Centers for Disease Control

and Prevention

National Institute for Occupational 

Safety and Health Page 1 of 6

Using Naloxone to Reverse Opioid Overdose in the 

Workplace: Information for Employers and Workers

Introduction

Opioid misuse and overdose deaths from opioids are 

serious health issues in the United States. Overdose 

deaths involving prescription and illicit opioids doubled 

from 2010 to 2016, with more than 42,000 deaths in 2016 

[CDC 2016a]. Provisional data show that there were more 

than 49,000 opioid overdose deaths in 2017 [CDC 2018a]. 

In October 2017, the President declared the opioid 

overdose epidemic to be a public health emergency. 

Naloxone is a very effective drug for reversing opioid 

overdoses. Police officers, emergency medical services 

providers, and non-emergency professional responders 

carry the drug for that purpose. The Surgeon General 

of the United States is also urging others who may 

encounter people at risk for opioid overdose to have 

naloxone available and to learn how to use it to save lives 

[USSG 2018].

The National Institute for Occupational Safety and Health 

(NIOSH), part of the Centers for Disease Control and 

Prevention (CDC), developed this information to help 

employers and workers understand the risk of opioid 

overdose and help them decide if they should establish a 

workplace naloxone availability and use program.

Background

What are opioids? 

Opioids include three categories of pain-relieving drugs: 

(1) natural opioids (also called opiates) which are derived 

from the opium poppy, such as morphine and codeine; 

(2) semi-synthetic opioids, such as the prescription drugs 

hydrocodone and oxycodone and the illicit drug heroin; 

(3) synthetic opioids, such as methadone, tramadol, and 

fentanyl. Fentanyl is 50 to 100 times more potent than 

morphine. Fentanyl analogues, such as carfentanil, can 

be 10,000 times more potent than morphine. Overdose 

deaths from fentanyl have greatly increased since 2013 

with the introduction of illicitly-manufactured fentanyl 

entering the drug supply [CDC 2016b; CDC 2018b]. The 

National Institute on Drug Abuse [NIDA 2018] has more 

information about types of opioids. 

What is naloxone? 

Naloxone hydrochloride (also known as naloxone, 

NARCAN® or EVZIO®) is a drug that can temporarily stop 

many of the life-threatening effects of overdoses from 

opioids. Naloxone can help restore breathing and reverse 

the sedation and unconsciousness that are common 

during an opioid overdose. 

Side effects 

Serious side effects from naloxone use are very rare. 

Using naloxone during an overdose far outweighs any 

risk of side effects. If the cause of the unconsciousness is 

uncertain, giving naloxone is not likely to cause further 

harm to the person. Only in rare cases would naloxone 

cause acute opioid withdrawal symptoms such as body 

aches, increased heart rate, irritability, agitation, vomiting, 

diarrhea, or convulsions. Allergic reaction to naloxone is 

very uncommon.

Limitations

Naloxone will not reverse overdoses from other 

drugs, such as alcohol, benzodiazepines, cocaine, or 

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amphetamines. More than one dose of naloxone may 

be needed to reverse some overdoses. Naloxone alone 

may be inadequate if someone has taken large quantities 

of opioids, very potent opioids, or long acting opioids. 

For this reason, call 911 immediately for every overdose 

situation. 

Opioids and Work

Opioid overdoses are occurring in workplaces. The Bureau 

of Labor Statistics (BLS) reported that overdose deaths at 

work from non-medical use of drugs or alcohol increased 

by at least 38% annually between 2013 and 2016. 

The 217 workplace overdose deaths reported in 2016 

accounted for 4.2% of occupational injury deaths that 

year, compared with 1.8% in 2013 [BLS 2017]. This large 

increase in overdose deaths in the workplace (from all 

drugs) parallels a surge in overall overdose deaths from 

opioids reported by CDC [2017]. Workplaces that serve 

the public (i.e. libraries, restaurants, parks) may also have 

visitors who overdose while onsite. 

Workplace risk factors for opioid use

Opioids are often initially prescribed to manage pain 

arising from a work injury. Risky workplace conditions 

that lead to injury, such as slip, trip, and fall hazards or 

heavy workloads, can be associated with prescription 

opioid use [Kowalski-McGraw et al. 2017]. Other factors, 

such as job insecurity, job loss, and high-demand/lowcontrol jobs may also be associated with prescription 

opioid use [Kowalski-McGraw et al. 2017]. Some people 

who use prescription opioids may misuse them and/

or develop dependence. Prescription opioid misuse 

may also lead to heroin use (Cicero et al. 2017]. Recent 

studies show higher opioid overdose death rates among 

workers in industries and occupations with high rates 

of work-related injuries and illnesses. Rates also were 

higher in occupations with lower availability of paid sick 

leave and lower job security, suggesting that the need 

to return to work soon after an injury may contribute to 

high rates of opioid-related overdose death [MDPH 2018, 

CDC 2018c]. Lack of paid sick leave and lower job security 

may also make workers reluctant to take time off to seek 

treatment.

