Using Naloxone in the Moment

NOTE: Quotes are presented word for word apart from minor editing for readability and clarity. Identifying details have been removed. Square brackets show text that has been added or, where ellipses (three dots) appear, removed. For example, ‘Since I actually participated in this Narcan [training], I’ve administered it to two people and it’s brought them around […] I wouldn’t think twice about [doing] it. Saving someone’s life is the main thing.’

Opioid overdoses can be highly stressful events. Throughout our interviews, participants describe negotiating overdoses and giving naloxone in different ways. Some recount feelings of panic and anxiety, others recount a sense of calm, and others recount simply going through the motions.

Relationships can affect the ways people administer take-home naloxone and shape many of the experiences. For example, some people recall experiences of reviving friends, partners and family members and then telling the recipient what happened afterwards. Others describe administering naloxone to people they had never met before and may never meet again.

Many participants speak about worries and concerns when using take-home naloxone. For example, they discuss the role of emergency services such as paramedics, and the potential involvement of police.

The experiences they recount here indicate the range of different thoughts and feelings that can emerge during overdoses and take-home naloxone use.

As reported by many of our participants, the people present at an overdose often work together. For example, Tony (M, mid 40s, NSW, non-prescribed opioids) recounts giving naloxone with the help of another man who was also present. The man who helped Tony administer the naloxone hadn’t had overdose response training, but Tony was able to explain enough to allow a successful revival. (Read his personal story here)

[I] just got it ready with the other dealer that I was with in the house, and we both sort of done it, you know. Like, I filled it up […] He hadn’t done the course, but I’d done it. It’s not a course, it’s five minutes, you know. But I think the main thing that they tell you is you can give the injection anywhere, so I injected him in the leg, you know, not through clothing, just straight into the leg, you know. I’m trying not to drag any dirt into him […]

I think the main thing, too, is because the guy was dealing out of his house, we can bring the bloke back quicker rather than have to call the police. If he keeps having overdoses in the house, the police are going to, just after a while, think, ‘Well, there’s a lot of activity going on in the house,’ you know.

Lance (M, late 40s, NSW, non-prescribed opioids) describes a situation in which he and two other people worked together to look after a person who had overdosed. (Read his personal story here)

We had a young fellow who was a regular overdoser, and he overdosed immediately. And we had him on the bed, and we had someone taking his heart, someone was breathing for him, and someone was taking his pulse. His pulse was going right down and I’m pretty sure this is when the Narcan was administered […] and he came good.

Gabrielle (F, late 40s, Vic, non-prescribed opioids) describes administering naloxone during an overdose in her apartment building. She also describes instructing people to help by doing other things such as CPR. (Read her personal story here)

When I’m attending to someone overdosing, unless it’s my partner, my emotions aren’t there. I’m just running on automatic, like [I] become robotic […] A lot of the time, I’m the one administering the CPR while somebody else gives the Narcan. People are scared about doing heart compression, that sort of thing, so I can talk somebody through giving an injection while I’m doing heart compressions. Sometimes it’s a matter of needing both, and Narcan will bring somebody around, but if they haven’t had blood circulating and oxygen, [they may not be that great when they come around].

While groups of people can offer lots of help during an overdose, sometimes the group can be distracting.

Lenny (M, early 40s, Vic, non-prescribed opioids) describes trying to focus on administering naloxone at the right intervals while avoiding becoming side-tracked by other people and their concerns. (Read his personal story here)

Like, I’m focused on one thing going straight forward, and trying not to go [on a] sidetrack, which is easily done, and just trying to juggle people throwing questions, doing this, doing that, at you. And at the same time trying to respond to the person that’s down laying there […] trying to get the syringe ready, at the same time trying to make sure the timing’s right and everything: by the time you give the first one, or if you do give a second one or a third, like the timing for it […] Under the pressure, like, you want to do the right thing, but [it’s hard with] the pressure of it, or the surrounding, and it doesn’t help when you got people talking to you and yelling at you at the same time and the person’s just lying there, and no one’s doing anything. It’s more frustrating watching people just standing there and just [making demands] but not doing anything.

Alongside these quite dramatic accounts of responding to overdose, some of our participants also recount take-home naloxone revival in very matter-of-fact terms.

Andrew (M, early 40s, Vic, non-prescribed opioids) tells the story of reviving a young woman who had overdosed in a public toilet. (Read his personal story here)

Yeah, a girl I knew, one of the girls in our group, and a couple of other girls, turned up and they went off into the dunny, and one of my friends came running out the dunny screaming at me. She knew I had the Narcan there. Her friend had dropped in the dunny. We pulled her out and put her on the grass in the recovery position and gave her one Minijet at the time. It wasn’t the vials. [We] put a tip on it and put it into the top of her bum muscle, and she came to […] The ambulance was rung as well. One of the girls was on the phone to them, and told them what I’d done and everything, and the ambos turned up and checked her out and made sure her heart was all right and everything [and…] yeah, she didn’t go to the hospital.

