Does Naloxone Cause Addicts to Use More Heroin?

In a recent study published in the International Journal of Drug Policy, it was determined that opiate addicts had a high awareness of naloxone (Narcan). However, their attitudes and practices with naloxone were varied and not all addicts were inclined to carry naloxone to prevent overdoses. This study provides us with some insight into the world of the addict and what they are thinking. Here are some key takeaways from this study.

Naloxone (Narcan) Enables Addicts to Increase Opioid Doses

There it is. The ugly side affect of giving Naloxone to anyone and everyone has allowed users to increase their doses without fear of repercussions.

…some participants expressed strong statements that naloxone access changed their use behaviours in term of quantity and frequency. One participant stated that “you can do plenty more [heroin] if you have Narcan, because the chances of overdosing are much greater” (Participant 02, 26 year old female). Several participants described different ways naloxone access changed opioid use patterns. For example, one participant described how a user’s wife would remain sober while he used, “Yep, I have it [naloxone]. My wife has it, she stays right next to me, I get high. In case I die, then they give it to me” (Participant 08, 34 year old male).

Others talked about how naloxone diminished concerns about mortality associated with opioid overdose, such as, “I’ve seen people, instead of doing four bags they’ll do eight because they’ve got the Narcan laying around” (Participant 02, 26year old female). These users talked about how naloxone access allowed them to chase a bigger high,

I’ve seen a couple of my friends use it’s like a…[]… just a security. They would get high knowing they have it, knowing they can fall [out], trying to get to that place to be able to fall out [overdose] and then have someone bring them back. (Participant 17, 26 year old male).

Another participant talked about how naloxone was “an excuse just to be more dangerous, I guess, do a bigger shot” (Participant 02, 26 year old female).

The ‘safety net’ aspect of naloxone was particularly important for those who suspected heroin was cut with fentanyl. For example, one participant discussed asking a fellow user to get his naloxone kit ready because he knew the opioid he was about to use had fentanyl in it and was going to use anyway. Others discussed the idea of tolerance dictating if/when naloxone would be needed. One participant felt he did not need to have naloxone available because “when you’re consistently buying the same product, you know what you can handle and what you can’t” (Participant 13, 24 year old male). He continued, talking about the uncertainty with this approach, particularly for users with a lower tolerance.

“but there were certain people, say like me and another buddy, we’d go down with two other people, people who don’t have too much of a high tolerance, we go, ‘Okay, wait ‘til we try it first and let you know how it is, and we’re gonna let you know what you can handle.’ (Participant 13, 24 year old male).”


Learn everything you need to know about Fentanyl, including fentanyl investigations (from the street to the lab), decontamination and safety protocols.

drug free schoolsAddicts are Engaging in “Survival Selling”

It’s not surprise to street cops that heroin addicts will sell to support their habit. Now we have it in a study.

Participants talked about how they would engage in ‘survival selling,’ or selling drugs in order to fund their own opioid use, and how they would want to have naloxone while doing so (participants, not researchers, developed and used this term). Selling was fairly common, with five participants (25%) indicating they had sold drugs or participated in ‘survival selling.’ Several participants talked about this, particularly those with a longer history of opioid use.

This same person also talked about how she would supply her clients with nalxone and that she had used it multiple times on others in the past year.

I’ve been the one to supply them [naloxone kits], because my fellow users they’ve never tried to reach out and get help, but they have asked me for the kits.” This participant talked about how she had 10 or 11 kits in the past year alone and used seven of them on fellow users.

Addicts are Using While Driving Their Cars

As a Drug Recognition Expert, I’ve made over 1,000 arrests for drugged driving. I’ve learned that addicts are often driving under the influence and are using while driving. This puts all of us at risk. This excerpt from the study shows the depth of the problem.

…participants talked about how they would keep naloxone kits in their cars, “throw it in their glove box, or in their centre console” (Participant 09, 27 year old male). This is particularly important as participants described an urgency to use opioids, and preferred to use in locations that were quickly available. For some participants this meant they would use in the car. While some would use when the car was stationary, others talked about using opioids while driving, including one participant who talked about how “people that sniff it, you can just drive down the road, have someone hold the wheel, hurry up, snort it, and you’re done. It’s not the smartest thing to do, but a lot of people do it” (Participant 08, 34 year old male). Therefore, keeping naloxone in the car may provide a quick access point for such individuals, despite potentially risky driving behaviours (such as using opioids while operating a vehicle) that may result.

Author: Keith Graves
Keith is a retired Police Sergeant and worked in the San Francisco Bay Area for 29 years. Keith was named as California’s Narcotics Officer of the Year and is a prior winner of MADD’s California Hero Award. He has years of experience as a Narcotics Detective and a Narcotics Unit Supervisor and is a Drug Recognition Expert Instructor (IACP #3292). Keith teaches both the DRE course and the Drug Abuse Recognition Course and has taught at the Police Academy. He has developed several drug courses for the California Narcotics Officers Association, California POST and California Colleges and currently consults POST on drug investigation procedures. Keith has held other assignments besides narcotics including Training Sergeant, Patrol Sergeant, COPPS Officer, Traffic Officer, and 20 years as a SWAT Team member and Sniper Team Leader. Keith has taught thousands of officers and businesses around the world about drug use, drug trends, compliance training and drug investigations. He is recognized as an international drug expert and has testified as an expert in court proceedings on drug cases, homicide cases and rape prosecutions. Keith earned a BA in Business Management from Saint Mary's College of California and a MA in Criminal Justice. Keith is the Founder and President of Graves & Associates, a company dedicated to providing drug training to law enforcement and private industry.