If you’ve seen the news lately, you know that opioid overdose deaths have reached record highs in recent years.1 But what many people may not be aware of are the complications that can sometimes occur in people who survive opioid overdose.2 Because an opioid overdose can happen anywhere and at any time, it’s important to be prepared. Naloxone is a medicine that can reverse an opioid overdose and possibly save a life.3 If you encounter someone who you think may be experiencing an opioid overdose, act fast and reverse the opioid overdose with naloxone.3

Opioid overdose survivors may have complications

During an opioid overdose, a person’s breathing may slow down or stop altogether.3 As a result, some people who survive opioid overdose suffer complications related to oxygen deprivation.2,3 (According to the Cleveland Clinic, brain damage begins within 4 minutes of not having enough oxygen.4) Research shows that more than 75% of people who suffer a non-fatal opioid overdose have one or more complications.2 Brain injury caused by lack of oxygen during an opioid overdose may lead to the development of severe disability, including but not limited to:2

  • Mental disorientation
  • Ataxia (poor muscle control that causes clumsy movements5)
  • Gait disturbances
  • Incontinence
  • Paraplegia (paralysis that affects your ability to move the lower half of your body6)
  • Catatonia (a neuropsychiatric syndrome characterized by abnormal movements, behaviors and withdrawal7)

Fentanyl is powerful and works quickly

Synthetic opioids like fentanyl contribute to nearly 70% of overdose deaths.8 Fentanyl is fast-acting and very strong—up to 50 times stronger than heroin.9 Just a tiny amount (2 mg) can cause a fatal opioid overdose.9,10 Fentanyl is also fairly cheap and easy to make.9 That’s why it’s often used in fake pills (made to look identical to real prescription medicines) or illicit drugs.9 (People who use fake pills or illicit drugs may take fentanyl without even knowing it.9) And unlike a heroin overdose, during which a bystander might have anywhere from 1 to 3 hours to take action with naloxone, a fentanyl overdose can set in within seconds to minutes.11,12

Be prepared with naloxone

Naloxone works fast to restore normal breathing to a person who is suffering an opioid overdose.13 It does this by attaching to opioid receptors in the body and reversing or blocking the effects of opioids.13 One brand of naloxone is Kloxxado® (naloxone HCl) nasal spray 8 mg.14 Narcan® (naloxone HCl) Nasal Spray 4 mg is another.15 The main difference between Kloxxado® and Narcan® is that each dose of Kloxxado® contains 8 mg of naloxone, while each dose of Narcan® contains 4 mg of naloxone.14,15

Multiple doses of naloxone may be needed to reverse opioid overdose

The amount of naloxone needed to reverse an opioid overdose often depends on the opioid involved.16 It may take more naloxone to revive a person who has overdosed on a larger quantity of an opioid or on a more potent opioid (like fentanyl).16 Because naloxone typically wears off in 30 to 90 minutes, the person who has overdosed may need a second or even a third dose.13,17 If they don’t receive it, they may fall back into unconsciousness (as a result of the overdose) and stop breathing again.18 Research shows that 78% of opioid overdose reversals involve at least 8 mg of naloxone.17

Naloxone is easy to use and convenient to carry

If someone you care about is at risk for opioid overdose, consider carrying naloxone to revive them in the event of an overdose. If you are at risk for opioid overdose, carry naloxone with you and be sure your friends and loved ones know how to give it to you if you need it (you won’t be able to give it to yourself). Intranasal naloxone products like Kloxxado® are safe and easy to use—even for someone without medical training.14,19

What to do if you think someone is overdosing

You never know when you might come face to face with a person suffering a potentially deadly opioid overdose. Signs of an opioid overdose may include:9,20

  • Unconsciousness or unresponsiveness (doesn’t respond when shaken or called)
  • Very small (pinpoint) pupils in their eyes
  • Shallow breathing
  • Limpness
  • Blue lips, gums or fingertips
  • Slow or irregular heartbeat or pulse

If you suspect overdose, start by administering one dose of naloxone and call 911 right away.3 If the person is not breathing but has a pulse, give rescue breaths while you wait for emergency help.9,14,21 If the person is not breathing and has no pulse, start CPR.14 Wait 2-3 minutes to see if normal breathing returns.3,14 If it doesn’t, give the second dose of naloxone in the other nostril.3,14 Do your best to keep the person awake and breathing, lay them on their side to prevent choking and stay with them until emergency help arrives.3 Even if the person is revived by the first dose of naloxone and seems to feel better, it is essential that they get emergency medical care as quickly as possible.22

Kloxxado® is a registered trademark of Hikma Pharmaceuticals USA Inc.

Narcan® is a registered trademark of Emergent Operations Ireland Limited

Please see the Full Prescribing Information and Medication Guide for Kloxxado® for complete product details.

