Roger-Luc Chayer (Image: AI by Gay Globe)
Naloxone (Narcan) is a powerful antidote used in cases of opioid overdose, regardless of the type of opioid involved. In many countries, kits are offered free of charge to anyone who requests one, ensuring quick and easy access to a medication that can potentially save lives.
These kits typically include two nasal spray applicators, two injectable doses with syringes, and sterilization materials for injection. The problem is that the instructions for use and the way naloxone works are still not widely understood. As a result, many people hesitate to intervene in the event of an obvious overdose, fearing they might make a mistake that could harm the very person they’re trying to help.
What are the most common legal and illegal opioids involved in overdoses?
Opioids, whether legal or illegal, work by binding to receptors in the brain that regulate pain, breathing, and well-being. When taken in excessive amounts, they can slow breathing to the point of causing respiratory and cardiac arrest. This applies both to prescription medications—like powerful painkillers used in medical settings—and to substances diverted from their intended use or produced illegally.
On the street, some synthetic opioids, often stronger than those used in medicine, are mixed with other drugs, significantly increasing the risk of overdose. The danger is heightened by the fact that users often don’t know what’s actually in the substance they’re taking. Whether obtained by prescription or on the black market, high doses or reduced tolerance can lead to respiratory arrest—and subsequently cardiac arrest—in just minutes.
Fentanyl, for example, is a highly effective medication designed to relieve severe pain, often in hospital settings. However, it has now found its way into the street drug market, where it’s used in all sorts of combinations. It’s frequently mixed with other substances such as heroin, cocaine, or even pills that mimic well-known medications. The idea behind this is to deliver a stronger effect at a lower cost. The problem is that fentanyl is extremely potent, and even trace amounts can be dangerous. Since doses are neither measured nor disclosed, users have no real idea what they’re taking—making each use a risky gamble. It’s precisely this uncertainty, combined with its strength, that makes fentanyl one of the main drivers of the current overdose crisis.
A recent example of poor judgment in the use of naloxone
I recently witnessed an emergency situation firsthand where a police officer was struggling to save a person in respiratory and cardiac arrest in a business located in Montreal’s Gay Village. The victim was no longer breathing, and in such a scenario—without any sign of a heart attack, choking, or seizure—one must immediately suspect an opioid overdose, which is now one of the leading causes of cardiopulmonary arrest in both Europe and North America.
The first responder on the scene was a young policewoman who had presumably received basic training on how to administer naloxone. Although informed that the person had not been breathing for several minutes, she chose to use the nasal spray to try to counter the effects of the overdose. Why this method was chosen in such a critical situation—where an intramuscular injection may have been more appropriate—is hard to explain.
After the first dose of nasal spray, the victim still showed no response, and the officer continued attempting stimulation without success. As a trained emergency responder familiar with naloxone use, I noticed that the officer seemed overwhelmed and visibly nervous. I calmly approached and said, “He’s not breathing. The nasal spray won’t work if he’s not breathing. You need to use the injection. I can help you if you want.”
She responded somewhat irritably, as though my presence was interfering with her intervention. Yet the logic is straightforward: without breathing, the product cannot be absorbed nasally. That’s precisely why naloxone kits also include an injectable version, better suited for such critical cases.
I repeated my suggestion, reminding her that an injection was necessary, but she wouldn’t act on it. The officer appeared confused and nervous, and I even began to wonder, with some concern, whether she had a fear of needles—which could explain her refusal to inject the dose into the still-unconscious victim.
For the record, the paramedics arrived just seconds later. They immediately administered a naloxone injection to the victim. Despite 45 minutes of resuscitation efforts, the person was transported to the hospital without regaining consciousness. At least ten minutes had passed between the officer’s arrival and that of the paramedics.
How to administer naloxone and when to choose the nasal spray vs. the injection
The recommendations are simple: if the person is breathing, start with the nasal spray; if they are not breathing, the injection is preferred. There’s no need to hesitate—the instruction is clear and easy to apply.
How to use the nasal spray:
Naloxone nasal spray is very easy to use. You just remove the cap, gently insert the nozzle into one nostril of the person needing help, and firmly press the plunger to release the dose. No special training is needed—it’s fast, convenient, and designed for use even by people with no medical background.
How to administer the injection:
The naloxone injection is a bit different but still manageable. Prepare the syringe included in the kit, then choose an appropriate site on the body—usually the thigh or upper arm. Gently insert the needle into the muscle and push the plunger to inject the medicine. Though the idea may seem intimidating, the action is simple. To find the right muscle, aim for a broad and accessible area like the outer thigh or the upper arm, where the muscle is firm beneath the skin. Precision isn’t critical—what matters is choosing a site where the syringe can easily penetrate the muscle.
Is it dangerous to administer multiple doses of naloxone?
One of the benefits of naloxone in opioid overdoses is that administering multiple doses is not dangerous. You cannot overdose on naloxone—it only works on specific opioid receptors in the body. If no opioids are present, naloxone has no effect.
Naloxone is a safe antidote that only works to counteract opioids. In some overdoses, especially when potent or large quantities of opioids are involved, a single dose may not fully revive the person. In such cases, repeat dosing is necessary, following recommended guidelines, without fear of overdose or serious side effects from naloxone itself.
It’s also important to note that if the injection is not administered in the ideal location or manner, it won’t harm the person—though the medicine may be less effective.
What to do when naloxone takes effect and the person regains consciousness
When naloxone takes effect and the person regains consciousness, it is essential to keep them under close supervision. Naloxone acts for a very short duration, meaning the person can quickly relapse into respiratory or cardiac arrest, or lose consciousness again if not promptly cared for by paramedics, firefighters, or medical personnel.
According to naloxone use protocols, it is strongly recommended not to let the person leave before they are seen by healthcare professionals. Even if they seem alert and fully recovered, this is often only a temporary effect of the antidote. In a hospital setting, they will receive proper care to prevent relapse from lingering opioids in their system.
What is the legal responsibility of someone who helps?
Generally, in both Europe and Canada, a person who helps an overdose victim is not criminally liable as long as they act in good faith and behave reasonably. Laws encourage emergency assistance, notably through “Good Samaritan” laws, which protect those who help from legal consequences as long as they don’t act recklessly or with intent to harm.
This means that anyone administering naloxone or calling for help during an overdose is acting within a legally and morally protected framework.
In Canada, the Good Samaritan Drug Overdose Act provides legal protection to individuals experiencing or witnessing an overdose who call 911 or their local emergency number for help.
This law can protect you from:
- Charges for simple possession of controlled substances.
- Breaches of conditions related to simple possession in situations such as:
- Parole,
- Probation,
- Pretrial release,
- Conditional sentences.
The Good Samaritan Drug Overdose Act applies to anyone seeking emergency help in an overdose situation, including the person overdosing. The law protects individuals whether they stay or leave the scene before help arrives, and also those who remain at the scene when emergency responders arrive.
However, the law does not provide protection in cases of more serious criminal offenses such as:
- Unrelated criminal activity not specified by the Act,
- Outstanding warrants,
- Production or trafficking of controlled substances.
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