“Naloxone can't reverse fentanyl overdoses"
The Tired Narrative:
Powerful synthetic opioids, such as fentanyl and carfentanil, are so potent that they are resistant to the overdose antidote, naloxone. News articles suggest that overdoses involving these powerful synthetic compounds cannot be reversed with naloxone.
The Informed Narrative:
That naloxone is ineffective in reversing fentanyl-involved overdoses is a myth. Naloxone is an opioid antagonist that reverses the effects of opioid overdoses, including fentanyl analogues and other synthetic opioids. Since fentanyl is faster-acting than opioids like heroin and oxycodone, the window to reverse an overdose and save a life is shorter. Naloxone rescue must occur in a timely manner using appropriate doses of the antidote. An overdose involving fentanyl or other synthetic opioids may require a larger dose of naloxone to reverse.
The Canadian Centre on Substance Use and Addiction says that naloxone does indeed reverse overdoses caused by synthetic fentanyl analogues. A review of the science on naloxone in the New England Journal of Medicine recommends that if the initial .04mg dose of naloxone is administered to no response, that the dose should be increased every two minutes to a maximum of 15mg.
If first responders and overdose bystanders are under the impression that naloxone does not reverse overdoses caused by fentanyl and its analogues, they may not respond in an effective manner. During an opioid overdose, every second counts, and naloxone and rescue breathing must be given as soon as possible. Cases where an overdose is mistakenly deemed “naloxone-resistant” could have occurred where naloxone rescue came too late. This scenario is especially likely because synthetic analogues trigger more rapid onset of respiratory depression and death. Drug poisonings may also involve non-opioid substances like K2, which do not respond to naloxone reversal.