Narcan Can Save Your Character's Life in an Opioid Overdose : for Writers and Other Curious Folks

This information was gathered at a Narcan Training as a volunteer for the Medical Reserve Corps.



First one of the best descriptions of substance addiction I've ever seen:

This article addresses the basics you need to know when you've written a drug overdose into your plot line. 

*Note there are several helpful articles in my archives. Go to the search button on the top right of this blog to access them.

An opioid overdose emergency happens when an excessive amount of opioid is in the system by itself or is combined with other substances that overwhelms the character's body. 

Heroin and prescription pain medications can cause the breathing and heart rates to slow and eventually cease.

Here's a scene from my novella MINE where the characters died from the overdose:

“And two boys missing. You’re jumping to conclusions. That’s not what a scientist does, and it’s certainly not what a detective does. We collect evidence and then try to see the pattern, not create a pattern and try to fill it in with evidence.”

“I’m not officially a CSI until Monday. I’m telling you what my teacher’s gut is saying. I bet you anything that when we have access to those kids’ phones, we’ll find two things. One, that someone Googled how to get high on OxyContin. And two, that one of the dead kids either called or texted the two boys that are missing. Remember that Pemberly said she told Chad to send his friends home. Friends, plural. We only found one friend.”

Tim flipped his lights on to go around a tractor-trailer. “There’s more,” he said. “Stop drip feeding me.”

“OxyContin is the prescription name for Oxycodone. Do you know much about that drug?”

“They use it for long term pain management for cancer patients and the like. It’s from the opiate family. Abuse was a real problem for counties further west of us out toward Bristol, though, you hear about it less and less. We haven’t had trouble with it here.”

“Okay, well, Pemberly’s prescription threw up all kinds of flags you should consider.”

“Go on.”

“The strength stamped on the pills was 80mg. The usual dosage is 40mg or less. Anything over 40mg is for opioid-tolerant patients only. As a matter of fact, a dose of 80mg in a day can be lethal to someone who hasn’t built up resistance.”

“There’s an interesting piece of information. So Pemberly’s prescription was a potentially lethal dose?”

“Yes, unless she was used to using opioids. Maybe you should get a look at her medical records. Here’s another flag, the pills were stamped OC. They should have been stamped OP.”

He swung his head to look at Kate before focusing back down the road. “You think her meds got mixed up?”

“Something very bizarre is going on. You see, the formulation of the pills allows the ingredients to be time-released over twelve hours. The druggies couldn’t get a good high because of the time-release component. They found if they crushed the pills, they could snort them or shoot them and take the full hit of the narcotic all at once. That was with the first formulation, the OC pills.”

“But you said they’re supposed to be stamped OP.” The muscles in Tim’s face became taut with concentration.

“People OD’ed in large enough numbers that the FDA considered pulling Oxycodone. The pharmaceutical company reformulated it so when a druggy tried to powder the pill to get around the time-release component, all they got was goo. That goo can’t be snorted or shot-up. The new formulation is stamped OP. With the OC off the market, druggies turned to easier highs.”

“But these were OC pills. And because the pill was a potentially lethal quantity when time-released, we can assume a full dose, shot directly into a teenager’s system, would be sure death,” Tim said.

Kate rubbed the back of her hand. “That’s the conclusion I came to last night.”

“Could the pharmacy be dispensing the old pills until they’re gone, and then replace them with the new ones?”

“I sincerely doubt it. The formulation change took place a long time ago.”

“What’s a long time look like?” Tim asked.

“Eighteen months or so. The street price for an 80mg OC pill would be astronomical. You simply can’t find them anymore. I would assume the pharmaceutical reps came through, picked up the OC, and swapped them with OP. Even if that weren’t true, most meds have a shelf life of about a year. The pill’s sell-by date should have expired, and they’d be destroyed.”

“These pills should have lost their potency by now?”

“Some of their potency, but obviously not enough.”

“And you know this how?” Tim asked.

“I took my final exam in Narcotics and Substance Abuse in May. I checked my notes on my computer when I got home last night.”

Tim’s grip tightened on the steering wheel. “We need to find out if the pharmacy has distributed these pills to anyone else.”

These might include (among others):

• Hydrocodone
• Oxycodone
• Morphine
• Fentanyl
• Methadone
• Heroine

How does your heroine know if the character is really high or overdosed? 

• Really high
• Muscles are lax
• speech is slow and slurred
• sleepy-looking
• responds to shouting earlobe pinching or sternal rub
• normal heart rate/ pulse
• normal skin tone
• Overdosed
• pale clammy skin
• breathing is infrequent or has stopped
• deep snoring or gurgling (death rattle)
• unresponsive to any stimuli
• slow or no heart rate
• blue lips or fingertips

Some things you might have seen/read somewhere that you DO NOT put in your prose because they're wrong and could kill someone if they tried it in real life.

DO NOT

• Put them in a bath
• Induce vomiting 
• Give them something to eat or drink
• Put ice on them, in their clothes, in an ice bath (this depresses the heart rate)
• Shake, slap , kick, or take agressive actions to wake them
• Inject a substance into them like salt water or milk

WHAT SHOULD HAPPEN if you want to save them. (or not, I'm not judging your plot arc):

• Check for responsiveness
• Administer Narcan and apply first sticker or write in pen on their forehead. (watch video to see how easy) My kit came with stickers so if your character wanted to save a life and NOT get arrested for whatever they were doing that was illegal, they could do the dosage, slap the sticker on (or 2 stickers if they used 2 dosages) and walk away calling 9-1-1 from a payphone.

• Put individual in recovery position

• Call 9-1-1 (this is one of those rare times that you don't call 9-1-1 first)
• If the character is not breathing, depending on how you want this to turn out, you could have someone do rescue breathing if the overdosed character isn't breathing on his own.
• Assess. 
• If the person recovers, monitor while you wait for the ambulance. 
• If they don't recover within 3 minutes, administer a second dose.
• If person recovers but relapses into overdose after 30-45 minutes then repeat. But because Narcan works for a short period of time and then the opioids are functional in the system again, this is why your character needs to get to a hospital. They could still die.

Narcan is about 150$ a dose. Why do I have two doses? How would your character get the doses? 

• If they're part of the emergency teams they will have training and access to doses.
• In my county, if you train how to use it, they give you 2 doses. If it expires or you use it, you can go in to county medical and get another set of doses for free.

Things that you should know:

• Your character can't keep this in their car in most geographical locations because the substance in Narcan has a temperature range.
• Narcan has an expiration date.
• Other brands exist like EVZIO which works more like an EpiPen.

Good luck to your heroine! It's a wonderful thing to save a life.

Happy writing,

Fiona