While most of the participants who report reviving someone had enough naloxone on hand to do so, some describe situations when they did not.

Describing an event that occurred at a private residence, Simone (F, late 40s, Vic, non-prescribed opioids) recounts trying to revive a friend who overdosed at her home. She gave her friend a dose of naloxone and remembers quickly realising she would need more but had run out. In her interview she describes ringing an ambulance and then taking a range of steps to keep her friend alive while waiting for the ambulance to arrive. (Read her personal story here)

Yeah, the first time I used naloxone was on one of my best friends. She hadn’t used heroin for a while and I tried to tell her to only use half a dose of what she had, but she wouldn’t listen to me and she used the whole of what she had, and she overdosed. So I gave her a shot of naloxone and she wouldn’t come back, so I had to ring the ambulance. And then I had to give her mouth-to-mouth, and then I couldn’t hear her heartbeat, so then I had to give her CPR. By then the ambulance had come and they had given her three more shots of naloxone and she come to. But she didn’t want to go in the ambulance, and she didn’t want people to know that she was a drug user. It was really taboo for her. Yeah, that’s the most serious time.

For many participants, the negative effects of naloxone are also important, and some describe trying to revive people without causing undue discomfort. For example, Dylan (M, early 30s, Vic, non-prescribed opioids) describes how he always uses a gentle approach to administration in order to reduce discomfort or illness afterwards. (Read his personal story here)

So, […] I was walking around [name of an inner Melbourne suburb] doing a general check on people, asking people if they need any equipment while I’m around. It was a Thursday morning and [name of a primary health service] doesn’t open until 1pm. It was about 11:30am [when I] came across a friend of mine who was lying down in the middle of the mall. Normally she doesn’t lie down in the middle of the mall. [I] started to approach her and people are going, ‘She’s just dropped, she’s just dropped, we don’t know what to do.’ And I’m like, ‘Okay, she’s just dropped. Do you know what she’s had?’

‘Yeah, she’s had alcohol, she’s had pills, we don’t know what pills.’

‘Has she had any heroin?’

‘Yeah, she’s had about a gram in the last 24 hours.’

‘Okay, she’s potentially overdosing. I need you to call an ambulance. I’m going to start preparing naloxone to give it.’

‘Don’t give her naloxone – she won’t like it.’

‘No, I promise I’m going to be better than the ambulance at this. I know what I’m doing. Just trust me, have faith in me.’

‘All right, but if she comes around and she clocks you one, don’t say we didn’t tell you so.’

So, [using] the gently-gently approach, [I] gave the first shot, and while I was giving the shot, I noticed that her lips are starting to turn blue. So [I] gave the first shot, put her in the recovery position, checked her airways were clear, turned her back on her back and started breathing for her. Two minutes later, [I] still had no response, [so I] gave her a second naloxone shot. Her lips were no longer blue. It looked like she was starting to breathe on her own, so I just observed the situation. She still wasn’t awake after four minutes, so I gave a third naloxone shot [and] by that time the ambulance had arrived.

As Dylan recounts, the paramedics then took the woman to hospital for further care.

Opioid overdoses and revival can produce many different feelings for people. Some of our participants describe a range of challenging feelings such as anxiety, while others describe smooth or calm revivals and a positive sense of achievement. Some discuss hesitations or concerns while others describe almost running on ‘automatic’.

Also describing a group situation, Gabrielle (F, late 40s, Vic, non-prescribed opioids) tells the story of responding to an overdose in her apartment block, saying she needed to administer several doses before the person was revived. She and the other people present also responded to the overdose in other ways, for example, by performing mouth-to-mouth resuscitation and heart compressions. (Read her personal story here)

When I was called [to an overdose] the other day, it was like, grab the kit and run down a couple of flights of stairs, and when I got there a girlfriend of mine was administering CPR on a guy that I’d never met. They had called triple zero and he was non-responsive. Just non-responsive, and wouldn’t respond to any sort of pain or anything, so I administered the Narcan, a full ampoule of Narcan into the top of his leg […] and after 90 seconds, a second one, and could see that nothing was changing. [But…] within like 30 seconds of the second one, he gave a cough and a bit of spluttering and things were good.

While for Zippy (M, late 50s, Vic, non-prescribed opioids), ‘saving someone’s life is the main thing’, reviving people from overdose can also cause him a lot of stress. He describes having to use his nebuliser to help calm his breathing before being able to administer the naloxone. (Read his personal story here)

The anxiety … oh mate, I had to get my [asthma] nebuliser out. I’ve got this little … it’s like a bong, but it’s battery operated and it’s like your puffer […] I had to get that out, because of the anxiety. […] You know, I was on my own and, you know, I didn’t have anyone to help me. And I [knew that I] probably would have [to] give him one injection and if that didn’t do anything, I would have had to get another one together as quick as possible, and I was having trouble breathing, so that added to the anxiety too.

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Using Naloxone in the Moment

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