What Is Naloxone? Where To Get Narcan And How To Reverse Overdoses

The overdose crisis continues to worsen in the U.S., and overdose deaths reached an all-time high in 2021. Experts say that a simple drug — naloxone — is a key tool in preventing more deaths. But not enough people know about it, have access to it or actually carry it with them.

“Naloxone is a miracle drug,” Dr. Kimberly Sue, medical director for the National Harm Reduction Coalition and associate professor of medicine at Yale School of Medicine, told TODAY. “It’s literally a Lazarus drug that prevents people from dying of an opioid overdose.”

And in the midst of the overdose crisis, which claimed nearly 108,000 lives just last year, getting naloxone to those who need it is vitally important. Here, experts discuss what naloxone is, how to get it and how it can save lives.

How does naloxone work?

Naloxone, also referred to by the brand name Narcan, is what experts call an opioid antagonist, Dr. Sarah Wakeman, medical director for the Massachusetts General Hospital Substance Use Disorder Initiative, told TODAY. Narcan is not the only branded naloxone product; a high-dose nasal spray called Kloxxado works similarly, according to the FDA.

That means it “binds to the opioid receptors in the brain — the same receptors that opioid drugs or medications like oxycodone or heroin or fentanyl bind to — and then blocks those receptors,” Wakeman explained. In the event of an opioid overdose, naloxone “can actually kick off the opioid from the receptor, reverse the acute effects of an opioid overdose and save someone’s life.”

A standard dose of naloxone is effective against even fentanyl, Wakeman said. If they’ve taken an opioid and something else, or if they took something like cocaine that was tainted with illicit fentanyl, naloxone will still work against the opioid in their system.

“And naloxone won’t be harmful to someone who doesn’t have an opioid in their body,” Wakeman said. “So if there’s a possibility that you think someone is having an overdose … then it is always a good idea to give naloxone.”

When should naloxone be given?

Before using naloxone, check to see if someone has the telltale signs of an overdose, Dr. Ayana Jordan, an addiction expert and associate professor of psychiatry at NYU Grossman School of Medicine, told TODAY. She pointed to the Center for Disease Control and Prevention‘s tips to learn about the signs of an overdose.

According to the CDC, someone having an overdose may have:

  • Loss of consciousness.
  • Weak, slow or no breathing.
  • Small or constricted pupils.
  • Choking or gurgling sounds.
  • Limp body.
  • Clammy or cold skin.
  • Blue or discolored skin, especially around the lips. (However, Jordan notes that this may not apply to people with darker skin.)

In general, someone who is in the midst of an overdose will “have slowed and very shallow breathing to the point that, ultimately, they’ll stop breathing,” Wakeman said. “So they may look blue or cold and not be responsive.”

Giving someone naloxone

Once you’ve identified that someone might be having an overdose, you should call 911, the CDC says. Even if you’re able to reverse the overdose, they will likely still need emergency services. (Some states, but not all, have Good Samaritan laws, which protect people calling for medical help from some drug-related charges, Sue explained.)

From there, the right way to use naloxone depends on the specific formulation you’re using. For most people, that will likely be the nasal spray called Narcan, Wakeman said. In the hospital, naloxone may be given through an IV or as an injection into the muscle, she added.

After administering naloxone, the person should wake up within seconds to minutes, Wakeman said. And you should always start with as low a dose as possible. If someone is a regular opioid user and you give them a massive dose of naloxone all at once, “they’re going to immediately go into withdrawal,” Wakeman explained. While that isn’t necessarily harmful, it is pretty unpleasant and uncomfortable.

After giving someone naloxone, you should stay with them if you can until emergency medical help arrives. “Naloxone works very quickly, but it also wears off very quickly,” Wakeman said. In fact, the effects of naloxone can wear off within 30 minutes. And if someone still has the other opioid in their system, they may fall back into an overdose after the naloxone has worn off.

Where to get naloxone

If you use drugs, your doctor may give you a naloxone prescription as a regular part of their practice. “I make sure that everyone that sees me gets prescribed naloxone and that they understand how to use it,” Jordan said.

Depending on the state, you may be able to get naloxone at a local pharmacy without a prescription through the use of a standing order, Wakeman noted. (Standing orders allow pharmacies to give out prescription medications, like the annual flu vaccine, without requiring each individual person to have their own prescription.)

Another option is to connect with local harm reduction groups in your area, which frequently hand out naloxone kits, Wakeman said. These community-based organizations may also offer in-person or virtual trainings on how to use naloxone. Jordan noted that her research group also does large virtual naloxone training sessions for people who participate in their studies looking at drug use.

