Naloxone nasal spray is a single-use device that reverses an opioid overdose by pushing opioids off receptors in the brain, restoring normal breathing within minutes. It requires no medical training, no assembly, and no prescription. The 4 mg nasal spray (sold as Narcan) is available over the counter at pharmacies, convenience stores, grocery stores, and online. Here’s exactly how to use it.
Recognizing an Opioid Overdose
Before you reach for naloxone, you need to know what you’re looking at. Not every sign will be present, but the combination of several is a strong signal:
- Breathing: Slow, irregular, or completely stopped
- Skin: Pale and clammy to the touch
- Lips and fingernails: Blue or purple
- Pupils: Extremely small, often called “pinpoint” pupils
- Responsiveness: The person won’t wake up when you shout their name, shake their shoulders, or rub your knuckles firmly on their breastbone
If you see these signs and suspect opioids are involved, act immediately. Naloxone does nothing harmful to someone who isn’t on opioids, so using it on the wrong person won’t cause injury. Waiting too long is far more dangerous than giving it unnecessarily.
Step-by-Step Administration
Call 911 first, or have someone nearby call while you prepare the spray. Then follow these steps:
1. Open the package. Take the Narcan nasal spray out of its box. Peel back the tab with the circle to open the plastic backing. Do not remove the device until you are ready to use it, and do not test it or press the plunger beforehand. Each device contains only one dose.
2. Hold the device correctly. Place your thumb on the bottom of the plunger. Rest your first and middle fingers on either side of the nozzle. Think of it like holding a small flashlight upside down.
3. Position the person’s head. Tilt their head back gently and support the back of their neck with your free hand. This opens the nasal passage so the medication absorbs properly.
4. Insert and spray. Gently slide the tip of the nozzle into one nostril until your two fingers rest against the bottom of the person’s nose. Press the plunger firmly with your thumb. One press delivers the entire dose. Remove the device from the nostril.
5. Wait and watch. Give the naloxone 2 to 3 minutes to take effect. Stay with the person. If they are not breathing or are breathing very slowly, perform rescue breathing or CPR while you wait.
What to Do If the First Dose Doesn’t Work
If the person hasn’t responded after 2 to 3 minutes, use a second nasal spray device in the other nostril. Follow the same steps: new device, opposite nostril, firm press. You can continue alternating nostrils with additional doses every 2 to 3 minutes until the person starts breathing normally or emergency responders arrive.
Some overdoses, particularly those involving fentanyl or other extremely potent synthetic opioids, may require more than one dose. This is why many naloxone kits come with two devices. If you carry naloxone regularly, keeping at least two doses on hand is worthwhile.
After the Person Responds
Once the person begins breathing again, they may not be out of danger. Naloxone works fast, but it also wears off faster than most opioids. The drug’s effects typically last 30 to 90 minutes, while opioids in the body can last much longer. This means the overdose can return after the naloxone fades, which is why calling 911 is critical even if the person seems to recover.
While waiting for help, roll the person onto their side in a recovery position. Bend their top knee forward for stability, and tilt their head so their mouth faces the ground. This prevents choking if they vomit, which is common after an overdose reversal.
Do not leave the person alone. Monitor their breathing continuously. If it slows or stops again, administer another dose of naloxone.
Withdrawal Symptoms After Naloxone
Because naloxone strips opioids from their receptors all at once, the person will likely go into sudden withdrawal. This is uncomfortable and sometimes frightening, but it is not life-threatening. Expect them to be irritable, anxious, or confused. Physical symptoms can include nausea, vomiting, abdominal cramping, flushing, sweating, and yawning. Some people become agitated or combative.
The person may be angry at you for reversing their high. They may want to leave or refuse further help. Try to keep them calm and in place until paramedics arrive. Explain what happened and that the overdose could return. If they insist on leaving, make sure someone stays with them for at least two hours.
How Naloxone Works in the Body
Opioids bind to specific receptors in the brain that control breathing. At high enough doses, they slow breathing to the point of suffocation. Naloxone competes for those same receptors, knocking the opioid molecules off and blocking them from reattaching. This reverses the respiratory depression that makes overdoses fatal. It works on heroin, fentanyl, oxycodone, morphine, and essentially any opioid, though stronger opioids may require additional doses.
Naloxone has no effect on someone who doesn’t have opioids in their system. It will not get anyone high, it has no abuse potential, and it will not affect overdoses caused by alcohol, benzodiazepines, stimulants, or other non-opioid drugs. If you’re unsure what substance is involved but the person isn’t breathing, giving naloxone is still the right call.
Storing Your Naloxone
Keep naloxone at room temperature, away from direct sunlight and extreme heat. A medicine cabinet, glove compartment (in moderate climates), desk drawer, or backpack all work. Avoid leaving it on a dashboard in summer or anywhere it freezes for extended periods.
Check the expiration date periodically. That said, if you’re facing an overdose and the only naloxone you have is expired, use it. The American College of Medical Toxicology supports using expired naloxone when unexpired doses aren’t available. Research shows that naloxone stored in controlled conditions remains stable well past its printed expiration date, and one study found it maintained over 90% of its potency for more than a year even under extreme temperature swings.
Where to Get It and Legal Protections
The 4 mg naloxone nasal spray is sold without a prescription at most pharmacies, many convenience stores, and online retailers. Prices vary, but community health organizations and harm reduction programs often distribute it for free. Higher-dose formulations (8 mg) exist but are currently available by prescription only.
Every U.S. state has some form of legal protection for people who administer naloxone in good faith during an emergency. These laws generally shield you from civil liability and criminal prosecution, including charges related to unauthorized practice of medicine. Most states also have Good Samaritan provisions that protect both the person who gives naloxone and the person who calls 911, even if controlled substances are present at the scene. The typical conditions are straightforward: act in good faith, call for emergency help, stay until responders arrive, and cooperate.