Many people take opioids to manage their pain. Commonly misused prescription opioids are methadone, oxycodone, hydrocodone, and fentanyl.

Canada is facing a growing opioid crisis.

  • Opioid use and resulting overdoses have been affected by emergence of new and increasingly potent illicit opioids.
  • Fentanyl is an extremely concentrated and potent painkiller approximately 50-100x stronger than morphine.
  • Bootleg Fentanyl, an illicit version of the drug produced in China, is more potent than Fentanyl and is finding its way to our streets. As a powder, it can be mixed with heroin, cocaine or other street drugs.
  • Carfentanil, a product 100X more potent than fentanyl and 10,000x more potent than morphine is rapidly gaining traction across the country.
  • This veterinary medicine was never intended for human use – a few grains are enough to kill a person.


People who:

  • use prescription opioids, especially those taking higher doses
  • use opioids in combination with other sedating substances
  • use opioids and have medical conditions such as HIV or liver or lung disease, or who suffer from depression
  • inject opioids

People with:

  • household members in possession of opioids
  • opioid dependence and reduced tolerance following detoxification, release from incarceration, or cessation of treatment
  • a suspected or confirmed history of substance abuse, dependence or non-medical use of prescription or illegal opioids

Since most overdoses are witnessed by a friend or family member, if a friend or family member had access to naloxone, they may be able to reverse the effects of opioid overdose, while waiting for medical care to arrive.

*Adapted from World Health Organization, 2013.


Prescription medication pain relievers

  • Hydrocodone (e.g., Hycodan®*, Tussionex®*)
  • Oxycodone (e.g., Percocet®*, OxyNEO®*, Targin®*)
  • Codeine (e.g., Codeine Contin®*, Tylenol®* with Codeine No. 3)
  • Morphine (e.g., M-Eslon®*, MS Contin®*, Kadian®*)
  • Hydromorphone (e.g., Dilaudid®*)
  • Fentanyl (e.g., Duragesic®* MAT, Fentora®*)
  • Methadone (e.g., Methadose®*)

Illegal drugs

  • Heroin
  • Fentanyl made or sold by unauthorized parties

Indications and Clinical Use

NARCAN® Nasal Spray is a pure opioid antagonist indicated for emergency use outside of a hospital to reverse known or suspected opioid overdose, as manifested by respiratory and/or severe central nervous system depression.

NARCAN® Nasal Spray can be administered by a bystander (non-healthcare professional) before emergency medical assistance becomes available, but it is not intended to be a substitute for professional medical care. Emergency medical assistance (calling 911) should be requested immediately when an opioid overdose is suspected, before administering naloxone.


  • Patients who are hypersensitive to this drug or to any ingredient in the formulation or component of the container.

Most Serious Warnings & Precautions

  • Emergency medical assistance (calling 911) should be requested immediately when an opioid overdose is suspected, before using naloxone.
  • Individuals with a satisfactory response to an initial dose of naloxone should be kept under continued surveillance.
  • Caregivers administering naloxone should be prepared to act in response to or assist the patient in cases of potential adverse reactions such as aggressive reactions, convulsions and vomiting. Special attention is warranted if naloxone is administered to a neonate or a pregnant woman.

Other Relevant Warnings and Precautions

  • In opioid dependent people, naloxone may trigger an acute opioid withdrawal syndrome
  • Rebound opioid toxicity, including respiratory depression, following the temporary reversal of the opioid overdose
  • Not effective against respiratory depression due to non-opioid drugs
  • Rare cases of cardiac arrest, tachycardia and ventricular fibrillation
  • Post-operative consideration: instances of hypotension, hypertension, ventricular tachycardia and fibrillation, dyspnea, pulmonary edema and rare cases of cardiac arrest have been reported. Death, coma, and encephalopathy have been reported as sequelae of these events
  • Rare cases of convulsions or seizures
  • Irritability and aggressive behaviour
  • Gastrointestinal reactions including diarrhea, nausea, vomiting and abdominal cramps
  • Use in nursing women has not been established

For More Information:

Please consult the product monograph at for important information relating to contraindications, adverse reactions, drug interactions, patient selection, and dosing information which have not been discussed in this piece.

The product monograph is also available by calling 1-844-898-0657.

Please see full Product Information including the Patient Information for NARCAN® Nasal Spray.

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1. World Health Organization. “Management of Substance Abuse: Information sheet on opioid overdose.” November 2014. Accessed March 1, 2017.

2. Ontario College of Pharmacists. “Dispensing or Selling Naloxone: Guidance for pharmacy professionals when dispensing or selling naloxone as a Schedule II drug.” February 9, 2017. Accessed March 1, 2017.

3. Government of Ontario. “Recognize and temporarily reverse an opioid overdose.” Available at: Accessed October 17, 2018.

4. Santé et Services sociaux Québec. “Le Gouvernement du Québec confirme la gratuité de la naloxone dès le 10 novembre.” Available at: Accessed October 17, 2018.

5. NARCAN® Nasal Spray Product Monograph. Adapt Pharma Operations Limited, March 24, 2017.

6. Howlett, K et al. “How Canada got addicted to fentanyl.” Globe and Mail, January 5, 2017. Accessed January 10, 2017.

7. National Institutes of Health, PubChem Open Chemistry Database, Carfentanil, Available at: Accessed on January 20, 2017.

8. Harm Reduction Coalition. “Overdose FAQs.” Accessed January 11, 2017.

9. Government of Canada. “Opioids.” Accessed Jan 9, 2017.

10. Government of Canada. “Opioids.” Available at: Accessed January 25, 2017.

Distributed by Adapt Pharma Canada Ltd. Mississauga, ON L5N 6A6 CANADA

© 2019 ADAPT Pharma Canada Ltd. NARCAN is a registered trademark of ADAPT Pharma Operations Limited.

*All other trademarks are the property of their respective owners.
ADAPT Pharma Canada Ltd. and ADAPT Pharma Operations Limited are wholly-owned subsidiaries of Emergent BioSolutions Inc.

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