The Limits of Narcan Alone

Too much is being asked of the miracle drug. Brain injuries from overdose are an unrecognized threat.

A while back, I was on a radio talk show about fentanyl overdose deaths with some other panelists.

One of the panelists said, as I recall, “we saved the lives of 768 people last month,” by reviving them with Narcan, the brand name for the miracle opioid-overdose antidote, naloxone.

There’s no doubt that those revivals were essential and welcome.

However, it occurred to me then, as now, that a Narcan revival alone is not saving someone’s life -- not in a time when fentanyl (and meth) are so rife on streets that are themselves full of daily trauma and lethal threats.

A Narcan revival is an undisputed good thing. But today, if a person then returns immediately to the street, a Narcan revival is more akin to temporarily postponing death.

Narcan is a band-aid. It helps a person weather a critical moment – once. It doesn’t keep that person from re-entering that critical moment, sometimes quickly thereafter.

I’ve been speaking with brain-injury specialists and workers for some time now because there’s another problem with allowing people to go from overdose back to streets where they were using drugs daily.

Every overdose, no matter how brief, they say, carries with it the real risk of brain impairment. That’s because an opioid overdose is a deprivation of sufficient oxygen to the brain.

Repeated overdose, especially without any time for brain healing, they say, virtually ensures brain impairment, and particularly when paired with street-inflicted trauma. That brain injury impairs a person’s ability to weigh the future consequences of current action.

So opioid overdose can lead to brain injuries, which, in turn, can lead to more opioid use and overdose.

Most recently, I spoke with Arlene Thompson, who works in a veterans court in Denver, and has been an educator involved with the Brain Injury Alliance of Colorado for many years, after her son suffered a brain injury playing baseball.

Historically, Thompson said, the great majority of brain injuries were due to blows to the head – car accidents, military and sports injuries, falls, beatings, domestic violence.

Massive supplies of fentanyl have changed that. A large number of brain injuries, she said, are now from the deprivation of oxygen caused by opioid overdose, and most of those from fentanyl. An overdose and a blow to the head are not exactly the same injury, researchers tell me, but they are similar because both affect the frontal lobe of the brain. That part of the brain governs decision making, warns against harmful behavior, and considers the benefits of postponing gratification, among other things.

By leaving people on the street to suffer more overdoses, believing that with Narcan they’ll be revived and return to “normal,” we are creating a population of people less able to make rational decisions, more given to erratic behavior, and more at the mercy of the street and its trauma.

I understand how important Narcan is. I carry it in my backpack, my car, my toiletries, though I’ve never had to use it. It should be as prevalent as fire extinguishers and defibrillators.

A box of Narcan stapled to a telephone pole in Skid Row L.A.

It has great benefits, but also serious limits, particularly in a time of fentanyl and meth, and particularly when it is used virtually without any other tool.

In the last half dozen years, fentanyl supplies from Mexico have driven overdoses (fatal and nonfatal) to record levels. Widespread supplies of Narcan have temporarily kept many people alive.

The result: It’s common now to find people who have overdosed 6, 10, 12, 20 times in two or three years, something that almost never happened when heroin was the opioid of addiction.

“If you allow your brain to have that time [to heal], the chances of your recovery are much higher,” Thompson told me. “But when you’re repeatedly damaging that area, there comes a time when that area of your brain cannot recoup.”

Many of Thompson’s court clients now have repeated overdoses. “They figure, `I have Narcan and I’m fine because I’m alive,’” she said. “But they are continually re-injuring, adding to the severity of the brain injury.”

One woman I interviewed had 26 overdoses in 15 months and described the effects to me:

As welcome as Narcan may be, it is no long-term solution, nor is it the sole solution. Yet in our time of fentanyl, too often it appears to be accepted as such.

[Note: Overdose deaths have been declining since late 2023. Many people believe that has almost entirely to do with Narcan on the street. I don’t doubt Narcan is part of the story. But a fuller explanation for the drop in overdose deaths must at least include the fact that fentanyl supplies themselves dropped during that very period. I think it’s no coincidence that DEA tests show that the amounts of fentanyl in the tens of millions of counterfeit pills out of Mexico that so many addicts smoke on the street have also declined consistently since late 2023*.]

The National Football League now requires that a player who suffers a concussion be removed from the field, often for weeks, during which he must first rest, then engage in light walking or swimming to boost heart rate and blood flow to the brain, followed by strength training, and, only then, light football activities.

A fentanyl addict revived from overdose with Narcan, however, is immediately released to the streets, perhaps less able than before to make rational decisions.

“Yes, you have revived them, and that is absolutely wonderful, but you don’t see the after effects,” Thompson said. “You don’t see them later on. You don’t see the impacts” of the overdose’s trauma to the brain.

Meanwhile, continual use of the methamphetamine out of Mexico, which is a more prevalent and potent meth than we’ve ever seen on our streets, may itself be a cause of brain injury, as symptoms of one mirror those of the other.

It’s unclear to me that the panelist on that radio show understood this — that a Narcan revival, while good, is not necessarily saving a life. As long as those people that her clinic revived remained on the street using drugs, their lives were at grave risk. Many who die have numerous Narcan revivals to their name.

Indeed, in some areas, activists have been distributing Narcan and paraphernalia for consuming both fentanyl and meth.

What alarms me is that this state of affairs is considered normal now, as if there’s not much else to do.

The stated aim is we need to keep Narcanning people until they can make the rational decision to seek treatment. But that misunderstands fentanyl and meth addiction, the brain injuries overdose can cause, and how quickly all that can kill.

Profound addiction to relentless supplies of fentanyl (and meth) makes rational thinking rare. Brain injuries due to overdose make it rarer still. The streets, meanwhile, remain trauma-inducing and lethal.

I’ll post more on this in the future.

But after reporting on this for more than a decade, I believe the solution must start with getting people off those lethal streets and — crucially — into places they cannot leave when the drugs insist that they must.

That way, their brains will have a fighting chance to heal. When that happens, readiness for treatment is far more likely to emerge than it will on those streets, where drugs and brain injury so easily conspire and lead to death.

This may mean civil commitment or a hospitalization or specialized mental-health housing. It may mean rethinking jail as a place for recovery, which some jails are doing and which I wrote about in detail in The Least of Us.

We haven’t begun discussing how that would be achieved.

Too often, we point to widespread supplies of Narcan as the response, too often the sole response.

In part, we misunderstand the nature of our current illegal-drug situation on the streets, believing it somehow comparable to those of decades past, which it is not.

Some believe that placing addicts in confinement amounts to heresy, despite the clear threats to those same addicts on the street, in tents, chained to drugs and a life that will batter and destroy their minds, then kill them.

We have relied on Narcan, which is understandable, given its miraculous properties. A Narcan revival, again, is a good thing. It will not prevent the very real damage to people on display on so many American streets today.

When we do begin providing critical refuges off the street, away from these ghastly drugs, it seems to me that Narcan can return to what it is — a miracle-working tool with limits — instead of filling a role it was never designed to play: the solution itself.

*See DEA National Drug Threat Assessment 2025, pages 22-23.

---