Administering Narcan is straightforward and requires no medical training. The most common form is a 4mg nasal spray that you insert into one nostril and press the plunger. If the person doesn’t respond within 2 to 3 minutes, you give a second spray in the other nostril. The key is acting quickly while someone calls 911.
Recognizing an Opioid Overdose
Before reaching for Narcan, you need to know what an overdose looks like. The hallmark signs are slow or stopped breathing, pinpoint pupils (unusually tiny, even in dim light), and unresponsiveness. The person’s skin may turn bluish, especially around the lips and fingertips. They may be making gurgling or choking sounds, or they may be completely silent with barely any chest movement.
If someone is unconscious and you even suspect opioids are involved, it’s better to give Narcan than to wait. The medication only affects opioids, so it won’t cause harm if the person overdosed on something else.
How Narcan Nasal Spray Works
Narcan contains naloxone, which competes with opioids for the same binding sites in the brain. Think of it as bumping opioids off the receptors that control breathing. Once naloxone locks into those receptors, it blocks the opioid’s effects and restores normal breathing. After a nasal spray dose, this process begins within 2 to 5 minutes.
The effect is temporary. Naloxone wears off in 30 to 90 minutes, but many opioids (especially fentanyl or extended-release pills) last much longer. That’s why calling 911 is essential even if the person wakes up. The overdose can return once the naloxone clears the system.
Step-by-Step Nasal Spray Instructions
Each Narcan nasal spray device contains one dose and can only be used once. Here’s the full sequence:
- Call 911 first or have someone else call while you prepare the Narcan.
- Open the package and peel back the backing to remove the device. Don’t test it or press the plunger before you’re ready, as it only sprays once.
- Position the person on their back. Tilt their head back slightly to open the airway.
- Insert the nozzle into one nostril until your fingers touch the bottom of the person’s nose.
- Press the plunger firmly with your thumb. One press delivers the full 4mg dose.
- Wait 2 to 3 minutes. Watch for signs of response: breathing, movement, or waking up.
- Give a second dose in the other nostril if the person hasn’t responded. Continue giving additional doses every 2 to 3 minutes, alternating nostrils, until the person responds or paramedics arrive.
If the person is not breathing at all while you wait for the Narcan to take effect, perform rescue breathing or CPR if you’re trained. Narcan reverses the opioid’s effect, but brain damage from oxygen deprivation can begin in minutes.
Using Injectable Naloxone
Some naloxone kits come as a prefilled auto-injector or a vial with a syringe. The auto-injector talks you through the process with voice prompts, similar to an EpiPen. You press it firmly against the outer thigh and it delivers the dose automatically. You can inject through clothing if needed.
If you have a vial and syringe kit, draw up the dose (typically 0.4 to 2mg depending on the kit) and inject it into the outer thigh muscle. Injectable naloxone works slightly faster, with onset in about 2 to 5 minutes for an intramuscular injection. The same rule applies: if there’s no response in 2 to 3 minutes, give another dose.
What to Expect After It Works
When naloxone kicks in, the person will likely wake up suddenly and may be confused, agitated, or combative. This happens because the drug throws them into immediate opioid withdrawal. Common reactions include nausea, vomiting, sweating, shaking, body aches, rapid heartbeat, and anxiety. These symptoms are intensely uncomfortable but rarely dangerous.
The person may not understand what happened or may want to leave. Try to keep them still and on their side in the recovery position (lying on their side with the top knee bent forward for stability). This prevents choking if they vomit. Stay with them until emergency responders arrive, because the naloxone can wear off before the opioid does, causing the person to stop breathing again.
Some people need multiple doses, particularly with fentanyl overdoses. Fentanyl binds to receptors very strongly, and a single spray may not be enough to fully reverse its effects.
Where to Get Narcan
In 2023, the FDA approved the 4mg Narcan nasal spray for over-the-counter sale, meaning you can buy it at most pharmacies without a prescription. A second OTC brand, RiVive (3mg nasal spray), is also available. You’ll typically find them near the pharmacy counter or behind it.
For prescription versions of naloxone, including injectable forms, over 40 states and Washington, D.C., have standing orders that let pharmacists dispense naloxone without you needing a personal prescription from a doctor. Many community organizations and harm reduction programs also distribute free naloxone kits.
Insurance often covers the prescription versions, while the OTC sprays are a cash purchase. If cost is a barrier, local health departments and naloxone distribution programs frequently give kits away at no charge.
How to Store It
Keep Narcan at room temperature or refrigerated, anywhere between 36°F and 77°F. Don’t freeze it, and avoid leaving it in places that exceed 104°F, like a car dashboard in summer or a glove compartment. Store it away from direct light. Check the expiration date printed on the package periodically and replace it when needed. Even expired naloxone is better than none in an emergency, but a fresh supply is more reliable.
If you carry Narcan in a bag or keep one at home, store it somewhere accessible to others. In an emergency, you might not be the one who needs to find it.