Make Opioid Overdose Reversal Medication Part of Site’s Safety Toolkit

We give you answers to four frequently asked questions.

Fentanyl and other opioids are fueling the worst drug crisis in the history of the United States. According to CDC drug overdose data, drug overdose deaths in the United States, driven by illicit fentanyl and other opioids, remain at historically high levels, with more than 107,000 lives lost in the past year. And millions more struggle with opioid and other substance use disorders.

As part of President Biden’s Unity Agenda priority to beat the overdose epidemic, federal agencies such as HUD, the White House Office of National Drug Control Policy (ONDCP), and the U.S. Department of Health and Human Services (HHS) recently issued a joint letter to public health departments and health care systems to partner with housing providers, community development organizations, and other housing agencies to help expand access to naloxone and other life-saving overdose reversal medications in the communities they serve. This announcement follows a fact sheet HUD released in October that highlights HUD’s commitment to equipping affordable housing sites with this life-saving medication.

Efforts to incorporate the availability of overdose reversal medication in multifamily housing represent a proactive approach to the opioid epidemic. The administration has likened carrying these medications as no different from carrying an “EpiPen” (a commonly known brand name epinephrine auto-injector) out of concern for someone with life-threatening allergies. As such, the Biden administration views making it easily accessible in communities as an important aim to combat the opioid epidemic.

We’ll discuss overdose reversal medication such as naloxone and federal efforts to get owners to participate in overdose prevention actively.

What Is Naloxone (Narcan)?

Naloxone is a life-saving medication that can reverse an overdose from opioids—including heroin, fentanyl, and prescription opioid medications—when given in time. It is an opioid antagonist. This means that it attaches to opioid receptors and reverses and blocks the effects of other opioids.

Naloxone can quickly restore normal breathing to a person whose breathing has slowed or stopped because of an opioid overdose. But naloxone has no effect on someone who doesn’t have opioids in their system, and it isn’t a treatment for opioid use disorder. Examples of opioids include heroin, fentanyl, oxycodone (OxyContin), hydrocodone (Vicodin), codeine, and morphine.

What Are the Different Delivery Systems?

Naloxone comes in two FDA-approved forms: injectable and prepackaged nasal spray. Narcan is a type of naloxone nasal spray. Typically, for injectable forms, the proper dose must be drawn up from a vial. It’s usually injected with a needle into muscle, although it also may be administered into a vein or under the skin. The FDA recently approved Zimhi, a single-dose, prefilled syringe that can be injected into the muscle or under the skin.

Prepackaged nasal spray (generic naloxone, Narcan, Kloxxado) is a prefilled, needle-free device that requires no assembly and is sprayed into one nostril while the person lays on their back. This device can also be easier for loved ones and bystanders without formal training to use.

Is Narcan an Illegal Drug?

No. In March 2023, the U.S. Food and Drug Administration (FDA) approved Narcan, 4 milligram (mg) naloxone hydrochloride nasal spray, for over the counter (OTC), nonprescription use. This is the first naloxone product approved for use without a prescription. OTC Narcan is now on shelves in pharmacies, grocery stores, and other retail settings, with newly approved products slated for availability in 2024.

This approval changed the emergency response options for multifamily housing sites. Since it isn’t a controlled substance, just as one might find an automated external defibrillator (AED) in public spaces, Narcan can be made accessible in common areas of multifamily housing. This easy access could make the difference between life and death.

Also, HUD is encouraging owners to collaborate with community organizations to distribute Narcan, whether it be through on-site clinics or community events. And, according to HUD, possession of Narcan shouldn’t be treated as evidence of drug use and isn’t grounds for any adverse action including termination of tenancy or eviction. This provision ensures that the fear of punitive measures doesn’t deter individuals from carrying a potentially life-saving tool.

What Precautions Are Needed When Giving Naloxone?

Naloxone works to reverse opioid overdose in the body for only 30 to 90 minutes. But many opioids remain in the body longer than that. Because of this, it’s possible for a person to still experience the effects of an overdose after a dose of naloxone wears off. Also, some opioids are stronger and might require multiple doses of naloxone.

Therefore, one of the most important steps to take is to call 911 so the individual can receive immediate medical attention. People who are given naloxone should be observed constantly until emergency care arrives. They should be monitored for another two hours after the last dose of naloxone is given to make sure breathing doesn’t slow or stop.

People with physical dependence on opioids may have withdrawal symptoms within minutes after they’re given naloxone. Withdrawal symptoms might include headaches, changes in blood pressure, rapid heart rate, sweating, nausea, vomiting, and tremors. While this is uncomfortable, it’s usually not life threatening. The risk of death for someone overdosing on opioids is worse than the risk of having a bad reaction to naloxone.

Overall, naloxone is a safe medicine. But it reverses an overdose only in people with opioids in their systems and won’t reverse overdoses from other drugs like cocaine or methamphetamine.