Bars. Nightclubs. Concert venues. Parties on college campuses. What do they all have in common? They’re all places people go to be social and have a good time. Unfortunately, they’re also places where fatal opioid overdoses can happen.1-4 Although a potentially fatal opioid overdose can happen almost anywhere and at almost any time, things may turn out differently if someone has a naloxone product like Kloxxado® (naloxone HCl) nasal spray 8 mg in their pocket or backpack.5 Read on to learn more about the top 4 places you need naloxone and what to do if someone is suffering an opioid overdose.

What is naloxone?

Naloxone is a medication that, when given in time, may reverse the effects of opioids and restore breathing in someone experiencing an overdose.6 It has been used to save countless lives, and is now available in every state in the US.6,7 Naloxone nasal sprays, such as Kloxxado® and Narcan®, are simple to use and small enough to carry in a pocket, purse or backpack.5,8 Anyone can save a life during an opioid overdose with naloxone.9

Why is it important to be ready for an opioid overdose emergency?

The number of opioid-related deaths in the US has been rising continuously since 1999, and more than 75% of the nearly 107,000 drug overdose deaths reported in 2022 involved an opioid.10 While the use of synthetic opioids like fentanyl can be blamed for many of these fatalities, opioid overdoses can happen to people who do not even realize they are taking opioids.11 Some drug dealers mix fentanyl in with other illicit drugs (like cocaine, for example) without the user’s knowledge.12,13 (This can help dealers “stretch” their inventory and/or create a final product that is more addictive.14 However, mistakes can happen and it takes just 2 mg of fentanyl to cause a deadly overdose.14,15) If the fact that illicit fentanyl is contaminating non-opioid substances isn’t scary enough, keep in mind that opioid overdoses involving fentanyl can set in quickly.16 A fatal overdose involving fentanyl can occur in a matter of seconds to minutes (compared to one to three hours for an overdose involving prescription pain relievers or heroin, for example).16,17

4 places you need naloxone

If you’re looking around and asking yourself the question, “Do we need naloxone here?” the answer may likely be “Yes.” According to Dr. Holly Geyer, an internal medicine practitioner at the Mayo Clinic with additional specialty licensure in Addiction Medicine, “It’s time to get [naloxone] out of just the pharmacies and into vending machines or other convenient locations where people live.”18 Carrying naloxone in your backpack or purse is like wearing a seat belt in the car or keeping a fire extinguisher in your home. It doesn’t increase the likelihood that an auto accident or house fire will happen, but it may prevent a tragedy.

Bars and nightclubs

Naloxone does not reverse the effects of alcohol, but it’s a good thing to have on hand in establishments where alcohol is served. Why? According to the Centers for Disease Control, drinking alcohol while using other drugs may result in effects that are stronger and more deadly.19 This may be why Honolulu recently became the first American city to require establishments that serve alcohol to keep naloxone nasal spray on hand.20 Naloxone is showing up in the bars, restaurants and nightclubs of many other cities as well.1

Concert venues

Drugs and alcohol are everywhere at music festivals like Bonnaroo and Burning Man, and sometimes people overdo it. When you consider the overwhelming presence of fentanyl in the illicit drug supply in recent years, it’s not hard to see why the risk of overdose is so high.21 According to Dr. David Deyhimy of MYMATCLINIC, “that’s why we need to have [naloxone].”21 Across the country, groups like This Must Be the Place, DanceSafe and Beats Overdose distribute naloxone kits at music festivals. (Hikma Pharmaceuticals USA, manufacturer of Kloxxado®, has donated 34,000 doses of naloxone to This Must Be the Place over the past few years in support of their efforts to prevent fatal opioid overdose.21)

College campuses

Because kids entering college may be likely to experiment with drugs and alcohol, colleges and universities are looking for ways to prevent opioid overdose tragedies before they happen.3 To this end, several schools have started initiatives to raise awareness and make naloxone more readily available.3 Bridgewater State University in Massachusetts, for example, has stocked 60 naloxone kits in defibrillator boxes across campus and placed several other kits in parking lots and on each floor of the campus garage. Anyone who needs it is allowed to take a dose.3 Universities are also launching training programs for students, faculty and staff on how to spot an overdose and administer naloxone.3

Rideshare services

For many people, rideshare services like Uber and Lyft represent a safer way to get around town when they’ve had a few drinks or are otherwise not safe to drive. But what happens when someone suffers an opioid overdose during their ride home? Harm reduction advocates Ryan Hampton and Chad Sabora are highlighting the potentially critical role drivers might play in saving lives by urging rideshare companies to encourage their employees to carry naloxone (and be prepared to use it).4

What are the signs of opioid overdose and what should you do?

The signs of opioid overdose include:22

  • Small, constricted “pinpoint pupils”
  • Falling asleep or loss of consciousness
  • Slow, shallow breathing
  • Choking or gurgling sounds
  • Limp body
  • Discolored skin (especially lips and nails)

Sometimes it can be hard to tell if a person is high or experiencing an overdose.22 If you aren’t sure, it’s important to act quickly—give the person naloxone right away and call 911.7,22 (If the person is not suffering an opioid overdose, it’s very unlikely that naloxone could harm them.7) Once you’ve given the naloxone, try to keep the person awake and breathing.22 If the person who has overdosed does not respond to the first dose of naloxone within 2 to 3 minutes, give another dose in the other nostril using a new nasal spray.5,8 And if the person does respond to the first dose of naloxone but falls back into unconsciousness, give additional doses of naloxone using a new nasal spray (alternating nostrils with each dose) every 2 to 3 minutes.5,8 Finally, keep the person comfortable and be sure to stay with them until emergency personnel arrive.22

Why Should You Consider Kloxxado®?

