A medicine that can reverse an opioid overdose, and buy time for help to arrive
OHC is abstinence-based, and that does not change. This article exists because recovery is not always a straight line, and because when a lapse does involve opioids, the risk is not embarrassment or disappointment. It is death. Knowing about naloxone is not an expectation that someone will use again. It is no different from knowing first aid: you hope never to need it, and you are glad to have it if you do.
Naloxone is a medicine that temporarily reverses the effects of an opioid overdose. It works on heroin, methadone, buprenorphine, fentanyl, codeine, morphine and other opioids. It does not work on alcohol, benzodiazepines, cocaine or other stimulants, although it is still worth giving if opioids might be involved, because it will not cause harm if they are not.
It is not an addiction treatment, and it does not get anyone high. It buys time. An opioid overdose slows and can stop a person's breathing. Naloxone reverses that for long enough, usually thirty minutes to an hour, to get emergency help to the person before it happens again.
Overdose risk is highest exactly when someone has been doing well. Tolerance drops fast during a period of abstinence, sometimes within a few days. If someone returns to opioids after time away, whether that is a planned lapse, a one-off, or a full return to use, the amount that felt normal before can now be enough to kill them; this is one of the most dangerous moments in the whole of recovery, and it is easy to miss because it looks like the opposite of what people expect a crisis to look like.
Mixing opioids with alcohol or benzodiazepines multiplies the risk further. A combination that a person might have handled once can be fatal when tolerance has fallen.
None of this is a reason to keep someone at arm's length from information about it. It is the reason to make sure the people around them, and they themselves, know what naloxone is and how to get it, before it is needed rather than after.
Signs of an opioid overdose include:
If you see any of this, call 999 immediately and say you suspect an opioid overdose. Stay with the person if it is safe to do so. If naloxone is available, give it. Ambulance staff will not automatically involve the police, and calling for help is the right call every time, regardless of what else is going on.
Naloxone is available free of charge, without a prescription, from most drug and alcohol treatment services, and from a growing number of pharmacies. You do not need to be the person at risk to be given it. Family members, friends, and anyone likely to be nearby when someone uses can ask for it and be shown how to use it.
It comes either as an injection or as a nasal spray. The nasal spray requires no training to administer injections and is straightforward to use under pressure. Whoever hands it over should also show you how to use it. It only takes a few minutes to learn.
Anyone who uses opioids, anyone who has recently stopped, and anyone who lives with, cares for, or spends time around someone who does. That includes partners, parents, adult children, friends, and hostel or house staff. It is worth keeping more than one supply somewhere easy to reach, rather than a single kit that might be in the wrong place at the wrong moment.
Call 999 first, or get someone else to while you help. Give the naloxone as directed in the instructions that come with it. Put the person in the recovery position once their breathing improves. Stay with them. Naloxone wears off before some opioids do, so the effects of the overdose can return once it does. Calling an ambulance is not optional, even if the person appears to be recovering and wants to leave. They need to be seen by a paramedic.
Some people worry that having naloxone around means expecting a lapse, or accepting one. It does not. It means recognising that opioid dependence carries a real risk of death, and that the people most likely to be present in that moment are usually not medical professionals. Knowing how to respond to an overdose is no different from knowing first aid. It does not make a return to use more likely. It makes surviving one more likely, and staying alive is what makes the rest of recovery possible.