If you live in a state without a standing order and want to get naloxone to use on someone else, you can likely get a third-party prescription through a doctor, Sue said. She recommended looking at the local health department’s website for more information about where to get naloxone in your area.

It’s most important for people who use drugs to have access to naloxone. But if you know someone who uses drugs, you should consider carrying naloxone, too, the experts said. “Carrying naloxone is no different than carrying an epi-pen,” Jordan said.

And even though there are several ways to get naloxone now, there are still barriers to actually accessing and using it, Sue explained. She recalled a story of pharmacy staff being simply unaware of the standing order for naloxone, for instance, and noted that harm reduction groups are experiencing an ongoing naloxone shortage.

Additionally, naloxone is something that, by definition, people can’t use on themselves in the event of an overdose, Sue said. (If you are going to use by yourself, Sue recommended calling the Never Use Alone hotline so there is someone who can notify emergency services if you lose consciousness.)

Naloxone is a crucial tool in reducing overdose deaths, experts say

“Really, no one should die from an opioid overdose,” Wakeman said. “Not only do we know how to prevent overdoses and how to treat people who have an opioid use disorder, but we also have this life-saving, immediately-acting medication that will quickly reverse the effects of an opioid overdose.” 

The challenge for experts now is to make naloxone more accessible to those who need it. “There’s no moral or medical reason to keep this life-saving medication behind the counter,” Dr. Bobby Mikkamula, chair of the American Medicine Association’s Substance Use and Pain Care Task Force, told TODAY.

Earlier this year, AMA urged the Biden administration to remove naloxone’s prescription status, which would make it available over-the-counter. “It’s not the kind of thing that needs to be protected or that people need to be protected from,” Mikkamula said. “This saves their lives, and the fewer barriers we have to getting this into their hands and into their medicine cabinets, the better.”

For Jordan, the importance of naloxone comes down to one simple truth: “I can’t help people who are dead,” she said.

By

Source: What Is Naloxone? Where To Get Narcan And How To Reverse Overdoses

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For World Population Day, a Look at The Countries With The Biggest Projected Gains  and Losses By 2100

A United Nations projection estimates that 19 of the 20 countries estimated to faced the biggest population decline are in the Eastern hemisphere.

Key Takeaways

  • Cuba is the only country from the Western hemisphere in the top 20 countries expected to have a population decline over the next few decades. Indicators that support these claims include very low immigration rate (0.1 percent of total population) and fertility rate (1.7 children per woman), which is among the lowest in Latin America.
  • Three countries are expected to see their populations decline by more than 20 percent between 2020 and 2050: Bulgaria, Lithuania and Latvia.
  • Visual Capitalist also points out that Japan is an outlier from Asia. Japan’s birth rates have fallen since 1970 and its population began shrinking a decade ago. Last year there were 811,604 babies born in Japan and 1.44 million deaths.

Visualizing Population Decline by Country

Since the mid-1900s, the global population has followed a steep upwards trajectory.

While much of this growth has been concentrated in China and India, researchers expect the next wave of growth to occur in Africa. As of 2019, for example, the average woman in Niger is having over six children in her lifetime.

At the opposite end of this spectrum are a number of countries that appear to be shrinking from a population perspective. To shed some light on this somewhat surprising trend, we’ve visualized the top 20 countries by population decline.

The Top 20

The following table ranks countries by their rate of population decline, based on projected rate of change between 2020 and 2050 and using data from the United Nations.

Many of these countries are located in or near Eastern Europe, for reasons we’ll discuss below.

The first issue is birth rates, which according to the Peterson Institute for International Economics (PIIE), have fallen since the collapse of the Soviet Union. Across the region, the average number of children per woman fell from 2.1 in 1988 to 1.2 by 1998.

Birth rates have recovered slightly since then, but are not enough to offset deaths and emigration, which refers to citizens leaving their country to live elsewhere.

Eastern Europe saw several waves of emigration following the European Union’s (EU) border expansions in 2004 and 2007. The PIIE reports that by 2016, 6.3 million Eastern Europeans resided in other EU states.

The Outliers

There are two geographical outliers in this dataset which sit on either side of Europe.

Japan

The first is Japan, where birth rates have fallen continuously since 1970. It wasn’t until 2010, however, that the country’s overall population began to shrink.

By the numbers, the situation appears dire. In 2021, 811,604 babies were born in Japan, while 1.44 million people died. As a result of its low birth rates, the island nation also has the world’s highest average age at 49 years old.