Overdoses involving highly potent opioids may require more naloxone to reverse, and some opioids may outlast the reversal effect of naloxone.23 (Each dose of Kloxxado® contains 8 mg of naloxone, compared to 4 mg for each dose of Narcan®.5,8) Consider the results of a 2021 survey of people who had administered Narcan® to another person during an opioid overdose in the previous year:24

  • In 78% of overdoses, 2 or more doses were used
  • In 30% of overdoses, 3 or more doses were used
  • More than 90% of respondents were worried that 1 box of Narcan® might not be enough for a successful future opioid overdose reversal
  • 86% reported more confidence in an 8-mg naloxone nasal spray compared to a 4-mg nasal spray
  • 77% reported a stronger preference for an 8-mg naloxone spray over a 4-mg naloxone spray

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

All other registered trademarks are the property of their respective owners.

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.

HK-2665v1

References

  1. Serve a Drink, Then Save a Life: This Is Restaurant Work During the Opioid Epidemic. The New York Times website. Available at: https://www.nytimes.com/2023/08/15/dining/narcan-naloxone-restaurants-bartenders-opioid-epidemic.html. Accessed July 11, 2024.
  2. Musicians Are Taking Bold Steps to Prevent Overdoses at Shows. Insidehook website. Available at: https://www.insidehook.com/music/musicians-reversing-overdoses-concerts-narcan. Accessed July 11, 2024.
  3. Preventing Opioid Overdoses on Campuses: The Naloxone Solution. Association of Governing Boards of Universities and Colleges website. Available at: https://agb.org/trusteeship-article/preventing-opioid-overdoses-on-campuses-the-naloxone-solution/. Accessed July 11, 2024.
  4. Narcan in the Backseat? Lyft and Uber Drivers Could Help Fight the Drug Epidemic With One Simple Tool. HuffPost Life website. Available at: https://www.huffpost.com/entry/lyft-uber-narcan-naloxone-overdose_b_59970b52e4b033e0fbdec36b. Accessed July 11, 2024.
  5. Kloxxado® (naloxone HCl) nasal spray 8 mg [prescribing information]. Columbus, OH: Hikma Specialty USA Inc.; 2021.
  6. Jordan MR, Patel P, Morrisonponce D. Naloxone. [Updated 2024 May 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441910/
  7. Lifesaving Naloxone. CDC Stop Overdose website. Available at: https://www.cdc.gov/stop-overdose/caring/naloxone.html. Accessed July 11, 2024.
  8. Narcan® (Naloxone HCl) Nasal Spray 4 mg [fact sheet]. Plymouth Meeting, PA: Emergent Devices Inc.; 2024.
  9. Access to Naloxone Can Save a Life During an Opioid Overdose. US Food and Drug Administration website. Available at: https://www.fda.gov/consumers/consumer-updates/access-naloxone-can-save-life-during-opioid-overdose. Accessed July 11, 2024.
  10. Understanding the Opioid Overdose Epidemic. CDC Overdose Prevention website. Available at: https://www.cdc.gov/overdose-prevention/about/understanding-the-opioid-overdose-epidemic.html. Accessed July 11, 2024.
  11. Polysubstance Overdose. CDC Overdose Prevention website. Available at: https://www.cdc.gov/overdose-prevention/about/polysubstance-overdose.html. Accessed July 11, 2024.
  12. 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 July 11, 2024.
  13. Drug Overdose Death Rates. NIH/National Institute on Drug Abuse website. Available at: https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates. Accessed July 11, 2024.
  14. If fentanyl is so deadly, why do drug dealers use it to lace illicit drugs?. ABC News website. Available at: https://abcnews.go.com/Health/fentanyl-deadly-drug-dealers-lace-illicit-drugs/story?id=96827602. Accessed July 11, 2024.
  15. Facts About Fentanyl. US Drug Enforcement Administration website. Available at: https://www.dea.gov/resources/facts-about-fentanyl. Accessed July 11, 2024.
  16. Somerville NJ et al. Characteristics of Fentanyl Overdose—Massachusetts, 2014-2016. MMWR. 2017;66(14):382-386.
  17. 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.
  18. What is naloxone and should everyone have access to it? Mayo Clinic News Network website. Available at: https://newsnetwork.mayoclinic.org/discussion/what-is-naloxone-and-should-everyone-have-access-to-it/. Accessed July 11, 2024.
  19. Drinking Alcohol While Using Other Drugs Can Be Deadly. CDC Alcohol Use website. Available at: https://www.cdc.gov/alcohol/about-alcohol-use/other-drug-use.html. Accessed July 11, 2024.
  20. Honolulu becomes first major US city to require naloxone in bars and clubs. Hawai’I Public Radio website. Available at: https://www.hawaiipublicradio.org/local-news/2023-07-26/honolulu-becomes-first-major-u-s-city-to-require-naloxone-in-bars-and-clubs. Accessed July 11, 2024.
  21. Narcan at music festivals? The life-saving drug naloxone is coming to a concert near you. USA Today website. Available at: https://www.usatoday.com/story/life/health-wellness/2023/04/24/naloxone-narcan-save-lives-music-festivals/11577378002/. Accessed July 11, 2024.
  22. Signs of Opioid Misuse, Opioid Use Disorder, and Overdose. CDC website. Available at: https://www.cdc.gov/overdose-prevention/media/pdfs/Signs-of-Opioid-Misuse-Opioid-Use-Order-and-Overdose_508compliant.pdf. Accessed July 11, 2024.
  23. Naloxone DrugFacts. NIH/National Institute on Drug Abuse website. Available at: https://nida.nih.gov/publications/drugfacts/naloxone. Accessed July 11, 2024.
  24. 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.