ACT FAQ

Is there a place where Narcan is not legally allowed?

Narcan is not a controlled medication. A person cannot become addicted to it. There have been no areas where Narcan has been banned. It is encouraged that business owners and work settings actually have Narcan on hand in case of an opioid emergency.

Does Narcan help with other types of overdose? (cocaine, meth, alcohol)

Narcan only works on opioid overdoses. If you suspect a non-opiate drug (e.g., cocaine) was laced or cut with an opioid such as fentanyl, giving Narcan will help. If you are unsure of what someone took, it is best to administer Narcan because it will not hurt the person.

How much does Narcan cost?

About $140 for a 2-dose box. As a reminder, our program will send Narcan free of cost to anyone who attends our training sessions.

Can someone be allergic to Narcan?

According to the Food and Drug Administration, Narcan or Naloxone hydrochloride contains itself, the antagonist as well as many inactive ingredients. EDTA which is a stabilizer, sodium chloride which is a salt, hydrochloric acid to adjust pH, and purified water. Many of these ingredients are found in products we use everyday making Naloxone hypersensitivity extremely rare.

How are we able to get more Narcan?

After a participant uses their Narcan, they can fill out the anonymous survey which is listed on the box where they can indicate that they would like another kit with Narcan.

Is Michigan the only state with Good Samaritan Laws?

All states have Good Samaritan Laws, but laws differ state to state. Generally, they cover any unintended consequences from CPR. The amount of personal drug possession varies. Related to performing CPR or other types of medical treatment: Any individual that performs CPR on another individual is not liable for any resulting damages, as long as that individual acts in good faith. This law also covers damages related to using an AED. Related to seeking medical help for an overdose: In Michigan, you are protected from prosecution for personal drug possession if you seek medical attention for yourself or another person. This can include reporting a drug overdose to law enforcement, calling 9-1-1, poison control center, a medical provider, or assisting someone in reporting a drug overdose or other overdose emergency.

How long does it take for Narcan to work?

Narcan works in 2-3 minutes. If the person does not respond in that time, administer a second dose.

If you find someone overdosed in a car, do they have to be removed from the car or lying down in order to administer Narcan?

No - Narcan can be administered to a person who is sitting or laying. However, CPR can only be used on an individual who is laying flat on a hard surface.

What can I do to save a person I think is Overdosing?

Call 911- this is the most important step. Check for breathing: If the patient is not breathing, begin CPR or direct someone else to begin CPR. If you can, direct someone else to administer Narcan. If you are alone, CPR is the most important thing you can do. If the person is breathing abnormally but is unresponsive, administer Narcan. If there is no response in 2-3 minutes, administer another dose. Repeat until EMS arrives or breathing returns to normal If a patient initially has normal breathing, or begins breathing normally after CPR/Narcan, place them into the recovery position. Remember that CPR is more important than administering Narcan. If you administer Narcan but the person's heart is not beating, the Narcan will not be effective.

What does ACT do outside of community trainings?

Day to day, ACT members engage in community outreach strategies and facilitate overdose rescue training sessions. Members demonstrate hands-only CPR as well as how to administer the life-saving medication, Narcan.

What about Fentanyl and ODs?

Fentanyl is a powerful synthetic opioid that is similar to morphine but is 50 to 100 times more potent. It has approved medical use in patients that are in severe pain and is often used during and after surgery. Since fentanyl is an opioid, Narcan will work to reverse an overdose caused by fentanyl. It is important to note that fentanyl may require more Narcan due to its potency. It is becoming increasingly common for fentanyl to be cut with other drugs, including heroin, cocaine, meth, and MDMA. In these cases, people are not usually aware that there is fentanyl mixed in. That is one reason it is so important to encourage people to administer Narcan even if they don't think the person has opioids in their system.

What about ice or cold showers?

Ice down the pants or cold showers can slow down the respiratory system and can send someone into shock or hypothermia. This is not a recommended strategy to use when responding to an overdose emergency. Rather a safer, quicker, more likely to work action is to call 911 and give naloxone/narcan.

What if the caller/overdose patient has more than person drug possession activities such as selling at their home?

Still encourage 911 to be called. This is a personal choice that people have to make in this situation. Refer to Good Samaritan laws.

Do you start CPR first then Narcan or vice versa?

If you are alone and the person is not breathing, you want to start chest compressions right away. The Narcan will not work if their heart is not pumping blood throughout their body. If the Narcan is near you, you can quickly admisniter it and then go back to doing chest compressions. If the Narcan is not within reach, just continue doing chest compressions until medical first responders relieve you. If there is another person present, one person can do chest compressions while the other person retrieves the Narcan and administers it. If the person doing chest compressions gets tired, the other person could also take over and keep the cycle going until medical first responders relieve you and can take over. If solo, AND you have an AED, you could administer Narcan while the AED charges/prepares.

