Naloxone at Discharge: A Family Checklist for Rehab
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Discharge day from residential treatment for opioid use disorder is usually a good day. Bags are packed, a family member is parked outside, and there is a follow-up appointment on the calendar. It is also, clinically, one of the higher-risk days in the whole recovery process. That is why the most practical item on a discharge plan is often the smallest one: a naloxone kit, and a household that knows where it is and how to use it.
This guide is written for families and for the person leaving care. It walks through what naloxone is, why the weeks after treatment matter, and a checklist you can complete before the car leaves the driveway.
Annandale’s Naloxone Rule, in One Paragraph
At Annandale Behavioral Health, a private six-bed residential program in Pasadena, California, the heroin treatment program lists a naloxone prescription as mandatory for every patient treated for opioid use, alongside connection to Los Angeles recovery communities and 12 months of alumni support. The reason is simple: after weeks without opioids, a person’s tolerance is lower than it was before treatment, so a dose they once used can now cause an overdose. Naloxone is the medication that can reverse an opioid overdose, and it only works if someone nearby has it and uses it quickly.
What Naloxone Does, and What It Does Not Do
Naloxone is an opioid antagonist. It knocks opioids such as heroin, fentanyl, oxycodone and methadone off the brain’s opioid receptors, which can restore breathing in someone whose breathing has slowed or stopped. The most familiar form is a nasal spray; it also exists as an injection. In March 2023 the U.S. Food and Drug Administration approved the 4 mg naloxone nasal spray for sale without a prescription, so it can now be bought over the counter at many pharmacies. A prescription is still useful, because it can let insurance cover the cost.
Naloxone has limits that families should understand plainly:
- It does not reverse alcohol, benzodiazepines, stimulants or xylazine. Federal guidance from NIDA still says to give naloxone in a suspected overdose involving xylazine, because xylazine is usually mixed with fentanyl.
- It can wear off before the opioid does, particularly with fentanyl or long-acting opioids, so a person can slip back into overdose. Calling 911 is not optional.
- More than one dose may be needed. Most kits contain two.
- Naloxone generally will not harm someone who has not taken opioids, so if you are unsure, give it.
For current federal information, see NIDA’s overview of fentanyl and overdose risk and the CDC’s overdose prevention resources.
Why Overdose Risk Rises After Treatment
Federal agencies, including NIDA, describe the period after a stretch of abstinence, such as after detox, residential care or release from incarceration, as a time of elevated overdose risk. The reasons are worth naming individually, because each one points to something a family can do:
Lower tolerance: After weeks without opioids, the body no longer handles the amount it once did, so a return to a previous dose can stop breathing.
An unpredictable supply: Street drugs in Los Angeles and elsewhere may contain fentanyl or other potent substances, and nobody can judge the strength of a pill or powder by looking at it.
Using alone: A return to use often happens in private, out of shame, which means there may be no one present to give naloxone or call for help.
Mixing sedatives: Alcohol, benzodiazepines and some sleep medications slow breathing too, and combining them with opioids raises risk in a way naloxone only partly addresses.
Stopping medication: People who stop buprenorphine or naltrexone early lose the protection those medications provide. Anyone considering a change should discuss it with their prescriber first. Our page on medication-assisted treatment in Los Angeles explains the options.
None of this means a return to use is expected. Many people leave treatment and never use again. It means the household prepares the way it would keep a fire extinguisher in the kitchen: not because a fire is planned, but because the minutes before help arrives matter.
The Discharge-Day Naloxone Checklist
These are steps you can complete today, or on the morning of discharge. None requires special training.
- Fill the prescription before you drive home. Ask the discharge team which pharmacy the prescription was sent to, and pick it up on the way. If cost is a problem, ask the pharmacist whether your plan covers it or whether a lower-cost option is available.
- Read the expiry date on the box. Write it on your phone calendar a month early as a reminder to replace it.
- Check the storage range printed on the label. A car glovebox in a Pasadena summer can get far hotter than the label allows. Keep kits indoors, away from heat and direct sun.
- Decide on two locations, and tell everyone. One kit at home in a spot every adult knows, such as a kitchen drawer, and one that travels with the person or a family member.
- Walk through the steps together. Read the leaflet out loud with everyone in the household in the same room. Know how to peel the package, where the nozzle goes, and that you press the plunger once per dose.
- Ask one question before leaving treatment: “Who in this household has been shown how to use naloxone, and who hasn’t?” Anyone who has not should read the leaflet that evening.
What to Do in a Suspected Opioid Overdose
Signs can include slow, shallow or stopped breathing, gurgling or snoring sounds, blue or grey lips and fingertips, pinpoint pupils, and being unresponsive to your voice or a firm rub on the breastbone. If you see these signs:
- Call 911 and say the person is not breathing or unresponsive.
- Give one dose of naloxone nasal spray into one nostril.
- If you have been trained, give rescue breaths; otherwise follow the dispatcher’s instructions.
- If there is no response after two to three minutes, give the second dose in the other nostril.
- Stay with the person. When they are breathing, roll them onto their side in the recovery position. Do not leave, even if they wake up, because naloxone can wear off.
California’s Good Samaritan law (Health and Safety Code section 11376.5) provides limited legal protections for people who seek medical help during an overdose. The details depend on circumstances, so do not let uncertainty delay a 911 call.
When Other Substances Are Involved
Many people treated for opioid use disorder have also used alcohol or benzodiazepines. Naloxone does not reverse those, and withdrawal from alcohol or benzodiazepines carries a real risk of seizures. Stopping either one should happen under medical supervision, not at home. If someone has returned to heavy use of alcohol or benzodiazepines after discharge, the next step is a medical assessment, not a solo attempt to stop.
Co-occurring conditions such as depression, anxiety, trauma or chronic pain can also raise relapse risk after discharge. In dual diagnosis care, these are treated alongside the substance use disorder, and follow-up with a psychiatrist or therapist should be part of the discharge plan.
What Families Can Say, and What Tends to Backfire
Some people leaving treatment feel that a naloxone kit in the house means their family expects them to fail. It helps to say out loud that it does not. A calm sentence works: “We keep it for the same reason we keep a first-aid kit. We’re proud of you, and we want every base covered.”
What tends to backfire is using the kit as a threat, searching someone’s belongings every day, or refusing to keep naloxone at home because it “sends the wrong message.” Shame pushes use into private places, which is exactly where overdose becomes most dangerous.
After Discharge: The Plan Around the Kit
Naloxone is a safety net, not a recovery plan. The plan itself usually includes outpatient therapy or an intensive outpatient program, medication follow-up, peer support, and a named person to call when cravings are strong. If you are still deciding on care, our overview of residential treatment in Los Angeles describes how a six-bed setting works from detox through discharge, and our heroin rehab program page outlines the opioid treatment phases.
If you have questions about discharge planning or admission, call Annandale Behavioral Health at (855) 778-8668. Our admissions team can talk through whether residential care fits your situation.
Crisis Resources
If someone is not breathing or cannot be woken, call 911 now. If you or someone you love is in emotional crisis, call or text 988 to reach the 988 Suicide and Crisis Lifeline. For free, confidential treatment referrals, SAMHSA’s National Helpline is available at 1-800-662-4357, 24 hours a day. To speak with our team, call (855) 778-8668.
This article is for educational purposes only and is not medical advice. It does not replace an evaluation by a licensed clinician. Follow the instructions on your naloxone package and from your pharmacist or prescriber, and always call 911 in a suspected overdose.
