects typically wear off in 20 to 90 minutes.

To administer the nasal spray, the Harm Reduction Coalition advises the following quick steps:

If the person is not breathing, do rescue breathing for a few quick breaths.
Affix the nasal atomizer (also called an applicator) to the needleless syringe and then assemble the glass cartridge of naloxone.
Tilt the head back and spray half of the naloxone up one side of the nose and half up the other side of the nose.
If there is no breathing or breathing continues to be shallow, continue to perform rescue breathing for them while you wait for the drug to work.
If there is no change in 3 to 5 minutes, give them another dose of naloxone and continue to breathe for them.

Pollack, the former paramedic, said he's administered naloxone this way more than 1,000 times and seen it work repeatedly. Since spending 18 years working as a paramedic for New York City, he's gone on to create a medical services team called ParaDocs which provides emergency medical services for events like concerts and festivals, which is where he encountered the girl who'd stopped breathing.

Pollack also cautioned that naloxone is not a cure-all: it can be delivered too late, for one thing, meaning the person's heart may have stopped, and it may not work with ultra-strong types of opioids such as fentanyl, the drug that was responsible for killing musicians Tom Petty and Prince.

"A lot of drugs are laced with fentanyl so people don’t realize what they've taken or how strong it is," Pollack said.

Fentanyl is roughly 30 times stronger than heroin and is available with a prescription. It is also sold illegally and swapped into fake pills sold as brand-name painkillers like Norco, Percocet, and Xanax.

Because fentanyl is so much stronger than morphine or other painkillers, fake drug makers only need a minuscule amount to create pills with roughly the same effect as Norco or Percocet. That makes their fake drugs cheaper to buy and manufacture — and even more profitable to sell to people who are desperate.

But fentanyl packs a powerful punch, and a tiny bit too much can kill before a solution like naloxone can even start to take effect.

"This isn’t a magic potion; it’s not always going to work," Pollack said.

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