There seems to be a little confusion about the difference between the two “nal-xone” drugs, naltrexone and naloxone. Two very different drugs, the similar names are confusing but what makes it worse is the fact that both are related to the treatment of drug and alcohol abuse. Hopefully this will clear up the misconceptions.

Naltrexone

Naltrexone, like naloxone, is an antagonist that binds to opioid receptors and blocks the effects of opiates. However, naltrexone is used primarily in the treatment of alcohol addiction in an effort to reduce the craving to drink. Its generic name is naltrexone hydrochloride, but it’s sold under the brand names Revia and Depade. An extended release formula is also sold as Vivitrol.

After detox off of opiates or alcohol, naltrexone may be prescribed to help people stay off the sauce—in any form. It effectively blocks any opiates from binding to your opiate receptors so if you do try to get loaded while you’re taking it, it won’t work. You won’t get high at all. But for some reason, it’s rarely prescribed to people who suffer solely from opiate dependence but rather to those who need help fighting the urge to drink. With studies to back it up, it works well to prevent relapse and decrease the severity of relapse when it does occur. For those who need help with opiate addiction, a better medication is Suboxone, which combines buprenorphine and naloxone.

Naloxone

Sold under the brand name Narcan, naloxone is injected into a muscle when overdose on an opioid-based drug occurs. Whether you overdose on a prescription painkiller like Fentanyl, Vicodin, Dilaudid, Darvon or Darvocet, Norco or OxyContin or you overdose on a street drug like heroin or morphine, naloxone stops the overdose dead in its tracks (no pun intended).  It works by heading straight to the opiate receptors and knocking off any opiates that are there, which stops the respiratory depression they cause and the subsequent overdose. It doesn’t work for benzodiazepines like Valium, Xanax, Valium, or Klonopin, nor does it work for stimulants like methamphetamine and cocaine.

Naloxone stays active in the system, blocking opiates from binding to your opiate receptors for 30 minutes to 90 minutes. When it wears off, the opiates that caused the overdose are still in your system and their effects will kick in again and, possibly, slam you right back into an overdose. This brief reprieve, however, can be what you need to keep you from dying before you get emergency medical help.

A few things you should know:

- Naloxone won’t let you give a clean drug test.
- Naloxone is effective in fighting an overdose even if you hit a vein.
- Naloxone is ONLY meant to be delivered with a needle in the event that someone is dying.

Suboxone

If you are addicted to opiates and taking Suboxone to detox off of your drug of choice, then you are taking naloxone. Suboxone is a combination of buprenorphine and naloxone, and it comes in a pill that you take by dissolving it beneath your tongue. The naloxone remains dormant unless you should try to abuse the Suboxone by dissolving it in water and inject it. If you do this, the naloxone will kick in and prevent you from experiencing any of the relief that the buprenorphine provides for those trying to avoid withdrawal symptoms.

So hopefully that clears that up! Any questions?

Now, I really mean it this time: this is the last I’m going to say about overdoses for awhile. I thought I’d pretty much gotten it out of my system with the urban myths about overdoses and the tips on how to avoid an overdose and how to know one when you see it. But yesterday, someone I know quite well overdosed unintentionally. They have had a lifetime methadone maintenance slot for years now, and if ever there was a success story to support methadone maintenance, he was it: after a lifetime of being a street junkie addicted to heroin and doing crimes to pay for his habit, he’s managed to hold onto the same job (even move up in the company), married a great gal and had a baby with her. Then yesterday, he had a migraine, happened to run into an associate from the old days who offered him a pill to wipe out the headache. He went home, had a couple of beers and woke up this morning in the hospital having suffered an overdose.

It’s that quick, and it’s that unexpected. Don’t think that because you have two, three, 10 or 20 years invested in a methadone maintenance program that you are immune to overdose. Sometimes all it takes is a one too many alcoholic drinks or one pill that unexpectedly mixes with your daily methadone dose to create an overdose situation. Maybe he hadn’t eaten very much that day or maybe he’d just come up or down a few milligrams on his methadone dose through the clinic. Maybe neither. Your body’s chemistry changes as you grow older and if you don’t get to the doctor for your regular checkups, you may not know when you’re developing a chronic issue that will affect how your body processes your methadone dose.

If your methadone dose is 30 milligrams or lower, you can switch to a Suboxone detox. Avoid the daily trip to the clinic, the liver damage associated with long-term methadone use and the possibility of overdose as you work your way toward a drug-free life. In the meantime, be aware of your body and if you are suddenly overwhelmingly tired, having difficulty breathing, have cold and clammy skin or muscle spasms. Any of these or a combination can indicate an overdose and it’s imperative that you get medical assistance while you still can or make sure that there is someone in the house with you who can watch over you and make sure that you’re okay.

The other day, I told you what not to do in the event that someone you are with overdoses on opiates. Here’s what you actually should do:

1 – Get Their Attention. Yell their name. Shake their shoulders. No response at all? Try again.

2 – Sternum Rub.  Yes, this is exactly what it sounds like: using your knuckles, you rub the possible overdose victim’s breast bone, up and down. It’s not pleasant for the person on the receiving end, but it’s a common practice used to rouse those who’ve had too much of anything.

3 – Get Help. If neither of these measures works, then call 911 immediately. As soon as they answer, tell them if the victim is not breathing, then answer the questions that they will most likely ask: the substances taken, how much, when the last dose was. They may also request information about the person’s age and weight. If you have a pill bottle with the prescriptions that the person took, hold onto it and give it to the paramedics when they arrive.

The emergency attendant will most likely ask you to stay on the phone with him or her until help arrives. If for some reason you have to leave the victim alone, turn them on their side so that they don’t choke if they vomit.

4 – The Naloxone Option. Some people who regularly use drugs to get high (as opposed to those who use them only in an attempt to manage pain and inadvertently overdose) often choose to keep naloxone on hand in case of a situation like this. If you have this available and the person is not breathing, then give them a few breaths CPR-style before administering the shot. If the person is breathing, give them the naloxone. Use .4cc of the drug and inject it into a large muscle like the thigh. If they don’t respond within three minutes, inject another .4cc into the muscle. In between, if they aren’t breathing, keep administering CPR.

**It’s important to remember that naloxone does not flush the offending drugs out of the system though it will put the victim into immediate withdrawal. When the naloxone wears off, if the drugs are still in the system, overdose is again a possibility. Stay with the person and try to keep them from taking more drugs to mitigate the withdrawal symptoms and make sure that they don’t overdose again.