Considering a Workplace Naloxone Use Program 

Anyone at a workplace, including workers, clients, 

customers, and visitors, is at risk of overdose if they use 

opioids. Call 911 immediately for any suspected overdose. 

Overdose without immediate intervention can quickly 

lead to death. Consider implementing a program to make 

naloxone available in the workplace in the event of an 

overdose. The following considerations can help you 

decide whether such a program is needed or feasible:

•	 Does the state where your workplace is located 

allow the administration of naloxone by nonlicensed providers in the event of an overdose 

emergency? 

•	 What liability and legal considerations should be 

addressed? Does your state’s Good Samaritan law 

cover emergency naloxone administration? 

•	 Do you have staff willing to be trained and willing 

to provide naloxone?

•	 Has your workplace experienced an opioid 

overdose or has there been evidence of opioid 

drug use onsite (such as finding drugs, needles or 

other paraphernalia)? 

•	 How quickly can professional emergency 

response personnel access your workplace to 

provide assistance?

•	 Does your workplace offer other first aid or 

emergency response interventions (first aid kits, 

AEDs, trained first aid providers)? Can naloxone 

be added? 

•	 Are the risks for opioid overdose greater in your 

geographic location? The National Center for 

Health Statistics provides data on drug overdose 

deaths in an online state dashboard. [CDC 2018a.] 

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•	 Are the risks for opioid overdose greater in 

your industry or among occupations at your 

workplace? [See MDPH 2018 and CDC 2018c.]

•	 Does your workplace have frequent visitors, 

clients, patients, or other members of the public 

that may be at increased risk of opioid overdose? 

Review the above questions periodically even if 

a program is not established right away. Ideally, a 

naloxone program is but a part of a more comprehensive 

workplace program on opioid awareness and misuse 

prevention. 

Establishing a Program

You will need policies and procedures for the program. 

These should be developed in consultation with 

safety and health professionals. Involve the workplace 

safety committee (if present) and include worker 

representatives. You also will need a plan to purchase, 

store, and administer naloxone in case of overdose. 

Additional considerations for establishing a program are 

described below.

Risk assessment

Conduct a risk assessment before implementing the 

naloxone program. 

•	 Decide whether workers, visiting clients, 

customers, or patients are at risk of overdose.

•	 Assess availability of staff willing to take training 

and provide naloxone. 

•	 Consult with professional emergency responders 

and professionals who treat opioid use disorders 

in your area. 

Liability 

Consider liability and other legal issues related to such a 

program. 

Records management

Include formal procedures for documenting incidents 

and managing those records, to include safeguarding the 

privacy of affected individuals. Maintain records related 

to staff roles and training. 

Staff roles 

Define clear roles and responsibilities for all persons 

designated to respond to a suspected overdose. Include 

these roles and responsibilities in existing first aid or 

emergency response policies and procedures (first aid 

kits, AEDs, training for lay first-aid providers, and/or onsite 

health professionals). 

Training 

Train staff to lower their risks when providing naloxone. 

Staff must be able to: 

•	 Recognize the symptoms of possible opioid 

overdose.

•	 Call 911 to seek immediate professional 

emergency medical assistance.

•	 Know the dangers of exposure to drug powders 

or residue.

•	 Assess the incident scene for safety concerns 

before entering.

•	 Know when NOT to enter a scene where drug 

powders or residues are visible and exposure to 

staff could occur. 

•	 Know to wait for professional emergency 

responders when drug powders, residues, or 

other unsafe conditions are seen.

•	 Use personal protective equipment (PPE; nitrile 

gloves) during all responses to protect against 

chemical or biological exposures including opioid 

residues, blood, or other body fluids.

•	 Administer naloxone and recognize when 

additional doses are needed.

•	 Address any symptoms that may arise during the 

response, including agitation or combativeness 

from the person recovering from an overdose.

•	 Use additional first aid, CPR/basic life support 

measures. Opioid overdose can cause respiratory 

and cardiac arrest. 

Prepare for possible exposure to blood. Needles or other 

sharps are often present at the scene of an overdose. 

Provide bloodborne pathogen training to responding 

staff members and consider additional protection, such 

as hepatitis B vaccination. 
Page 4 of 6

Purchasing naloxone 

Naloxone is widely available in pharmacies. Most states 

allow purchase without a prescription. Choose nasal 

sprays or injectable forms that can be delivered with an 

auto-injector, a pre-filled syringe, or a standard syringe/

needle. Customize training to fit the formulation stocked 

at your workplace. 