NOTE: This article was not written by a medical professional and is not intended to substitute for the guidance of a physician. These are not Hikma’s recommendations, but rather facts and data collected from various reliable medical sources. For a full list of resources and their attributing links, see below.

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References

  1. Drug Overdose Deaths in the United States, 2003-2023. CDC National Center for Health Statistics website. Available at: https://www.cdc.gov/nchs/products/databriefs/db522.htm. Accessed December 30, 2024.
  2. Zibbell J, Howard J, Clarke S, Ferrell A, Karon SL. Non-Fatal Opioid Overdose and Associated Health Outcomes: Final Summary Report. US Department of Health and Human Services/Office of the Assistant Secretary for Planning and Evaluation website. Available at: https://aspe.hhs.gov/reports/non-fatal-opioid-overdose-associated-health-outcomes-final-summary-report-0#results. Accessed December 30, 2024.
  3. 5 Things to Know About Naloxone. CDC Overdose Prevention website. Available at: https://www.cdc.gov/overdose-prevention/reversing-overdose/about-naloxone.html. Accessed December 30, 2024.
  4. Cerebral Hypoxia. Cleveland Clinic website. Available at: https://my.clevelandclinic.org/health/diseases/6025-cerebral-hypoxia. Accessed December 30, 2024.
  5. Mayo Clinic website. Available at: https://www.mayoclinic.org/diseases-conditions/ataxia/symptoms-causes/syc-20355652. Accessed January 31, 2025.
  6. Understanding Paraplegia. Healthline website. Available at: https://www.healthline.com/health/chronic-illness/paraplegia. Accessed January 31, 2025.
  7. Burrow JP, Spurling BC, Marwaha R. Catatonia. [Updated 2023 May 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430842/.
  8. Fentanyl Facts. CDC Stop Overdose website. Available at: https://www.cdc.gov/stop-overdose/caring/fentanyl-facts.html?CDC_AAref_Val=https://www.cdc.gov/stopoverdose/fentanyl/index.html. Accessed December 30, 2024.
  9. Learning About Fentanyl Overdose. Kaiser Permanente website. Available at: https://healthy.kaiserpermanente.org/health-wellness/health-encyclopedia/he.Learning-About-Fentanyl-Overdose.aco0352. Accessed December 30, 2024.
  10. One Pill Can Kill. US Drug Enforcement Administration website. Available at: https://www.dea.gov/onepill. Accessed December 30, 2024.
  11. US Department of Health and Human Services (HHS), Office of the Surgeon General, Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS, November 2016.
  12. Somerville NJ et al. Characteristics of Fentanyl Overdose—Massachusetts, 2014-2016. MMWR. 2017;66(14):382-386.
  13. Naloxone DrugFacts/What is naloxone? National Institute on Drug Abuse website. Available at: https://nida.nih.gov/publications/drugfacts/naloxone. Accessed December 30, 2024.
  14. Kloxxado® (naloxone HCl) Nasal Spray [prescribing information]. Columbus, OH: Hikma Specialty USA Inc., 2021.
  15. Narcan® (Naloxone HCl) Nasal Spray 4 mg [fact sheet]. Plymouth Meeting, PA: Emergent Devices Inc.; 2024.
  16. Frequently Asked Questions (FAQs) for naloxone. Oregon Health Authority website. Available at: https://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/SUBSTANCEUSE/OPIOIDS/Documents/naloxone-faq.pdf. Accessed December 30, 2024.
  17. Abdelal R, Banerjee R, et al. Real-world study of multiple naloxone administration for opioid overdose reversal among bystanders. Harm Reduct J. 2022. 19:49.
  18. Opioid Overdose. Cleveland Clinic website. Available at: https://my.clevelandclinic.org/health/diseases/24583-opioid-overdose. Accessed December 30, 2024.
  19. Naloxone Frequently Asked Questions. CDC Stop Overdose website. Available at: https://www.cdc.gov/stop-overdose/naloxone-faq/?CDC_AAref_Val=https://www.cdc.gov/stopoverdose/naloxone/faq.html. Accessed December 30, 2024.
  20. Access to Naloxone Can Save a Life During an Opioid Overdose. US Food & Drug Administration website. Available at: https://www.fda.gov/consumers/consumer-updates/access-naloxone-can-save-life-during-opioid-overdose. Accessed December 30, 2024.
  21. Basic Life Support/Opioid Overdose: Adults. American Red Cross Training Services website. Available at: https://www.redcrosslearning.com/course-bin/bls-healthcare-resuscitation/app/content/a/en-US/resources/TG-OpioidOverdose.pdf. Accessed January 15, 2025.
  22. Medications to Reverse Overdose/Naloxone 101. Arizona Health Care Cost Containment System website. Available at: https://www.azahcccs.gov/Members/BehavioralHealthServices/OpioidUseDisorderAndTreatment/ReversingOverdose.html. Accessed December 30, 2024.