Naloxone: Understanding Its Role In Overdose Intervention

Naloxone: Understanding Its Role In Overdose Intervention

by | Jun 26, 2023 | Blog Post

 

Naloxone, probably most-commonly referred to by the popular brand name NARCAN®, is a medication used to reverse the effects of opioids. It is most often administered to someone experiencing overdose, or other severe side-effects of opioid use, such as respiratory depression.

 

Although we hear a lot on the news these days about naloxone, it is certainly not new. It was patented in 1961 and approved for opioid use disorder in 1971. Of course, as the Fentanyl epidemic causes huge increases in opioid overdoses, naloxone has become a more-commonly discussed and reported-on medication.

 

In the simplest terms, opioids work by interacting with the opioid receptors in the human body and brain; they essentially attach to these receptors, and most opioids are considered agonists of these receptors. Conversely, naloxone is an opioid receptor antagonist, basically blocking the opioids from interacting with these receptors. Taking it a step further, naloxone is a competitive antagonist in that in addition to blocking the opioid receptors, it will take over the binding sites from the opioids that are already bound there. Of course, this is an oversimplification of the process, but it gives you an idea of the basic premise of naloxone’s functionality.

 

While there is some early indication that naloxone may also reverse a clonidine overdose, it is still being investigated. This is counter-intuitive, as clonidine is not an opioid, but we’ll know more as the research is developed. If this turns out to not be the case, then it would solidify the fact that naloxone can only reverse opioid overdoses. This is important to note as we see so many non-opioid adulterants and impurities in the illicit opioid supply; Xylazine is an excellent example of this. Since some 30% of Fentanyl overdoses are found to also include Xylazine, it is important to note that the NARCAN alone might not be enough to bring someone around if they are overdosing. Also, naloxone will last 30-90 minutes, while some opioids last longer; this means it is possible for the individual to experience additional overdose symptoms after the naloxone has worn off. So, while it is important to keep naloxone readily available, especially if you have an opioid user in your life, it should not be considered a 100% replacement for immediate medical attention.

 

Naloxone can be administered via injection; either IM (intramuscular), subcutaneous (below the skin), or IV (intravenous), but the more popular format currently is intranasal – basically as simple to use as regular nasal spray.

 

Most states allow pharmacists to offer Naloxone over the counter, some states require a physician’s prescription: unfortunately, there is no Federal Standing Order on naloxone, so it is left up to states how they want to address availability. And excellent resource of information regarding each state’s rules and availability can be found via this link: https://www.safeproject.us/naloxone/awareness-project/state-rules/

Xylazine: An Emerging Threat and What You Need to Know

by | May 23, 2023 | Media, NTS-U

Most of us have probably heard something in the news about Xylazine. The powerful veterinary sedative and anesthetic, often referred to as “Tranq” on the street, is becoming more commonly abused across the US. In this recorded live session, Chief Product Officer, Eric Malis, will talk about why this is important, things you should know, and what you can do to detect use and help fight this new emerging threat. 

Fine Print to Clarity: Critical Information You Need to Know from Product Inserts

by | Feb 28, 2023 | Media, NTS-U, Training Videos

Often thrown away or forgotten, the Product Insert holds key information to understanding how to properly use an instant diagnostic test and so much more. Join Chief Product Officer, Eric Malis, in another live webinar as he unlocks the power of the product insert and guides you through the important information it has to offer. Make sure you don’t throw this one away.

New Test Option on the Horizon

New Test Option on the Horizon

by | Feb 1, 2023 | Blog Post, News

If you read this blog with any regularity, you know I try to keep my topics educational. However, sometimes something new and interesting on the horizon is worthy of its own announcement, if only to determine if anyone else is excited about the potential as we are. In fact, more than ever, we would love to have feedback from you on the potential usefulness of this new test.

Just landed on my desk is an early version of an instant test that uses hair follicle as the specimen!