The Japanese government has introduced various social programs to make having kids more appealing, but these don’t appear to be getting to the root of the problem. For deeper insight into Japan’s low birthrates, it’s worth reading this article by The Atlantic.

Cuba

The second country is Cuba, and it’s the only one not located within the Eastern Hemisphere. Cuba’s fertility rate of 1.7 children per woman is the lowest in the Latin American region. It can be compared to countries like Mexico (2.2), Paraguay (2.5), and Guatemala (3.0).

Cuba’s immigration is also incredibly low compared to its neighboring countries. According to the International Organization for Migration, immigrants account for just 0.1% of its total population.

Four of the 10 most populous countries in the world will no longer be among the top 10 in 2100 – and all four will be supplanted by rapidly growing nations in Africa, according to recently released population projections from the United Nations.

Brazil, Bangladesh, Russia and Mexico are among the world’s 10 most populous countries today. By 2100, they are projected to be overtaken by the Democratic Republic of the Congo, Ethiopia, Tanzania and Egypt – none of which are currently in the top 10.

This changing of the guard is expected to occur because of sluggish population growth over the next eight decades in Mexico (+10% by 2100) and population losses in Brazil (-15%), Bangladesh (-8%) and Russia (-14%). Each of the four African countries, by contrast, is expected to more than double in population, with increases of 304% in the Democratic Republic of the Congo, 156% in Ethiopia, 378% in Tanzania and 120% in Egypt.

Source: https://www.visualcapitalist.com

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Global Covid-19 Infections Surpass 40 Million, 1.1 Million Deaths

The number of new Covid-19 infections around the world continues to grow, passing the grim milestone of 40 million on Monday morning as much of Europe and the U.S. struggle to contain a new surge in infections, according to data from Johns Hopkins University.   

Key Facts

The U.S. leads the world with over 8 million confirmed cases, with nearly 220,000 deaths.

India and Brazil have also been hit hard by the novel coronavirus, with 7.6 million and 5.2 million cases and around 150,000 and 115,000 deaths respectively. 

It took just one month for cases around the world to swell from 30 million to 40 million. 

Key Facts: 

This number is likely to be a gross underestimation of Covid-19 cases around the world, relying on official data of confirmed cases. Not all those who have caught Covid-19 will be tested, especially if symptoms are mild. Test availability is inconsistent around the world, further hindering accurate reporting of cases. Some countries have been accused of deliberately lying and deceiving about the number of cases they’ve had. 

Further Reading

Global coronavirus cases hit 40 million as second wave gathers pace (CNBC)

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Nearly 30 Million People Have Contracted Covid-19 Around The World (Forbes)

Global coronavirus cases surpass the 40 million milestone (Reuters)

Russia’s covid-19 outbreak is far worse than the Kremlin admits (Economist)

Full coverage and live updates on the CoronavirusFollow me on Twitter. Send me a secure tip.

Robert Hart

 Robert Hart

I am a London-based reporter for Forbes covering breaking news. Previously, I have worked as a reporter for a specialist legal publication covering big data and as a freelance journalist and policy analyst covering science, tech and health. I have a master’s degree in Biological Natural Sciences and a master’s degree in the History and Philosophy of Science from the University of Cambridge. Follow me on Twitter @theroberthart or email me at rhart@forbes.com 

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Our top story this morning. Global COVID-19 infections have now surpassed 40 million,… after seeing an increase of one million over the last three days alone. Lee Seung-jae reports. COVID-19 has now infected over 40 million people worldwide,… since the first cases were identified in Wuhan, China last December. The death toll currently stands at over 1-point-1 million,… with a mortality rate of 2-point-8 percent. With an average of one million cases being reported every three days,…

The world is seeing some of the biggest single day jumps since the initial outbreak,… with numbers exceeding 400-thousand in a single day on Friday,… for the first time ever. Among the worst hit countries in the world,… the U.S. remains at the top with over 8-point-3 million cases and 224-thousand deaths. The worst may yet to come for the U.S.,… as the nation’s top infectious disease expert Dr. Anthony Fauci warned last week,… that the country is “facing a whole lot of trouble” heading into the winter months. According to data by Johns Hopkins University,…

