More than two dozen people were hospitalized on Thursday for suspected overdoses in West Baltimore. There have been no deaths so far, but authorities continue to investigate the cause and full impact of the mass overdose.

Bill Brooks, CEO of Penn North Recovery Center, said he had never heard of anything on this scale. Hundreds of boxes of Narcan were passed out Thursday in the Penn North neighborhood as city and community workers raced to respond.

But what is Narcan? How do you use it? And how do you know you should be using it? Here’s what you need to know if want to help someone suffering form an opioid overdose.

What are the signs of an opioid overdose?

Some signs to look out for if you or someone around you seems to be overdosing are:

• Dilated pupils
• Difficulty walking or limpness
• Nausea or vomiting
• Unresponsiveness or unconsciousness
• Violent or agitated behavior

If you are unsure, call 911 and ask the operator for assistance.

Naloxone will only effectively reverse the effects of an overdose on opioids, such as heroin, fentanyl, oxycodone or codeine.

The Behavioral Health System Baltimore shared that anyone can call the 988 Hotline and be connected to a counselor to help them. The hotline is available for free and provides confidential, emotional support 24/7.

What is Narcan?

Narcan is a brand of a medication called naloxone that can rapidly reverse the effects of an opioid overdose. It does so by blocking opioid receptors in the brain.

Narcan is administered nasally, while other brands of naloxone require injection into a muscle of the body or sometimes into a vein or underneath the skin.

The medication works quickly. It can restore breathing to someone who has overdosed in one to three minutes.

How do you use it?

The first step is to try to get the person’s attention. This can be done by making sure they are awake or rubbing your knuckles up and down the middle of their chest, according to the Maryland Department of Health.

If there is no response, call 911 and administer the medication.

To administer Narcan: lay the person down on their back, grab the device, insert it into a nostril and press the red plunger at the base of the device firmly. A second dose can be given a minute after the initial dose.

Rescue breaths, by pinching the person’s nose shut and blowing air into their mouth every five seconds, can also be administered.

It is vital the person be placed on their side in a recovery position so they do not choke in the case of vomiting. Vomiting is a symptom of withdrawal from opioids, which Narcan induces.

The medication’s effects wear off 30 to 90 minutes after it is administered, which is why it is important to call emergency responders.

The video is also available in Spanish here.

The Baltimore City Health Department offers free training through its Staying Alive Drug Overdose Response Program for those interested in learning more about how to use naloxone.

What is a fentanyl test strip?

Fentanyl test strips are used to detect the presence of fentanyl in different kinds of drugs and drug forms, and cannot be used in place of naloxone.

You can test a drug for the presence of fentanyl by first diluting about three pinches of the drug in a teaspoon of water.

Then take the test strip, holding it by the colored end, and dip the other end of the strip into the liquid. Make sure that only the wavy lines at the tip are wet.

Then take the strip out of the liquid and lay it on a flat surface for five minutes to receive the results.

Fentanyl is a synthetic opioid that is 50 times stronger than heroin and 100 times stronger than morphine. Its presence in different drugs can increase the risk of an overdose and is a significant factor in the number of overdose deaths.

Baltimore’s fatal overdose rate, in recent years, has far surpassed that of any other large city in the country. In the past six years, nearly 6,000 lives have been lost.

Where can you get naloxone in Maryland?

In the Penn North neighborhood the morning following the mass overdose, community leaders passed out large cases of free Narcan.

Baltimore County has introduced free Narcan vending machines that include instructions on how to administer the medication. The machines are located at Drumcastle Government Center, Liberty Family Resource Center, Eastern Family Resource Center and Baltimore County Detention Center.

Naloxone is provided for free at Maryland’s Overdose Response Programs, listed here along with their contact information.

The Overdose Response Programs are governmental and community-based organizations that also provide overdose prevention education to the community.

Some ORPs have stipulations about who they serve. You may call ahead or visit an ORP’s website to learn more about their stipulations.

This can mean that an ORP provides its services for those who are likely to experience an overdose resulting from opioids or are around people who are likely to experience opioids.

A van and mobile clinic run by Charm City Care Connection also provides free Narcan in West Baltimore.

Most pharmacies in Maryland stock Narcan over the counter. The Maryland Department of Health advises calling a pharmacy ahead of time to make sure they have naloxone stocked.

At pharmacies, naloxone is not available for free. Its purchase is covered by some insurance plans, and co-pays may vary.