Can I use expired naloxone? Yes you can!

One of our favorite harm reduction physicians said “Expired naloxone is better than no naloxone.” At NEXT Distro, we agree!

This page includes some research and context for why expired naloxone should never be disposed of, and if possible, redistributed to communities at the highest risk for opioid overdose who may not otherwise have access to naloxone.

NEXT Distro exists because people who use drugs (and their friends and family) do not always have access to the resources and supplies needed to keep ourselves and each other healthy and well. We know for a fact that naloxone temporarily reverses the effect of an opioid overdose by blocking the opioid receptors in the brain allowing a person to resume breathing. We believe everyone at risk for overdose (and others who are likely to respond to an overdose) should always have access to naloxone. In our best effort to fill the gaps in naloxone access, we often distribute donated expired or soon-to-expire naloxone to folks living in rural areas without a local harm reduction program.

Luckily, naloxone has been proven to work well beyond its expiration date! We know this through scholarly research as well as the overdose reversal reports we receive from NEXT Distro participants who have received and used expired naloxone.

For more information we’ve included research and links below.

If you have a bulk amount of expired naloxone that you don’t need, you can donate it to US.

 
 

Scholarly research 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.”

Chemical stability of naloxone products beyond their labeled expiration dates, 2022 Journal of Opioid Management.

  • “In summary, since both naloxone nasal spray and injectable naloxone were found to be chemically stable beyond 10 months of the expiration date, shelf-life extension of climate controlled, commercially available naloxone products should be further investigated as a potential cost savings measure for national strategic stockpiles, emergency medical services, hospitals, and public responders.”

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.”

 
hand holding vials of naloxone
 

NEXT Distro has received hundreds of overdose reports from people who used expired naloxone to save a life!

 
 
 

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 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.

 
 

Special thanks to Zoe Martin del Campo for consolidating the information found on this page.