Naloxone at Rehab Discharge: What to Ask Before You Leave

Naloxone is a medication that can temporarily reverse an opioid overdose, and anyone leaving residential treatment for an opioid use disorder should walk out the door with a kit in hand, not just a recommendation to get one. At Annandale, a six-bed residence in the Los Angeles and Pasadena area, we treat naloxone as part of the discharge paperwork: one kit in the person’s bag, one in the family’s hands if they want it, and 911 as the next call every time it is used. This post covers what to ask for, when to ask, and what to check before the last day.

Why Naloxone Belongs on the Discharge Checklist

Most discharge conversations focus on aftercare: the next appointment, the sober living address, the medication refill. Naloxone gets a passing mention, or none. Yet the days after leaving a controlled setting are a period when risk can change quickly. Someone who has been abstinent in a residence may have a lower tolerance than before admission, and a dose that once felt familiar can be far more dangerous. Public health agencies including the CDC and the National Institute on Drug Abuse describe naloxone as a core overdose-prevention tool, and SAMHSA points people toward it as part of recovery planning.

None of this is a prediction that a particular person will relapse. Many people leave treatment and do well. A naloxone kit is closer to a smoke detector than a forecast: you hope never to use it, and you are glad it is on the wall if you need it. It also matters for fentanyl, which is now found in a great deal of the illicit supply, so someone who believes they are using something else may be exposed to an opioid without knowing it.

What Changes After Treatment: Labelled Risk Factors

These are the mechanisms we walk through with each person before discharge, because they explain why the kit matters even for someone who is committed to staying sober.

Lower tolerance: After days or weeks without opioids, the body may no longer tolerate amounts it once did, so a return to a previous dose can be dangerous.

Unpredictable supply: Illicit pills and powders can contain fentanyl or other substances the person did not intend to take, and there is no way to tell by looking.

Mixed sedatives: Opioids combined with alcohol or benzodiazepines can suppress breathing more than either alone, and naloxone does not reverse the alcohol or benzodiazepine part.

Being alone: A person cannot give themselves naloxone during an overdose, so the people around them need to know where the kit is and how to use it.

Stress at the transition: Returning to work, family, old routines and old contacts is a high-pressure stretch, and cravings may spike when structure falls away.

What to Ask Before the Last Day

Here is a practical script you can use today, whether you are the person in treatment or a relative helping them plan. Ask your treatment team these questions at least a few days before the planned discharge, so there is time to fix any gaps:

First, ask: “Will I leave with a naloxone kit in my hand, and what form is it?” Naloxone commonly comes as a nasal spray or as an injectable, and the best choice is the one the people around you will actually be able to use under stress. Second, ask: “Who else should be trained, and can you show them?” A kit that only the patient knows about is of limited use during an emergency. Third, ask: “Where do I get a refill, and does my insurance cover it?” Kits expire and get lost, and many pharmacies in California can dispense naloxone, so the plan should name a specific pharmacy rather than “somewhere.” Fourth, ask: “What is written in my discharge plan about overdose?” If the answer is nothing, request that it be added.

If you are still choosing a program, you can ask these same questions during the admissions call. Our guide to the pre-admission phone screen explains what that conversation covers, and our page on medication-assisted treatment in Los Angeles describes how medications for opioid use disorder fit into care. If you have already left a program and never received a kit, you can still ask your prescriber or a local pharmacist about getting one, or call us at (855) 778-8668 and we will tell you plainly what we would do in your position.

What the Kit Does and Does Not Do

Naloxone works by blocking opioids from acting on the brain receptors that slow breathing. It is not a treatment for opioid use disorder, and it does not remove the underlying risk. It can buy time, and the time is the point: the standard guidance from health agencies is to call 911 even if the person wakes up, because the effects of some opioids can outlast the effects of naloxone, and the person may need medical monitoring. If a second dose is needed, follow the instructions printed on the specific product you were given, and stay with the person until help arrives.

Naloxone will not reverse an overdose caused only by alcohol, benzodiazepines or stimulants. It is safe to give if you are unsure whether opioids are involved, which is why training materials generally encourage using it when in doubt, but it is never a replacement for emergency care. If someone is not breathing normally or cannot be woken, call 911 first or have someone else call while you act. In the United States, the 988 Suicide and Crisis Lifeline is available by calling or texting 988 if someone is in emotional crisis or you are worried about intentional harm.

Where This Fits in Residential Care

In a small residence, discharge planning is personal. With only six beds, the clinical team knows each person’s history, medications and family situation, and the naloxone conversation happens as part of a broader plan rather than as a handout at the door. That plan often includes ongoing medication for opioid use disorder when clinically appropriate, such as buprenorphine, which we cover in our post on buprenorphine after rehab discharge. It also includes outpatient follow-up and, for people with co-occurring conditions such as depression, anxiety or trauma alongside their substance use disorder, continued dual-diagnosis support. You can read how we approach this on our dual diagnosis treatment page.

Withdrawal itself needs supervision. Alcohol and benzodiazepine withdrawal can cause seizures and can be life-threatening, so neither should be attempted alone or without medical oversight. Opioid withdrawal is rarely dangerous in the same way but is intensely uncomfortable, and that discomfort is one of the most common reasons people return to use. If you or someone you love is considering stopping, speak with a medical professional first, and consider a supervised setting such as residential treatment.

For Families: A Short Home Checklist

If someone you love is coming home from treatment, a few steps today can make the first weeks safer. Find out where the kit is stored and keep it somewhere visible and easy to reach, not locked in a drawer. Check the expiration date printed on the package and set a reminder on your phone. Learn the steps for your specific product by reading the printed instructions once now, while nobody is in crisis. Agree on who calls 911 and who gives naloxone. And talk about it openly: having a kit in the house is a sign of care, not an accusation.

Keeping the conversation calm matters. People often feel shame about needing a kit, and families sometimes worry that having one signals a lack of faith. In our experience, the opposite tends to be true: people who are treated as capable adults with a plan are often more willing to keep following it.

Getting Help and Next Steps

If you are weighing treatment for yourself or a family member, you do not need to have everything figured out before calling. Our admissions team can talk through the process, what to expect, and what to ask any program you consider. Call (855) 778-8668 to speak with someone. If anyone is in immediate danger, call 911. If you are in emotional crisis, call or text 988.

This article is for educational purposes only and is not medical advice, diagnosis or treatment. It does not replace guidance from a licensed clinician who knows your situation. Annandale Behavioral Health is a substance use disorder treatment provider; mental health conditions are addressed only when they co-occur with a substance use disorder. Treatment outcomes vary and no program can guarantee results.