What is the concern or risk of touching someone who is overdosing if you think they may have used fentanyl?

In 2017, the American College of Medical Toxicology released a position statement titled " Preventing Occupational Fentanyl and Fentanyl Analog Exposure to Emergency Responders". Here is a quote from this statement: "Fentanyl and its analogs are potent opioid receptor agonists, but the risk of clinically significant exposure to emergency responders is extremely low. To date, we have not seen reports of emergency responders developing signs or symptoms consistent with opioid toxicity from incidental contact with opioids. Incidental dermal absorption is unlikely to cause opioid toxicity. For routine handling of drug, nitrile gloves provide sufficient dermal protection."

If we help people avoid overdoses, how will they ever learn how dangerous drug use is/hit "rock bottom"/ get a "wake up call"?

In Scott's words: Dead people can't seek treatment. It is not our job to judge someone, whether it's their first time experiencing an overdose or their 10th time experiencing an overdose. The idea that someone must hit rock bottom before they will correct their behavior is an idea we need to move away from.

How does Narcan work?

Naloxone/Narcan reverses an opioid overdose. Naloxone/Narcan works by blocking the effects of opiates on the brain. Naloxone will only work if a person has opiates in their system. It will not work with other drugs. A person cannot get "high" from using naloxone/narcan, and it is safe for practically anyone to use.

Can someone overdose on Naloxone?

It is not possible to give so much naloxone so as to harm a person. However, if a person is dependent on opioids (including people without substance use disorders, but on chronic pain medication) or has a habit, the more naloxone they get, the more uncomfortable they will be because of withdrawal symptoms. Vomiting is a possibility - be sure they don't aspirate (inhale) the vomit - that is very dangerous. If the person gets too much naloxone, try to explain to them that the withdrawals or "dopesickness" will begin to fade in a half hour or so.

What is AmeriCorps?

It's a national network of independent programs that all incorporate community service as a key strategy for addressing critical community challenges. It is supported by funding from the federal Corporation for National and Community Service (CNCS)

What are the benefits of joining AmeriCorps?

Living stipend, Education award

Can I buy Narcan over the counter?

Michigan a Naloxone standing order law. This allows a pharmacist to dispense Naloxone without an individual prescription and without identifying a particular patient.

Does the dose of Narcan differ according to the number of opioids taken?

Multiple doses of naloxone may need to be administered per overdose event because of fentanyl's high potency relative to other opioids.

What is the risk period for an OD to reoccur after giving Naloxone?

Naloxone /Narcan is active for about 30 - 90 minutes in the body. Since many opioids remain in the body longer than that, a person can experience an overdose after the 30-90 minute time period. Each person's body reacts differently, and some people may initially require more than one dose of Narcan to reverse their overdose. This is why it is so important to call 911 immediately. Someone who seems to be recovering from their overdose after receiving Narcan could easily overdose again.

Will Narcan hurt someone who is not overdosing?

Naloxone has no effect on someone who has no opioids in their system. It will not help anyone who is not in an OD, but it will not hurt them either.

Does ACT take Narcan or syringes back ?

No we do not take them. Expired Narcan as well as expired/unused medication can be returned to certain pharmacies across the nation. Many CVS and Walgreens as well as local pharmacies will accept your unused/expired medications. Select community locations like police departments will also accept unused/expired medication as well. Always make sure to call the location and confirm that they will be able to accept it since not all pharmacies and community areas are designated to take back unused/expired medications.

Can you develop immunity/tolerance to Naloxone?

No, people will not develop tolerance to naloxone - it can be used as effectively on the first overdose as on the 8th overdose, for example.

Is Narcan the only opioid antagonist?

No. But, the two most commonly used acting opioid receptor antagonists are naloxone and naltrexone.

Should we do a finger sweep of the mouth?

No. If a blockage is visible at the back of the throat or high in the throat, reach a finger into the mouth and sweep out the cause of the blockage. Don't try a finger sweep if you can't see an object.

Is Narcan available only through prescription?

No. In 2016, Michigan passed a Naloxone standing order law. This allows a pharmacist to dispense Naloxone without an individual prescription and without identifying a particular patient. With this, the "prescription" comes from the standing doctor's order from the State. Although individual doctor prescriptions still work for this, as an alternative, family, friends, or others can now obtain Naloxone to use in an emergency without an individual prescription.

Do big-box stores or other businesses have someone who is trained on using Narcan?

Not necessarily. Many organizations are working to train community members to respond to opioid emergencies. Some of these community members may be employed at public sites where they can use their training to save someone's life.

Is the box the Narcan comes in descriptive of what it contains?

