IDENTIFYING an OPIOID OVERDOSE

During an overdose, opioids overwhelm certain receptors in the brain, interrupting a key part of the body’s impulse to breathe. Breathing slows dangerously or stops. Reversing this process quickly is crucial because without breathing and oxygen, brain damage or death can occur.


What to do to identify an opioid overdose3

  • Ask the person if he or she is OK and shout their name.
  • Shake their shoulders and firmly rub the middle of their chest.
  • Check for signs of an opioid overdose:
    • Will not wake up or respond to your voice or touch
    • Breathing is very slow, irregular, or has stopped
    • Centre part of their eye is very small, sometimes called “pinpoint pupils”

    Not all of these signs will be present. If you suspect an opioid overdose, get emergency medical assistance right away.

    When used as directed, NARCAN™ Nasal Spray can reverse the effects of the opioids—temporarily restoring breathing and wakefulness.

Serious Warnings and Precautions

  • Before administering NARCAN™ Nasal Spray, call 911 for emergency medical help. Do this immediately if you suspect or are aware of an opioid overdose.
  • Make sure to watch the person who received NARCAN™ Nasal Spray. You may need to give additional doses of NARCAN™ Nasal Spray until emergency medical help arrives.
  • You may need to help the person who received NARCAN™ Nasal Spray. The patient may have a reaction such as becoming aggressive, shaking and/or vomiting. You will need to pay special attention when giving NARCAN™ Nasal Spray to a newborn who is less than four weeks old or a pregnant woman. Some of these reactions can be life-threatening for a newborn or a fetus.

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.

Contraindications

  • 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 http://narcannasalspray.ca/pdf/NARCAN-Product-Monograph-ca-en.pdf 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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References

1 World Health Organization. “Management of Substance Abuse: Information sheet on opioid overdose.” November 2014. http://www.who.int/substance_abuse/information-sheet/en/ 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. http://www.ocpinfo.com/library/practice-related/download/Naloxone.pdf Accessed March 1, 2017.

3 NARCAN™ Nasal Spray Product Monograph. Adapt Pharma Operations Limited, March 24, 2017.

4 Howlett, K et al. “How Canada got addicted to fentanyl.” Globe and Mail, January 5, 2017. http://www.theglobeandmail.com/news/investigations/a-killer-high-how-canada-got-addicted-tofentanyl/article29570025/ Accessed January 10, 2017.

5 National Institutes of Health, PubChem Open Chemistry Database, Carfentanil, Available at: https://pubchem.ncbi.nlm.nih.gov/compound/carfentanil#section=Top Accessed on January 20, 2017.

6 Harm Reduction Coalition. “Overdose FAQs.” http://harmreduction.org/issues/overdose-prevention/overview/overdose-faqs/ Accessed January 11, 2017.

7 Government of Canada. “Opioids.” http://healthycanadians.gc.ca/healthy-living-vie-saine/substance-abus…icomanie/prescription-abuse-abus-ordonnance/opiods-opiodes-eng.php#a2 Accessed Jan 9, 2017.

8 Government of Canada. “Opioids.” Available at: https://www.canada.ca/en/health-canada/services/substance-abuse/prescription-drug-abuse/opioids.html Accessed January 25, 2017.

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

© 2017 ADAPT Pharma Canada Ltd. NARCAN is a trademark licensed to ADAPT Pharma Operations Limited.

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