Average daily cases were already up by more than 5-percent in 36 states and the District of Columbia. Europe continues to see its infections reach all-time highs,… including Italy,…which registered 10-thousand-925 cases on Saturday,… surpassing its previous record posted the day before. France and Germany also reported record daily cases on Saturday,… as new restrictions went into effect. France reported over 32-thousand cases in a 24 hour span,… as the country deployed 12-thousand extra police officers to enforce their latest quarantine measures. The continent is seeing the fastest increase in COVID-19 cases,… and has so far seen over 6-point-7 million cases and more than 237-thousand deaths. Lee Seung-jae, Arirang News. 2020-10-19, 07:00 (KST) #COVID19 #US #Europe 📣 Arirang News(Facebook) : https://www.facebook.com/arirangtvnews 📣 Arirang News(Twitter) : https://twitter.com/arirangtvnews 📣 News Center(YouTube) : https://www.youtube.com/c/NEWSCENTER_…

MORE: https://globalnews.ca/news/7303904/eu… For more info, please go to http://www.globalnews.ca Subscribe to Global News Channel HERE: http://bit.ly/20fcXDc Like Global News on Facebook HERE: http://bit.ly/255GMJQ Follow Global News on Twitter HERE: http://bit.ly/1Toz8mt Follow Global News on Instagram HERE: https://bit.ly/2QZaZIB#Coronavirus#GlobalNews#COVID-19

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Final Results In Remdesivir Trial Confirm It Shortens Length Of Covid-19 Cases, But Has Small Impact On Death

Topline

A long-awaited study of Gilead Sciences’ experimental antiviral remdesivir published Thursday in the New England Journal Of Medicine shows that patients with Covid-19 who took the drug recovered from the disease faster compared to patients who took a placebo.

Key Facts

The trial, which was led by the National Institute of Allergy and Infectious Diseases (NIAID), was double-blinded and involved more than 1,000 Covid-19 patients from around the world.

The trial  found that hospitalized patients who took remdesivir recovered from the disease in 10 days on average, five days faster than those taking a placebo.

The greatest benefit occurred when remdesivir was given to patients early in their illness who were hospitalized and receiving supplemental  oxygen but not yet on a ventilator.

The researchers also say that the data suggests that remdesivir may prevent patients from getting more severely ill and needing more oxygen or ventilation.

While the study itself didn’t find a statistically significant reduction in death for patients taking remdesivir, a later analysis suggested a small benefit, finding that 11.4% of patients who took remdesivir died by day 29, compared to 15.2% of patients that took the placebo.

Key Background

While there is no drug approved yet to treat Covid-19, remdesivir has been a frontrunner for months. In May, after preliminary study results showed that it helped patients recover from Covid-19 four days faster than a placebo, the FDA issued an Emergency Use Authorization for remdesivir (brand name Veklury) to be used in hospitalized patients with severe Covid-19. In August the agency expanded the recommendation and said that remdesivir could be used for any patients hospitalized with Covid-19, no matter the severity of their symptoms. Last week, President Trump’s doctors announced that the president received infusions of remdesivir after his diagnosis of Covid-19. There is currently a global shortage of the drug, and Gilead has announced plans to manufacture 2 million treatment courses of the drug by December. 

Quote

“For patients who are hospitalized with Covid-19, the importance of speeding up recovery by five to seven days cannot be underestimated,” wrote Gilead CEO Daniel O’Day in an open letter published Thursday. “This represents a significant benefit in a disease where every day counts.”

Chief Critic

Overall, the final report does not change the preliminary conclusions,” wrote Joshua Niforatos, an emergency room physician at Johns Hopkins Hospital. “Based on the research to-date, for critically ill covid-19 patients, remdesivir is unlikely to change survival or the need for mechanical ventilation. The only drug to-date that has shown to improve mortality remains dexamethasone, a generic and inexpensive drug.”

What’s Next

Gilead will likely use the results of this study to apply for official FDA approval of remdesivir, which has never been approved by the agency before. If the FDA accepts the company’s application, it would be the first approval of a drug specifically to treat Covid-19.

Full coverage and live updates on the Coronavirus / Follow me on Twitter. Send me a secure tip

Leah Rosenbaum

Leah Rosenbaum

I am the assistant editor of healthcare and science at Forbes. I graduated from UC Berkeley with a Master’s of Journalism and a Master’s of Public Health, with a specialty in infectious disease. Before that, I was at Johns Hopkins University where I double-majored in writing and public health. I’ve written articles for STAT, Vice, Science News, HealthNewsReview and other publications. At Forbes, I cover all aspects of health, from disease outbreaks to biotech startups.