Our packaging does state that the contents inside include Narcan. The mailing package however will not indicate that it is Narcan.

Is there a target audience for our trainings?

Our trainings are open to anyone who wants to attend them. For the time being, we are leading training sessions in Wayne, Macomb, and Oakland county. During the Covid-19 crisis, our training sessions have gone virtual and are open to the public!

Have you noticed an increase in opiate overdoses since the pandemic started?

Researchers at University of Michigan have seen a 15% rise in suspected opioid overdose deaths across most of Michigan since March, compared with the same time last year, and a 29% rise in first responders' use of naloxone.

Is Narcan effective past its expiration date?

Studies have been done that show Narcan can remain effective beyond 10 years. However, most pharmacies are willing to exchange expired Narcan for a new dose. Throwing expired Narcan out is not recommended since having some Narcan is better than having no Narcan.

Is the syringe version of Naloxone effective past the expiration date?

The 2 most well known Naloxone products are Narcan and Evzio. Narcan comes in a nasal spray form and Evzio comes in an injection form. Research has shown that they are both effective well past their expiration date.

Where can we find more training for CPR?

The American Heart Association website allows you to search for CPR classes near you. Link. The American Red Cross also offers CPR courses.

Can someone be fired from work for seeking treatment for substance use disorder?

The Americans with Disabilities Act or the ADA provides vast coverages in these instances. You as an employee cannot be fired for reasons related to your treatment process, even if it causes you to miss work. Moreover, under the Family Medical Leave Act of FMLA an individual can take up to 12 weeks of time off for issues that include addiction disorders each year, although in most cases this would be unpaid.

How can the domestic violence program promote Narcan to empower their survivors?

The domestic violence program can advocate to all their survivors and members about the free training sessions that are being led by the ACT program. No one is immune to the disease of addiction. Having Narcan allows anyone to act in a situation where someone has overdosed and could potentially save a life.

Why is checking for a pulse unreliable?

The pulse check performs poorly when used as a diagnostic tool by lay responders. Such an error will lead at once to failure to diagnose cardiac arrest, failure to start CPR, and failure to assess the arrest rhythm for VF for approximately 10% of victims of cardiac arrest.

How much time should be given till the 2nd dose is administered?

The signs and symptoms of an opioid overdose can return after Narcan is given. If this happens, give another dose after 2 to 3 minutes using a new spray device and watch the person closely until emergency help is received.

How many doses come in one box?

There are 2 doses in boxes purchased/received from a pharmacy. For our program and training sessions, our kits come with one Narcan nasal spray which contains one 4mg dose of the medication.

Is Narcan stocked in schools?

There are organizations working on this. Alliance (in Oakland County) has ensured that every school in Southfield has 3 Narcan kits per school (as well as 3 trained staff members) to respond to an overdose emergency that occurs on site.

Is there data/statistics from the opioid epidemic that correlates with domestic violence survivors?

We do not have any specific data on whether there is an association in domestic violence survivors and the opioid epidemic. If that is something that interests you, we can look into it and get back to you with more information.

How long does it take to get the Narcan through the mail?

With Covid-19, the expected mailing dates are delayed. We cannot give an estimate of when you will receive your kit but it should hopefully not take too long!

Does Narcan interact with other medications?

Yes, it is possible for Naloxone to have a mild interaction with other medications. However, in an overdose emergency, the risk of brain damage and death is higher. Make sure to call 911 before intervening so EMS can deal with any effects that occur after the overdose has been reversed.

Is our contact information on the box?

Yes, our website (CUS/STOP) is listed on the box and resource cards. The website has more contact information about the program, how you can get involved and much more. If you would like to speak to one of us, our phone number is also listed on the website.

Does Narcan have an expiration date?

Yes. However, it has been shown to be effective beyond its expiration date.

Can they get another Narcan through our program if they used their first dose?

Yes. If they have used their 1st dose up, they can fill out the post questionnaire(link on the box) where they can indicate they would like another kit. Generally, each training participant will receive 1 kit (limited by grant requirements); In some cases, we can provide an additional kit that will remain on-site at the location (e.g., a group kit to keep in a shared office). *Be sure to complete an extra attendance slip* If it's a single/individual, let them know about upcoming public training.

Is Narcan safe for children?

Yes. It is safe and effective when given to children. For infants repeatedly exposed to opioids, giving Narcan/naloxone can induce more serious withdrawal symptoms.

How much Narcan can be administered?

You can administer as many doses of Narcan as you have if the person needs it. The hope is that EMS will arrive before you need to administer a second dose.

Can Narcan be stored in a car?

You can keep the Narcan in your car, but be mindful of extreme temperatures. So if it gets too hot or too cold, then we recommend storing it inside.

Will we be getting a certificate for this training?

You can opt for a certificate in the post training survey