Naloxone & Overdose Reference

Opioid Overdose Recognition

👁️

Pinpoint pupils

Miosis — bilateral, non-reactive

😴

Unconsciousness

Unresponsive, cannot be aroused

🫁

Respiratory depression

RR <12, shallow, slow, or absent

Naloxone Dosing

Intranasal (IN)

Narcan® 4 mg/0.1 mL · Kloxxado® 8 mg/0.1 mL

4 mg per nostril (one spray)

Repeat every 2–3 min if no response · Alternate nostrils

First-line lay responder

Intramuscular (IM)

0.4 mg/mL vial or 2 mg/0.4 mL auto-injector (Evzio®)

0.4–2 mg IM (lateral thigh or deltoid)

Repeat every 2–3 min · Max 10 mg (if no response, reconsider diagnosis)

EMS / clinical

Intravenous (IV)

0.4 mg/mL diluted to 0.04 mg/mL

0.04–0.4 mg IV q2–3 min (titrate to respirations, not full reversal)

Infusion: 2/3 of effective bolus dose per hour if recurrence expected

Hospital setting

High-potency opioids

Fentanyl, carfentanil, nitazenes

Higher doses often needed — start with 4–8 mg IN or 2 mg IM

Multiple doses may be required. Duration of naloxone (30–90 min) shorter than most opioids — observe ≥4 hrs after last dose

Redosing critical

Renarcotization risk: Naloxone duration (30–90 min) is shorter than most opioids. Patient can re-sedate after initial response. Observe for at least 4 hours after the last effective dose. IV infusion may be needed for long-acting opioids (methadone, extended-release formulations).

North Dakota — Legal Framework

Good Samaritan Law

ND Century Code § 19-03.1-23.4. Bystanders who call 911 in good faith for an overdose are protected from prosecution for minor drug possession offenses. Protection extends to the person experiencing the overdose.

Standing Order / Pharmacy Access

ND allows pharmacists to dispense naloxone without a prescription under a statewide standing order. Any ND resident can obtain naloxone at a participating pharmacy without seeing a provider first.

Prescriber Authority

Any licensed prescriber in ND may prescribe naloxone to a patient, family member, or caregiver. Prescribers treating patients on chronic opioids or with SUD are encouraged to co-prescribe naloxone.

Report overdoses

Overdoses are a mandatory reportable condition in ND (within 7 days). Report to ND HHS: 701-328-2372 or secure fax 701-328-2785.

North Dakota Overdose — Key Facts

~100

ND opioid overdose deaths / year (2022–2023)

Fentanyl — leading cause of overdose death in ND

77%

Of ND overdose deaths involve illicitly manufactured fentanyl

3–4×

Higher naloxone doses often needed for fentanyl vs. heroin

Resources

ND HHS Opioid Resources SAMHSA Helpline — 1-800-662-4357 CDC Overdose Prevention