Naloxone is a medication that can quickly reverse an opioid overdose. It works by temporarily blocking the effects of opioids in the brain, helping restore breathing in someone whose breathing has slowed or stopped. Naloxone can reverse overdoses involving fentanyl, heroin and prescription opioids such as oxycodone, hydrocodone and morphine.
Narcan is a brand-name nasal spray containing naloxone. The terms are often used interchangeably, although Narcan is only one of the naloxone products available. This guide focuses specifically on how to use Narcan and similar ready-to-use naloxone nasal sprays. Other products may have different doses or instructions, so always review the packaging before an emergency occurs.
Learning how to use Narcan does not require medical training. The device comes prefilled, does not need to be assembled and contains one dose. Because a person experiencing an overdose cannot administer naloxone to themselves, someone nearby has to recognize the emergency and act.
Why Is Naloxone So Important?
During an opioid overdose, a person’s breathing can become dangerously slow or stop completely. Without enough oxygen, permanent brain damage or death can occur within minutes.
Naloxone gives bystanders an opportunity to intervene while emergency medical help is on the way. It can begin restoring normal breathing within two to three minutes, although more than one dose may be necessary, particularly when potent opioids such as fentanyl are involved.
Naloxone is considered safe and has no potential for misuse. It will not make someone intoxicated, and the CDC advises giving it when an opioid overdose is suspected even when you are not certain opioids are involved. Naloxone will not reverse an overdose caused entirely by alcohol, cocaine, benzodiazepines or other non-opioid substances, but it is unlikely to harm the person if opioids are not present.
Narcan is temporary emergency treatment, not a replacement for medical attention. Always call 911 after administering the first dose, even if the person wakes up and appears to recover.
How to Recognize an Opioid Overdose
It is not always easy to distinguish between someone who is heavily intoxicated, asleep or experiencing an overdose. When in doubt, treat the situation as a possible overdose.
Common signs of an opioid overdose include:
- The person cannot be awakened by shouting, shaking or firm touch
- Breathing is slow, shallow, irregular or completely stopped
- Choking, gurgling or unusual snoring sounds
- Lips, fingertips or skin appear blue, gray or unusually pale
- Pupils are extremely small or “pinpoint”
- The body feels limp and the pulse is slow or difficult to detect
Try calling the person’s name loudly and gently shaking their shoulder. A person who is simply sleeping should normally respond. Someone who remains unresponsive and is not breathing normally needs immediate assistance.
How to Use Narcan: Step-by-Step Instructions
In an emergency, move quickly. The device is designed to be simple, but reviewing these instructions ahead of time can make it easier to respond calmly.
Step 1: Check for a Response
Call the person’s name, shout “Wake up,” and gently shake their shoulders. Look for normal breathing and chest movement.
If the person does not respond or is not breathing normally, prepare to administer Narcan. Do not wait until you are certain that opioids caused the emergency. Delaying treatment can be far more dangerous than giving naloxone unnecessarily.
Step 2: Lay the Person on Their Back
Place the person flat on their back. Support the back of their neck with one hand and gently tilt their head backward.
Remove the Narcan device from its packaging only when you are ready to administer it. Do not press the plunger to test or prime the device. Each nasal spray contains only one dose, and pressing it early will waste the medication.
Step 3: Position the Narcan Device
Hold the device with your thumb on the bottom of the plunger. Place your index and middle fingers on either side of the nozzle.
Gently insert the tip of the nozzle into either nostril. Continue until your fingers touch the bottom of the person’s nose. The medication is absorbed through the lining of the nose, so the person does not need to inhale or be breathing for the spray to work.
Step 4: Press the Plunger Firmly
Press the plunger all the way down to release the full dose into the nostril. Remove the device afterward.
Each Narcan device can be used only once. Do not attempt to administer a second spray from the same device.
Step 5: Call 911 Immediately
Call 911 immediately after giving the first dose. When possible, have another person call while you administer Narcan.
Tell the dispatcher that the person is unresponsive, is not breathing normally and may be experiencing an opioid overdose. Follow the dispatcher’s instructions. Rescue breathing or CPR may be necessary while you wait, particularly if the person has stopped breathing. Begin CPR or other first aid when instructed or when you are trained to do so.
Do not avoid calling because you are worried about legal consequences. Most states have Good Samaritan protections intended to encourage people to seek emergency help during an overdose. You should never delay calling 911.
Step 6: Place the Person on Their Side
After administering Narcan, move the person into the recovery position if they are breathing.
Lay them on their side with their upper leg and arm supporting the body. This position can help keep the airway open and reduce the risk of choking if the person vomits. Continue watching their chest and checking their breathing.
Step 7: Give Another Dose After Two to Three Minutes
Wait two to three minutes for the first dose to work. If the person does not wake up, respond to your voice or touch, or begin breathing normally, administer another dose using a new device.
Place the second dose in the other nostril. Continue administering a new dose every two to three minutes when additional devices are available, until the person responds or emergency medical personnel arrive.
A person may initially respond and then become unresponsive or stop breathing normally again. If that happens, give another dose immediately. Some opioids remain active in the body longer than naloxone, which means overdose symptoms can return after the Narcan begins wearing off.
Step 8: Stay Until Help Arrives
Never leave the person alone, even if they wake up and insist that they feel fine. Continue monitoring their breathing and be prepared to administer another dose.
A person who has received Narcan may wake up confused, frightened, nauseated or agitated. Naloxone can trigger sudden withdrawal in someone who is physically dependent on opioids, causing symptoms such as sweating, shaking, vomiting, body aches, irritability or an increased heart rate. These reactions can be uncomfortable, but the overdose remains the more immediate danger.
Stay calm, explain that they experienced a possible overdose and tell them emergency help is coming.
Where Should You Keep Narcan?
Keep Narcan somewhere accessible and tell other people where it is stored. A locked cabinet or an unknown hiding place can make it impossible to reach during an emergency.
Narcan should remain in its packaging, protected from light and extreme temperatures. Check the expiration date periodically and replace expired or damaged devices. Avoid leaving it in a vehicle for long periods, where temperatures can become extremely hot or cold.
Anyone can carry naloxone. It is available over the counter without a prescription at many pharmacies and retailers throughout the United States. Massachusetts residents can also obtain naloxone through pharmacies, stores and participating harm-reduction programs.
Naloxone Saves a Life, but Treatment Can Change One
Knowing how to use Narcan can mean the difference between life and death. However, surviving an overdose does not address the opioid use disorder, unsafe drug supply or other circumstances that caused it.
A nonfatal overdose should be treated as an urgent opportunity to connect someone with care. Evidence-based opioid addiction treatment may include medication, counseling, structured outpatient programming, medical support and help addressing the underlying factors that make continued opioid use difficult to stop.
Northstar Recovery Center helps adults and families understand their treatment options and take the next step after an overdose or ongoing struggle with opioid use. Recovery is possible, but the first priority is keeping the person alive long enough to begin.
Call 888-339-5756 today for a no obligation consultation.
