May 8, 2020

Guidance for Law Enforcement and First Responders Administering Naloxone

SAMHSA recognizes the tremendous work of our courageous first responders and law enforcement

officers who also take action when they encounter individuals who have overdosed. Their efforts

have saved thousands of lives with their ability to assess and treat opioid overdose. Naloxone is a 

medication classified as an opioid overdose antidote which works by reversing the respiratory 

effects caused by opioids to revive the person who might be sedated or unresponsive due to taking

too much of an opioid.

As the COVID-19 pandemic has spread throughout our country, SAMHSA has received reports that 

some first responders and law enforcement officers have been more reluctant to administer 

naloxone due to fear of potentially contracting the coronavirus. Further, SAMHSA has received

reports that law enforcement and emergency services management has, in some cases,

discontinued the carrying of naloxone by responders. The decision to withhold this lifesaving drug is

equivalent to withholding cardiopulmonary resuscitation (CPR) to an unresponsive person who may 

have had a heart attack. It is essential that naloxone continue to be administered during this time

period. 

SAMHSA recognizes the concerns about COVID-19 exposure and recommends the following to

promote first responder safety:

Intranasal Naloxone: Most individuals are familiar with the intranasal form of naloxone which is

administered through the nose by someone trying to reverse an overdose in an unresponsive

individual. Personal Protective Equipment (PPE) should be used as most law enforcement and first

responders are doing for all emergency calls. For those first responders who have gloves and facial 

protection, intranasal naloxone should still be considered. 
Intramuscular Naloxone: If law enforcement or first responders feel the use of intranasal naloxone 

poses too great a risk, there is another lower risk option. Intramuscular naloxone can be injected 

into the thigh muscle - far away from the nose and mouth - thereby reducing the risk to the rescuer. 

It has an onset of action of 2-5 minutes. There are both branded and generic versions of autoinjector devices that deliver naloxone with the generic prices significantly reduced for first 

responders and government entities. This manner of administration can be rapidly and safely used 

by both professionals and the general public. The autoinjector will prompt the user with verbal 

instruction to safely administer naloxone into the muscle and to replace the device cap to assure 

safe use of the product.

SAMHSA recognizes that all naloxone products may not be available in some jurisdictions and 

encourages the use of PPE regardless of the form of naloxone used. The COVID-19 pandemic brings 

with it important physical health considerations; however, other health conditions, such as 

substance use disorder and drug overdose, can be deadly if unaddressed. We must not forget that 

those with substance use disorder still need our help. SAMHSA’s goal is to provide information that 

can help first responders to make decisions about how to safely intervene in the case of opioid 

overdose. Substance use disorder, and specifically, opioid use disorder, affects many Americans and 

we must assure that our first responders are able to safely intervene in the case of an opioid 

overdose. It is critical that naloxone continue to be administered during this time period as needed 

and that its administration be done in a manner that reduces risk of COVID-19 transmission. For 

more information about overdose prevention, please see SAMHSA’s Opioid Overdose Prevention 

Toolkit.