How does Narcan actually work, what does it do to a person who had overdosed on opioids? Also after being given a dose of Narcan, why do the EMTs always take the person to the ER?
In: Chemistry
Narcan will send a person into severe withdrawal symptoms. Those symptoms typically aren’t deadly to healthy people but they can be. I’m not a doctor but I assume that’s the reason they go to the ER. Just Incase this person could die from withdrawal symptoms
Okay. For context I’m a paramedic.
Basically Naloxone (Narcan) kicks the opioids off of the receptors in the brain that cause things such as respiratory depression, low blood pressure etc.
Lay people, police officers and some healthcare providers believe that naloxone is given in order to “wake the person up”. Truly, the indication is solely in respiratory depression, or when a person is breathing ineffectively. In a perfect world, we give just enough of the naloxone to get the person breathing and to not send them into withdrawal.
As someone else mentioned, yes naloxone can put a chronic opioid user / abuser into withdrawal. This may result in things such as seizures and pulmonary edema. However this is not the primary concern. The primary concern in that the opioid taken has a longer half life than the naloxone. Causing a second overdose that could potentially be life threatening.
With all of this being said. If the person happens to “wake up” and be awake alert and oriented. They DO have the right to refuse care. Certain parameters must be met, such as the clinician feeling certain that the person has the capacity to make such a decision. This includes the person understanding and repeating the risks, benefits and alternatives to further treatment, transport and hospital evaluation.
Remember that autonomy allows every cogent person to choose healthcare that is in line with their personal values, so long as they have all of the proper information.
Opioids like heroin bind to opiate receptors in the brain, causing potentially lethal nervous system depression.
Chemically, Narcan zooms in and knocks all of those opioids off the receptors and strongly binds to them instead, nullifying the effects of the opoids.
The reasons you take the victim to the hospital aftee are twofold.
1- you’ve just put that person into severe withdrawal by instantly reversing all the effects of those opoids in their blood. That can be quickly lethal in an addict.
2- The half-life of Narcan is less than that of most opoids. So it will flush out of the system relatively quickly, allowing all those opoids to reattach to the receptors and start the process over again. Hospital detox is required to clear the victim’s system.
Basically: Naloxone very strongly binds to the same receptors opioids do, but doesn’t activate then. This rapidly displaces the opioids and largely prevents them from acting.
One huge issue is that Naloxone is eliminated from the body much faster than many opioids (especially for delayed release prescription pills), and it’s possible to relapse into an overdosed state hours after the initial administration of naloxone.
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