Have This Naloxone Conversation With Your Patients

September is National Recovery Month, which makes it a natural time to have a conversation that belongs in every visit anyway: have you recommended naloxone training to your patients? Not just the ones in active recovery or on opioid prescriptions, but anyone who might one day find themselves first on the scene. The training is free, takes two hours, and most Montgomery County residents still haven't done it.

The CPR comparison is worth making directly with patients. We don't save CPR training for people with heart conditions. We treat it as something every person should know because cardiac emergencies happen fast and in any room. An opioid overdose works the same way, and the intervention is just as simple to learn.

Recognizing an overdose

Reviewing the signs with patients is part of the training, but worth covering in the visit as well:

• Unresponsive or unconscious and can't be woken up
• Slow, shallow, or stopped breathing (fewer than one breath every five seconds)
• Choking, gurgling, or snoring sounds
• Blue or grayish lips or fingertips
• Pinpoint pupils
• Limp body, pale or clammy skin

Breathing, or the absence of it, is the key indicator. Someone in opioid overdose will often be breathing very slowly or not at all, which is what separates it from being deeply asleep.

What naloxone does and how to use it

Naloxone temporarily blocks opioid receptors and can reverse an overdose within minutes. The nasal spray version requires no medical training: one spray into one nostril, then call 911 if not already done. If there's no response within two to three minutes, a second dose in the other nostril is appropriate. Naloxone wears off within 30 to 90 minutes, which is why staying on scene until EMS arrives matters.

Where patients can get trained

NARCAN nasal spray and its generics are over the counter at most Maryland pharmacies without a prescription, and Maryland Medicaid covers it. For hands-on training, Montgomery County's Overdose Response Program runs free two-hour sessions and gives a kit to everyone who completes one. Registration is by email at OverdoseResponseProgram@montgomerycountymd.gov or by phone at 240-777-1836.

Patients who prefer to start at home can request a free kit and instructions by mail through NEXT Distro. Maryland's opioid helpline at 1-800-422-0009 can connect anyone with the closest local option. A full list of county resources is at montgomerycountymd.gov/opioids.