In the past, hair testing was only available via laboratory testing. The lab testing for hair is generally expensive and limited in which substances it can detect. The potential to have an instant POC (point of care) hair test will counter both of these shortcomings. While we do not have a price-point for these yet, we anticipate a cost not much higher than oral fluids tests, far from the cost of the laboratory version. Also, while most laboratories who even offer hair testing are only testing for five basic drug classes or so; no Fentanyl, no Alcohol, not even Benzodiazepines are being offered for screening by most laboratories performing hair testing. Early information indicates that the instant version would have the potential to detect any substance where there is already a urine test version available.

There is one other reason hair follicle testing remains less-popular than urine testing, and that is the window of detection. To learn more about the different specimen types, please read my previous blog post on the topic here. I will summarize here: while in urine we detect substances used within the past few days or weeks, depending on the substance, substances in hair follicle specimens are detected for 10-90 days. In other words, it will take about 10 days for a substance to begin to be detected (onset) and will be detectable for about 90 days after (outset). This window of detection does not work well for every setting.

There are a few other benefits of hair testing. One being that there is no need for same-sex collectors or even a bathroom. Another would be that it is almost impossible to adulterate a hair specimen. No more “shy bladder” excuses for producing a specimen is also a bonus of hair testing.

In the coming weeks I will be testing the early version that I have here and will be documenting my process and my results, and will post a full report of the testing process from start to finish.

In the meantime, as I mentioned, we would love to hear from you: Is this something that would be useful or not? Please reach out to me or your consultant and share your thoughts.

 

The Importance of Hydrocodone and Clonazepam Specific Panels

The Importance of Hydrocodone and Clonazepam Specific Panels

by | Dec 7, 2022 | Blog Post

If you’ve watched our “Understanding the Limitations of Drug Testing” webinar or have had conversations with me about that subject, you’ve heard me talk about substances that many people expect to be detected on the tests that they are using, but actually are not.  An excellent example of this that we are all hopefully familiar with is Fentanyl. This synthetic opioid, for a long time, was expected to be detected on an Opiate panel but in fact it is not. As Fentanyl became more problematic, we increased our efforts to ensure that we were giving our customers the knowledge and the tools needed to test for this dangerous substance. Today we will discuss Hydrocodone and Clonazepam. While not nearly as prevalent as Fentanyl, these are two commonly prescribed drugs that do have the potential for abuse and are worth knowing about.

Hydrocodone is an Opioid pain medication, with Vicodin being the most prominent brand name. If you’ve ever had any serious dental work, you have probably heard of this one. Since it is an Opioid, it has a high potential for misuse and addiction, so it is a substance that is important to test for. However, the misconception is that this substance would be detected on the standard Opiate panel, or at least the Oxycodone panel.  Because these substances share a similar molecular structure, there is a possibility that Hydrocodone could be detected on either of those panels. However, the concentration of Hydrocodone in the specimen would have to be much higher than the other substances being detected, and therefore neither of those panels will ever be reliable tools for detecting Hydrocodone. Fortunately, we do have a Hydrocodone specific test, both as separate single-panel dip tests, and also included in select multi-panel cup configurations.

Clonazepam is a Benzodiazepine commonly known by the brand name Klonopin. Benzodiazepines, or Benzos, also have a high potential for misuse and addiction and is also an important substance to test for. Also, like Hydrocodone, it is possible that Clonazepam will trigger a positive on the standard Benzodiazepine panel, but it will not be at all reliable. The Benzodiazepine panel was designed to detect the most common Benzodiazepines. So, a standard test will detect about 20 of the 50+ Benzodiazepines that exist in the world, but Clonazepam is different enough in both molecular structure, and in the way the human body metabolizes it, that it will not be reliably detected. For this reason, such as with Hydrocodone, we do offer a Clonazepam specific test in both a single-panel dip test, and as part of select multi-panel cup configurations.

The big takeaway here is that it is important to know what substances will be detected on the panels you are testing with. While the tests are engineered to detect as many drugs in a specific class as possible, sometimes differences in chemistry and biology make this impossible. Fortunately, in almost all cases, we have the tool available that will fill these “blind spots”.

As always, for additional information or discussion on this topic, please reach out to me or your consultant.