Understanding Naloxone: How It Works, Key Facts, and Common Misconceptions

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Article posted by Aaron Vestal

At XFoundation, we’re always looking for new ways to keep our communities safe and informed. When we started this journey four years ago, we didn’t know much about naloxone. Through countless conversations, events, and firsthand experiences across the state, we’ve learned a lot, and we’re still learning.

One thing we’ve noticed is that many people still have questions about naloxone or haven’t heard of it at all. We’ve also come across a lot of myths and confusion. That’s why we created this blog: to share what we’ve learned, answer common questions, and offer clear, honest information that we wish we had known when we started. We hope that it helps you feel more prepared to protect yourself and support those around you.

Frequently Asked Questions

  • What is naloxone?

Naloxone is a medication most commonly available as a nasal spray under the brand name, NARCAN®. It has the potential to reverse an opioid poisoning or overdose.

  • Is Narcan different from naloxone?

No, Narcan is a brand name for naloxone. Kloxxado is another brand name version of naloxone. The only difference between the two is the dosage: 4mg for Narcan and 8mg for Kloxxado.

  • How does naloxone work?

Naloxone acts as an opioid antagonist, meaning it blocks the effects of opioids at receptor sites in the brain. When opioids are taken in excess, they can slow or stop a person’s breathing; naloxone displaces opioids from those receptors, quickly restoring normal breathing in someone experiencing an overdose or poisoning. Watch demonstration video.

  • What substances does naloxone work on?

Naloxone is effective for overdoses involving opioids. This includes heroin, fentanyl (and its analogs), oxycodone, hydrocodone, morphine, codeine, methadone, and buprenorphine (though it may be less effective with buprenorphine due to its strong receptor binding).

  • Which substances does naloxone NOT work on?

Naloxone does not reverse overdoses caused by non-opioid drugs. It is not effective against cocaine, methamphetamine, benzodiazepines (such as Xanax or Valium), alcohol, or xylazine (a veterinary tranquilizer sometimes found in illicit drug supplies). Importantly, naloxone is safe to administer even if the person has not taken opioids, as it only acts on opioid receptors (NIH, 2022).

Important side note: If the person has ingested a non-opioid and is experiencing possible symptoms of an overdose or poisoning, it is recommended to administer naloxone anyway. According to the DEA, roughly 6 out of every 10 counterfeit pills contain fentanyl, so they may be experiencing fentanyl poisoning, which can be reversed by naloxone.

  • How quickly does naloxone work?

Naloxone typically begins to take effect within 2 to 3 minutes. If there is no response after the first dose, a second dose should be administered in the other nostril. Each naloxone kit includes two doses to allow for repeated administration, especially in cases of re-overdose or incomplete initial reversal.

  • How is naloxone given?

It is typically administered as a nasal spray (Narcan/Kloxxado). In a medical setting it may be administered as an injection (intramuscular, subcutaneous, or intravenous).

  • Can naloxone be used on someone who is not breathing?

Yes, naloxone is absorbed through the nasal mucosa or muscle and does not require the person to be breathing.

  • Is naloxone safe for pregnant women or children?

Yes, naloxone can be used in pregnant women and children; it should be given at the lowest effective dose.

  • Can you develop a tolerance to naloxone?

No, naloxone remains effective with repeated use.

  • What should you do after giving naloxone?

Always call emergency services (911) immediately, as additional medical care may be required. Stay with the individual, monitoring their condition and checking their pulse/breathing often. Give chest compressions if the individual loses a pulse, and continue with chest compressions until emergency services have arrived or the individual regains a pulse and/or consciousness.

  • Is naloxone available over the counter?

Yes, in most places, naloxone is available without a prescription; it depends on your specific region and the local regulations.

  • Can naloxone be used more than once on the same person?

Yes. If there’s no response after 2–3 minutes, use the second nasal spray in the kit—not the same one—as each device is single-use and delivers a full, fixed dose. Reuse won’t work and may delay care. Multiple doses may be needed, especially with strong opioids like fentanyl. Always call emergency services, even if the person wakes up.

  • Can naloxone be used as a preventive measure before taking opioids?

No, naloxone only works to reverse an overdose after it has occurred.

  • Are there side effects of Narcan?

The most common side effects are withdrawal symptoms in opioid-dependent individuals, which can include nausea, headache, irritability, and more.

  • Should you throw out expired naloxone?

No! Research indicates that naloxone remains potent for years beyond its expiration date, especially if stored properly. Studies have found that expired naloxone can retain more than 90% of its labeled potency for up to 30 years, and public health agencies recommend using expired naloxone if nothing else is available in an emergency (Illinois Department of Human Services, 2021).

  • How should you store naloxone?

Naloxone should ideally be stored at room temperature (between 59°F and 77°F or 15°C and 25°C). Prolonged exposure to temperatures above 104°F (40°C) can reduce its potency by up to 20%. If naloxone freezes, the nasal spray device may not function until it is thawed, but the medication itself generally remains effective after a freeze-thaw cycle. Short-term exposure to extreme temperatures usually does not significantly impact its potency, but repeated or prolonged exposure can degrade effectiveness (NIDA, 2023).

Common Misconceptions About Naloxone

Despite its proven benefits, several misconceptions persist about naloxone:

  • Myth: Naloxone encourages riskier drug use.
    • Fact: Extensive research shows that naloxone availability does not lead to increased drug use or riskier behaviors (CDC, 2023).
  • Myth: Naloxone is addictive or can be abused.
    • Fact: Naloxone has no potential for abuse or addiction and does not produce a high (SAMHSA, 2022).
  • Myth: One dose is always sufficient.
    • Fact: With potent opioids like fentanyl, multiple doses may be needed to reverse an overdose (CDC, 2023).
  • Myth: Naloxone prevents people from seeking treatment.
    • Fact: There is no evidence that naloxone delays or prevents treatment; surviving an overdose (or poisoning) can motivate individuals to seek help (NIH, 2022).
  • Myth: Naloxone is dangerous if given to someone not overdosing on opioids.
    • Fact: Naloxone is safe and only affects opioid receptors; it will not harm someone who has not taken opioids (SAMHSA, 2022).
  • Myth: Naloxone causes violent behavior.
    • Fact: While naloxone can cause withdrawal symptoms, violence is rare and most commonly results in confusion or agitation (NIH, 2022).
  • Myth: Only medical professionals can administer naloxone.
    • Fact: Naloxone is designed for use by anyone, including bystanders, and is available without a prescription in many places (CDC, 2023). Narcan has many great educational videos outlining how it is used on their website: https://narcan.com/en/resources
  • Myth: Naloxone is not effective against fentanyl.
    • Fact: Naloxone is effective for fentanyl overdoses and poisonings, though higher or repeated doses may be required (CDC, 2023). So always carry two nasal sprays when possible.

Conclusion

Naloxone is a safe, effective, and essential tool for reversing opioid poisonings or overdoses. It is easy to use, has no potential for abuse, and can be administered to virtually anyone, by anyone. While it is best to use naloxone that is within its expiration date and has been stored properly, expired naloxone may still be effective in an emergency. Dispelling myths and increasing awareness about naloxone can save lives and support us and our communities as we try to keep our friends and families safe.

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