“Before the Bus” - Essential First Aid Skills for Police Officers: Naloxone / Narcan and Opioid Overdoses

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What is an opioid?

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An opioid agonist (agonist meaning causing certain actions to occur once in the body) is a class of drugs created from poppy plants, or semisynthetic and synthetic compounds that interact with opioid receptors naturally present in the body. Opium from poppies has been used for thousands of years, however it was first isolated in 1806 when it was sold as morphine.

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What are common opioids?

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Opioid medications are commonly used for treating pain. Examples of opioids include:

• Heroin
• Hydromorphone - AKA Dilaudid
• Meperidine - AKA Demerol
• Morphine - AKA Doloral, MS Contin, Statex
• Oxycodone - Oxycontin, percocet
• Oxymorphone 
• Tramadol 
• Methadone
• Fentanyl
• Codeine
• Tylenol with codeine no. 1 (T1)
• Tylenol with codeine no. 2 (T2)
• Tylenol with codeine no 3 (T3)
• Tylenol with codeine no. 4 (T4).

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How do opioids work on various receptor sites?

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Opioids work on various receptor sites to cause specific effects in different areas of the body.

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Opioids bind to opioid receptors in nerve cells of the brain, spinal cord and other areas including the gastrointestinal tract. 

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Opioids work on the brain by binding to receptors in the limbic system (the area of the brain responsible for our emotions) to elicit feelings of pleasure and euphoria. It also binds to areas in the brain stem which further reduces pain and can lead to respiratory depression. 

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Opioids bind to receptors in the spinal cord to reduce nerve excitability leading to decreased pain. 

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Opioids bind to receptors in the gastrointestinal tract causing decreased contractions and decreased GI secretions. This often leads to constipation.

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How long before an opioid OD takes effect?

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The length of time before an opioid OD takes effect varies depending on the route of administration.

• Oral medications such as codeine takes approximately 30 minutes for an overdose to set in.
• Intravenous (IV) OD effects occur almost immediately. 
• The effects of smoking can lead to an OD almost immediately.
• Transdermal (patches): 12 - 16 hours

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What are the signs and symptoms of an opioid overdose?

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The signs and symptoms of an opioid overdose include:

• Cool, pale, sweaty skin that could be turning blue.
• Respiratory depression (slow or no breathing)
• Unconsciousness or reduced level of consciousness (difficult to rouse, not responsive to voice or painful stimulus)
• Pinpoint (very small) pupils even in dark environments

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What is Naloxone (Narcan)? 

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Naloxone (trade name Narcan) is in a class of drugs called opioid antagonists (Antagonist = prevents a response from happening). It is considered a life saving drug as it is the antidote for opioid overdoses. It works by competitively binding to the opioid receptors. Due to its high affinity (attracted to receptor sites), it bumps opioids off the receptor site and blocks the opioid’s ability to bind. Due to the strength of synthetic opioids, larger doses of Naloxone are sometimes required to bring a patient out of an overdose. Narcan is most often supplied in a nasal spray format. 

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Can you overdose if you get an opioid powder on your skin?

The short answer is no, you cannot overdose if you get an opioid powder on your skin.

Contrary to media portrayals, you cannot overdose just by touching fentanyl powder, pills etc. In fact, there are no confirmed cases of overdose from touching fentanyl powder or pills. While fentanyl can be absorbed through the skin, this happens only with constant direct contact over hours or days through a transdermal patch. It is safe to approach and help someone who is overdosing even if they may have been exposed to fentanyl as it is nearly impossible to overdose through casual contact. Still, it is important to wear gloves if available, and wash your hands with soap and water after potential skin exposure.

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How can you help an unconscious patient with a suspected opioid overdose?

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As a Police Officer, it is important to be prepared with the knowledge of how you can help an unconscious patient with a suspected opioid overdose. The treatment plan can be broken down into several categories to help guide you through the process.

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Assess the situation: 

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When you first arrive on scene of an unconscious patient, you must assess the situation. This includes:

• ensuring your safety and the safety of others
• Communicating with bystanders on scene 
• Observe the scene for any drug paraphernalia including pill bottles, needles, powders that could indicate the involvement of opioids.
• Don appropriate PPE including gloves

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Assess the patient’s responsiveness

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Once you have ensured that the scene is safe and you have gathered necessary information, you should approach the patient to assess their level of responsiveness.

• Shout their name or tap their shoulders or foot

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When the patient is not fully responsive, call for paramedics and the fire department to assist. Send for an AED and Naloxone if possible.

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Assess for Breathing

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While waiting for backup, begin assessing the patient for breathing.

• Perform a head tilt chin lift and visualize the chest for normal chest rise and fall
• Notice ineffective breathing, which includes very slow breathing, breathing that appears erratic, or no breathing at all

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Begin CPR

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If you find breathing is absent or ineffective, begin CPR.

• Start chest compressions
• Perform 30 chest compressions followed by two breaths if you have access to a barrier device.
• If no access to a barrier device and/or you are not comfortable performing mouth to mouth, continue with compression only CPR. 
• For more information on what CPR is and how to perform it, Para CPR & First Aid offers a variety of courses to ensure your CPR skills and knowledge are up to date.

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Assess for signs of an Opioid Overdose

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Signs of an opioid overdose include:

• Blue skin, lips or nails
• Small pupils
• Sweaty
• Unresponsive
• Not breathing

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Administer Naloxone

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If you suspect that the patient is experiencing an opioid overdose, administer Naloxone.

• Administer one spray (4mg) of naloxone from a narcan kit. 
• Open the clear packaging, placing the nozzle into the patient’s nose and depress the plunger. 
• The plunger will spray the naloxone as a mist into the patient’s nose. 
• Evaluate the effectiveness of naloxone after 2-3 minutes (about 5 rounds of 30:2 CPR)

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Continue until help arrives

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Continue treatment until paramedics or the fire department arrive.

• Continue CPR
• If the patient begins breathing again, roll the patient into a recovery position and monitor their breathing status.

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Ongoing Care

When the patient’s condition changes, ensure that you continue to provide ongoing care while you wait for help.

• If the patient begins to move, talk, or wake up, remain calm and re-introduce yourself, explain to them what happened and reassure them that help is on the way
• Naloxone may cause instant withdrawals which may include agitation, anxiety, vomiting, muscle cramping, excessive sweating and fever.
• If naloxone was administered, tell the paramedics or fire department the time of administration, the dose and any changes to patient condition.

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