Can I use expired naloxone?

One of our favorite harm reduction physicians said “Expired naloxone is better than no naloxone.” We agree with her. This page will provide some research and context for why expired naloxone should never be disposed of- and if possible, redistributed to communities at the highest risk of opioid overdose i.e., accidental drug poisoning.

NEXT Distro exists because people who use drugs-and their friends and family-do not have access to the resources and supplies they need to keep themselves and each other, healthy and well. HIV and Hepatitis C transmission occurs when syringe scarcity forces people who inject drugs to share needles. The factors that contribute to opioid overdose death are numerous. However, we know for a fact that naloxone temporarily reverses the effect of an opioid overdose allowing the person who is experiencing the opioid overdose to resume breathing.

Naloxone has been proven to work well beyond its expiration date. We know this through scholarly research and through the overdose reversals reported to NEXT Distro using expired naloxone. For more information we’ve included research and links below. If you have expired naloxone you can donate it to NEXT, we could also work with you to mail it to one of our affiliates within your state.

Scholarly reviewed research articles about naloxone expiration

Quality Assessment of Expired Naloxone Products From First-responders Supplies, Journal Of Prehospital Emergency Care

• “Most tested samples were found containing more than 90% of labeled Naloxone, including those stored for nearly 30 years. The Naloxone degradation was slow, but generally correlated with storage time length. There was no significant amount of degradation products detected across all samples.”

• “This quality assessment demonstrates that expired Naloxone products may still meet USP standards, even after many years.”
  

Evaluation of Chemical Stability of Naloxone Products Beyond Their Labeled Expiration Dates, 2018 American Association of Pharmaceutical Scientists (AAPS) PharmSci 360 Annual Meeting.

• “The Naloxone products, obtained after expiration from individual terminal users, were maintained at room temperature for more than one year beyond their labeled expiration dates to evaluate the chemical stability for both impurities as well as active Naloxone.”

• “Our preliminary data suggests a shelf life extension of climate controlled commercially available Naloxone products (NNS – Narcan® and NIJ – Evzio®).”
  

Naloxone Could be Used Past Expiration Date Studies Say, American Pharmacists Association

• “In Naloxone samples with expiration dates ranging from 1990 to 2018, expired Naloxone products may still meet usability standards, even after many years.”

• “The chemical analysis found that 11 of the 12 Naloxone samples retained between 90% - 110% of their potency, the range designated by the USP as meeting the standard for safe and effective use (see chart below).”

I just received naloxone that is past its expiration date and I don’t know how it was stored, can I still use it? 

Again, any naloxone is better than no naloxone. Studies within the past two years have demonstrated that naloxone retains its effectiveness for as long as nearly 30 years past its expiration date. A study published February 27th, 2019, The Effects Of Heat And Freeze-Thaw Cycling On Naloxone Stability, sought to evaluate whether non-standard storage conditions affect stability, investigating the impact of heat and freeze-thaw cycling on Naloxone. They found that “Naloxone exhibits no changes in drug concentration following exposure to heat or freeze-thaw cycles for up to 28 days compared to Naloxone stored at room temperature.”

The 2019 study Quality Assessment of Expired Naloxone Products from First-Responders’ Supplies sought to quantify the quality and stability of expired Naloxone. This study found that in naloxone samples with expiration dates ranging from 1990 to 2018, expired naloxone products may still meet usability standards, even after many years, illustrated by the blue bar graph below.

NEXT has received hundreds of opioid overdose reversal reports from individuals who used redistributed expired naloxone.

The Effects of Heat and Freeze-thaw Cycling on Naloxone Stability, Harm Reduction Journal, 2019

• “Naloxone hydrochloride ampoules exhibit no changes in drug concentration following exposure to heat or freeze-thaw cycles for up to 28 days compared to ampoules maintained at room temperature.”

• “Our findings suggest that exposure of naloxone hydrochloride ampoules to temperatures up to 80 °C or daily freeze thaw cycles for 1 month appear to have no impact on its stability. Therefore, naloxone hydrochloride ampoules should remain efficacious should [take home naloxone] kits be temporarily stored outside of the recommended storage conditions.”