Naloxone Readiness Plan: How to Keep Patients Safe on Opioids

When someone is prescribed opioids for pain, the risk of overdose doesn’t disappear just because they’re following their doctor’s instructions. Opioids slow breathing - sometimes so much that it stops. And when that happens, minutes matter. Naloxone isn’t a cure for addiction. It’s a safety net. A simple, fast-acting tool that can bring someone back from the edge. But having it isn’t enough. You need a naloxone readiness plan.

Why a Naloxone Readiness Plan Isn’t Optional

Naloxone reverses opioid overdoses by kicking the opioids off the brain’s receptors. It works in 2 to 5 minutes. It’s safe. It doesn’t work on non-opioid overdoses - so if you give it to someone who hasn’t taken opioids, it does nothing. No harm. No side effects. That’s the beauty of it.

But here’s the problem: most people don’t know how to use it. Or they don’t have it nearby. Or they wait too long to call 911. In 2022, the CDC found that nearly 9 out of 10 opioid overdose deaths happened to people who weren’t even on a prescription at the time. That means the danger isn’t just for people with addiction. It’s for anyone taking opioids - even for a week after surgery.

A readiness plan isn’t about fear. It’s about control. It’s knowing exactly what to do before the emergency happens.

What’s in a Naloxone Kit? (And How Much Do You Need?)

There are two main types of naloxone kits used today: nasal spray and injection.

• Nasal spray (NARCAN®): One 4mg dose. Easy to use - no needles. Just insert the nozzle into one nostril and press the plunger. FDA approved for over-the-counter sale in March 2023. Retail price: $130-$150 without insurance.
• Intramuscular injection: Two 0.4mg vials with a syringe. Cheaper - about $25-$40 per dose - but requires training. Used in clinics and by first responders.

The American Academy of Family Physicians recommends keeping at least two doses on hand. Why? Because naloxone wears off in 30 to 90 minutes. Many opioids - especially fentanyl - last much longer. If you only give one dose, the person can slip back into overdose. That’s called renarcotization. It’s why you need at least two doses ready.

For rural areas, where emergency response takes over 20 minutes on average, keep three or four doses. In homes, workplaces, or clinics, store kits where they can be grabbed in under 30 seconds. Not in a locked cabinet. Not in a drawer. On a hook by the door. In a first aid kit on the counter.

How to Use Naloxone: A Step-by-Step Guide

Time is everything. Here’s what to do when someone isn’t responding:

1. Check for signs: Unresponsive to shaking or shouting. Slow, shallow, or stopped breathing. Blue lips or fingertips. Pinpoint pupils.
2. Call 911 immediately. Even if you give naloxone, they still need medical care. Overdose can cause other complications like aspiration or muscle breakdown.
3. Give naloxone: For nasal spray: Tilt head back, insert nozzle fully into one nostril, press plunger firmly. For injection: Inject into the outer thigh - through clothing if needed. Use a 22-25 gauge needle at a 90-degree angle.
4. Start rescue breathing: Tilt head back, lift chin. Give one breath every 5 seconds. Don’t stop until they’re breathing on their own or help arrives. Brain damage can start in under 3 minutes without oxygen.
5. Wait and watch: If they don’t respond in 2-3 minutes, give a second dose. Keep giving breaths. Stay with them. Monitor for at least 2-3 hours. They may need more doses.

Training matters. A 20-minute hands-on session improves correct use by 92%. Annual refreshers keep skills sharp. Don’t assume someone knows how to do it just because they’ve seen it on TV.

Who Needs Naloxone? It’s Not Just for ‘Addicts’

The biggest myth? That naloxone is only for people with substance use disorder.

In 2021, 38.2% of opioid overdose deaths involved prescription opioids alone - no street drugs. That’s someone taking oxycodone for back pain. Or hydrocodone after a knee replacement. Or morphine in hospice care.

The CDC says you should consider naloxone for anyone prescribed more than 50 morphine milligram equivalents (MME) per day. That’s about 10 tablets of 5mg oxycodone. But many doctors don’t ask. A 2022 survey found only 32.4% of primary care providers routinely discuss naloxone with high-risk patients.

The American Medical Association now says: Co-prescribe naloxone with any new opioid prescription longer than 3 days. That’s the new standard. Not a suggestion. Not an option.

And it’s not just for patients. Family members, caregivers, coworkers - anyone who might be around someone taking opioids should know where the naloxone is and how to use it.

Barriers Are Real - And Fixable

Cost is the biggest hurdle. Nearly 42% of uninsured people say they can’t afford naloxone. But help exists. Forty-seven states have laws allowing pharmacists to dispense naloxone without a prescription. Many pharmacies offer it for free or low cost through public health programs.

In Pennsylvania, standing orders let pharmacies give out naloxone without individual prescriptions. In South Carolina, over 12,000 free kits were distributed in just one quarter. In Oklahoma, over 37,000 were given out in 2022.

Workplaces are catching on too. OSHA now recommends naloxone in any workplace with more than 15 employees. Why? Workplace overdose deaths have jumped 619% since 2011. That’s not just a health issue - it’s a safety issue.

Stigma still holds people back. Some fear that having naloxone means you’re enabling drug use. But naloxone doesn’t encourage use. It saves lives. And when someone survives, they have a second chance - to get treatment, to reconnect with family, to rebuild.

What Happens After Naloxone?

Naloxone saves breathing. It doesn’t fix the underlying problem. That’s why follow-up care matters.

After reversal, patients can experience:

• Withdrawal symptoms - nausea, vomiting, sweating, agitation. Pain can return sharply.
• Delayed complications - aspiration pneumonia, rhabdomyolysis (muscle breakdown), kidney injury. These caused nearly 17% of post-reversal deaths in Massachusetts in 2021-2022.

That’s why emergency services are non-negotiable. Even if they wake up, they need to be monitored in a hospital.

And long-term? They need access to treatment. Only 18.5% of Americans with opioid use disorder get medication-assisted treatment (MAT). That’s the real crisis. Naloxone buys time. But treatment saves lives over time.

Building Your Plan: A Checklist

Here’s what your readiness plan needs:

• At least two naloxone doses (nasal spray preferred)
• Stored in an easy-to-reach place - not locked up
• Check expiration dates every 6 months - replace every 18-24 months
• Everyone who might be present knows where it is and how to use it
• A written plan posted near the kit: “If unresponsive, call 911, give naloxone, start breathing”
• Annual training for caregivers, staff, or family members
• Know your local resources - where to get free kits, who to call for help

Final Thought: It’s Not About If - It’s About When

Opioids are powerful. They help. They heal. But they carry risk. A naloxone readiness plan doesn’t mean you expect an overdose. It means you’re prepared - just like you keep a fire extinguisher in the kitchen or a first aid kit in the car.

In Washington State, over 28,000 overdoses were reversed with naloxone in 2022. That’s 28,000 people who went home. 28,000 families who didn’t bury someone too soon.

You don’t need to be a doctor. You don’t need to be an expert. You just need to be ready.