Narcan in possible illegal drug use?

Noryn · Aug 14, 2007

I want to clarify that this is a suspected overdose so my opinion would be different than if someone was post op, etc.

Generally on these boards I find no one more knowledgeable than Siri but wow on this topic I think I disagree with almost everything. I will agree that when giving narcan generally you should avoid giving a sudden and large amount unnecessarily causing frank withdrawal.

Opiate/Opioid withdrawal is not life threatening. It is a case of being subjectively severe and objectively mild as the pt may think they are dying but their clinical sx are rather mild. You really shouldnt have seizures or major arrhythmias although you can see some tachycardia. (There are always exceptions, I think withdrawal in neonates may be associated with seizures and giving narcan to a pregnant addict can cause fetal demise--but I think we are talking a general overdose patient).

As others have posted Narcan is antidotal for opiates/opioid. Also there are reports of it being successful with Clonidine and ace inhibitors. It wont work on Cocaine but will work on other common drugs of abuse such as oxycontin, hydrocodone and heroin.

I also would generally disagree with starting at .1 mg increments with an overdose. I would start at .4 mg if no response then I would go to 2 mg. There really isnt a max dose but if you havent seen a response after 10 mg then you likely wont. Some medications like Propoxyphene will take a large amount of narcan to reverse--generally more than 2 mg.

As others have posted Narcan and dextrose are commonly given to unresponsive patients. You also have to take into consideration the effects of the overdose. Once an opiate has caused hypoxic brain injury then narcan will not be able to reverse that.

Although I do disagree about Narcan causing life threatening withdrawal, I do think you should use caution if they are awake and alert. Don't give it prophylactically, otherwise you will turn an awake or drowsy pt into a combative or sick pt.

NursingAgainstdaOdds · Aug 14, 2007

Great thread, very informative!

Editorial Team / Admin · Aug 14, 2007

I want to clarify that this is a suspected overdose so my opinion would be different than if someone was post op, etc.
Generally on these boards I find no one more knowledgeable than Siri but wow on this topic I think I disagree with almost everything. I will agree that when giving narcan generally you should avoid giving a sudden and large amount unnecessarily causing frank withdrawal.
Opiate/Opioid withdrawal is not life threatening. It is a case of being subjectively severe and objectively mild as the pt may think they are dying but their clinical sx are rather mild. You really shouldnt have seizures or major arrhythmias although you can see some tachycardia. (There are always exceptions, I think withdrawal in neonates may be associated with seizures and giving narcan to a pregnant addict can cause fetal demise--but I think we are talking a general overdose patient).
As others have posted Narcan is antidotal for opiates/opioid. Also there are reports of it being successful with Clonidine and ace inhibitors. It wont work on Cocaine but will work on other common drugs of abuse such as oxycontin, hydrocodone and heroin.
I also would generally disagree with starting at .1 mg increments with an overdose. I would start at .4 mg if no response then I would go to 2 mg. There really isnt a max dose but if you havent seen a response after 10 mg then you likely wont. Some medications like Propoxyphene will take a large amount of narcan to reverse--generally more than 2 mg.
As others have posted Narcan and dextrose are commonly given to unresponsive patients. You also have to take into consideration the effects of the overdose. Once an opiate has caused hypoxic brain injury then narcan will not be able to reverse that.
Although I do disagree about Narcan causing life threatening withdrawal, I do think you should use caution if they are awake and alert. Don't give it prophylactically, otherwise you will turn an awake or drowsy pt into a combative or sick pt.

Thank you for the kind words and respectful post, Noryn.

My reply, too, relates to a suspected OD. And, I think we agree on the major aspect of Narcan administration (avoid slamming a large dose to prevent sudden w/d).

I have seen, in my long career, many who have had sudden and dramatic w/d when given full doses of Narcan; inhibiting the opiate leading to tachydysrhythmias (and flash pulmonary edema) and some with fatal outcomes.

caroladybelle, BSN, RN · Aug 16, 2007

Thanks for all the great responses. So now that I know it is indicated, do you guys usually give a full 2 mg dose?

As I work oncology, and most of my use is with patients that are accidently OD'd on narcs, or mixed something from the street with their legal scripts, I generally titrate. As we generally don't want to reverse out the entire effects of the drug, just get them out of excess sedation or respiratory depression. We mix either a 0.4mg or 1mg amp with enough saline for a 0.1mg to one mL/concentration, and do slow push, titrating until appropriate results achieved.

I have known nurses that have pushed the full amp and had patients go nuts and become belligerent and dangerous on them.

psalm, RN · Aug 16, 2007

Friday in the ER we had a Pt come in with an alcohol level of 499. He was unconcious and we intubated. Pupils were equal and reactive. The Dr ordered Narcan 0.4 mg IV now. I thought I remember something about not giving Narcan if it is illegal drugs the Pt is on but I cant remember. Help? (The reason he wanted the Narcan was the Pt is a known drug user, crack I think)
Jessica

Okay, I have a question. When you say the pt. had an alcohol level of 499, how is that based? As in a level of alcohol being 0.08 is recognized in some states as legally intoxicated, is the 499 level you used actually 4.99?

(exposing my ignorance) Thanks!

Altra, BSN, RN · Aug 16, 2007

Okay, I have a question. When you say the pt. had an alcohol level of 499, how is that based? As in a level of alcohol being 0.08 is recognized in some states as legally intoxicated, is the 499 level you used actually 4.99?
(exposing my ignorance) Thanks!

That would be 0.499. As in nearly 1/2 of 1%, and over 6 times the legal limit of 0.08.

MadisonsMomRN, BSN, RN · Aug 16, 2007

Just 2 weeks ago (I work in a prison) we had 3 heroin overdoses. We had to administer Narcan to two of them because they were NOT breathing and were cyanotic. We bagged them with O2 and gave them 0.4mg of Narcan and they perked right up. If we didnt give it they would have died... quickly!!