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We regret that the WHO prematurely posted information regarding the study, which has since been removed. The investigators in this study did not provide permission for publication of results,” a Gilead spokesperson said in a statement to CNBC. “Furthermore, we believe the post included inappropriate characterizations of the study. Importantly, because this study was terminated early due to low enrollment, it was underpowered to enable statistically meaningful conclusions,” according to Gilead. “As such, the study results are inconclusive, though trends in the data suggest a potential benefit for remdesivir, particularly among patients treated early in disease.” For more coronavirus live updates: https://www.cnbc.com/2020/04/23/coron… For access to live and exclusive video from CNBC subscribe to CNBC PRO: https://cnb.cx/2JdMwO7 » Subscribe to CNBC TV: https://cnb.cx/SubscribeCNBCtelevision » Subscribe to CNBC: https://cnb.cx/SubscribeCNBC » Subscribe to CNBC Classic: https://cnb.cx/SubscribeCNBCclassic Turn to CNBC TV for the latest stock market news and analysis. From market futures to live price updates CNBC is the leader in business news worldwide. Connect with CNBC News Online Get the latest news: http://www.cnbc.com/ Follow CNBC on LinkedIn: https://cnb.cx/LinkedInCNBC Follow CNBC News on Facebook: https://cnb.cx/LikeCNBC Follow CNBC News on Twitter: https://cnb.cx/FollowCNBC Follow CNBC News on Instagram: https://cnb.cx/InstagramCNBC

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Advertisement

Hospital Beds Filling, Bars Closing With Nearly All Threshold

Countries across Europe are imposing new restrictions as the second wave of coronavirus infections that’s swept across the region since summer-time has recently taken a turn for the worse—seeping into older, more vulnerable populations and driving a surge in hospitalizations.

Key Facts

All but three European countries—Cyprus, Finland and Norway—have reached the European Centre for Disease Prevention and Control’s (ECDC) coronavirus alarm threshold, which designates countries reporting above 20 cases per 100,000 residents on a seven-day average at high risk.

The ECDC’s most recent report, published last Thursday, also noted the rising death rate in Europe and identified sustained case increases in 27 countries, many of which are reporting more new infections than in the spring (though better detection methods play a factor). 

Among the countries faring the worst, the Czech Republic, reporting 22,179 cases and 158 deaths in the past week, enacted a second state of emergency Monday, while Madrid has entered a partial lockdown, barring non-essential travel to and from the city, as Spain reports nearly 10,000 new cases per day. 

France’s capital, which moved into a state of “maximum alert” on Monday as 30% of emergency beds in hospitals filled, leading to the closure of Paris bars and cafés, may be on the verge of tougher restrictions as the number of Covid-19 patients in emergency beds jumped to 40% on Tuesday. 

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Brussels, which has overtaken Paris and trails only Madrid in terms of infections per capita among Europe’s major cities, also announced it is shutting down bars and cafés in the city for a month on Wednesday. 

Meanwhile, a slew of other countries, including Ireland and Scotland, are mulling tough new restrictions.

Key Background 

While France, Spain, the Czech Republic and the U.K. are reporting higher numbers of new cases on average than they were during the peak of their spring outbreaks, the crisis isn’t as severe as it was through March and April. However, European authorities are concerned that rising infections, which have begun to spill into older populations, could soon bring hospitals back to the brink.

Crucial Quote 

“The enemy hasn’t been defeated yet,” said Italian Prime Minister Giuseppe Conte last weekend, calling on Italians to be careful as to avoid a return to stricter pandemic measures. Italy, once the centre of the coronavirus pandemic, was the first country in the world to activate a nationwide lockdown in March.

Further Reading 

“British universities re-open with students locked-down and forced to care for infected classmates” (The New York Times) 

“As Second Covid-19 Wave Rolls Through Europe, Deaths and Hospitalizations Rise” (The Wall Street Journal)

Full coverage and live updates on the Coronavirus/Follow me on Twitter. Send me a secure tip.

Jemima McEvoy

I’m a British-born reporter covering breaking news for Forbes.

 Jemima McEvoy

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There are mounting concerns the pandemic will cause a global recession. It has been another torrid day on the markets. Stocks plunged around the world, despite a coordinated effort by central banks to protect growth and jobs. Al Jazeera’s Neave Barker begins our coverage with a look at the situation around Europe. –

Subscribe to our channel: http://aje.io/AJSubscribe – Follow us on Twitter: https://twitter.com/AJEnglish – Find us on Facebook: https://www.facebook.com/aljazeera – Check our website: https://www.aljazeera.com/ #AlJazeeraEnglish #Coronavirus #Europe

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