Consider the nasal spray formulation for its safety to lay 

providers and its ease of administration. Research shows 

that people trained on intranasal spray reported higher 

confidence both before and after training compared 

with people trained on injectable forms [Ashrafioun et al. 

2016]. 

Stock a minimum of two doses of naloxone. Some 

workplaces may choose to stock more. In some cases, one 

dose of naloxone is inadequate to reverse an overdose. 

The size, layout, and accessibility of the workplace 

may require placement of doses in multiple locations. 

Consider the time needed to replace supplies when 

determining the number of doses to stock. 

Naloxone storage

Follow manufacturer instructions for storing naloxone. 

Keep in the box or storage container until ready for use. 

Protect from light and store at room temperature (59-

77°F or 15-25°C). Naloxone can expire and its potency 

can wane over time. Note the expiration date for timely 

replacement. 

PPE and other equipment storage

Store personal protective equipment, such as disposable 

nitrile gloves, and other first aid equipment, such as a 

responder rescue mask, face shield, or bag valve mask 

(for use in rescue breathing or CPR) close to the naloxone 

for quick response. Include sharps disposal containers if 

injectable naloxone is used.

Follow-up care planning 

Develop a plan for immediate care 

by professional healthcare providers, 

referral for follow-up care, and 

ongoing support for any worker who 

has overdosed. Include emergency 

assistance and support (i.e. Employee 

Assistance Program, mental health 

services) for lay staff responders and 

bystanders if necessary. 

Maintaining a program

Re-evaluate your program periodically. Assess for new 

risks. Plan for maintaining equipment and restocking of 

naloxone (including replacement of expired naloxone), 

other first aid supplies, and PPE. 

Check for updates to procedures and guidance 

Incorporate new medical and emergency response 

guidance regarding naloxone purchase, storage, and 

administration.

Training review and update 

Schedule refresher training annually. Training on opioid 

overdose and naloxone use can be combined with other 

first aid/CPR training and certifications. 

Photo by ©Thinkstock
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References

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overdose prevention training: A comparison of types of training participants and naloxone administration methods. 

Subst Abus 37(1):76-81. doi: 10.1080/08897077.2015.1110550

BC [2017]. Naloxone risk assessment tool – for non-public sector organizations. Prepared for the Joint Task Force on 

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assessment_-_non-governmental_sectors.pdf

BLS (Bureau of Labor Statistics) [2017]. Economic News Release: Census of Fatal Occupational Injuries Summary, 2016. 

Washington, DC: Bureau of Labor Statistics, December 19, https://www.bls.gov/news.release/cfoi.nr0.htm

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CDC [2016b]. Fentanyl Law Enforcement Submissions and Increases in Synthetic Opioid–Involved Overdose Deaths — 

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Resources

Burden of opioid use

edworkforce.house.gov/news/documentsingle.aspx?DocumentID=402497

Commonly abused drugs

drugabuse.gov/drugs-abuse/commonly-abused-drugs-charts

Confidentiality

hhs.gov/hipaa

Emergency response resources

cdc.gov/niosh/topics/emres/responders

hhs.gov/about/news/2018/04/05/surgeon-general-releases-advisory-on-naloxone-an-opioid-overdose-reversing-drug

cdc.gov/niosh/docs/wp-solutions/2010-139

Fentanyl

cdc.gov/niosh/topics/fentanyl/risk

cdc.gov/niosh/ershdb/emergencyresponsecard_29750022

cdc.gov/drugoverdose/opioids/fentanyl

Liability Issues 

drugpolicy.org/sites/default/files/Fact%20Sheet_State%20based%20Overdose%20Prevention%20Legislation%20%28January%20

2016%29

shrm.org/resourcesandtools/legal-and-compliance/employment-law/pages/employers-naloxone

networkforphl.org/_asset/qz5pvn/legal-interventions-to-reduce-overdose

Naloxone

samhsa.gov/medication-assisted-treatment/treatment/naloxone

drugabuse.gov/related-topics/opioid-overdose-reversal-naloxone-narcan-evzio

tn.gov/health/health-program-areas/health-professional-boards/csmd-board/csmd-board/naloxone-training-information

ccohs.ca/oshanswers/hsprograms/firstaid_naloxone

Naloxone access

drugabuse.gov/publications/medications-to-treat-opioid-addiction/naloxone-accessible

narcan.com/availability

getnaloxonenow.org

NIOSH resources on opioids

cdc.gov/niosh/topics/opioids

cdc.gov/niosh/topics/fentanyl

Overdose prevention

surgeongeneral.gov/priorities/opioid-overdose-prevention

surgeongeneral.gov/priorities/opioid-overdose-prevention/naloxone-advisory

cdc.gov/drugoverdose/prevention

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DOI: https://doi.org/10.26616/NIOSHPUB2019101

HHS (NIOSH) Publication No. 2019–101

October 2018