Narcan nasal spray delivers a single 4 mg dose of naloxone into one nostril, and it requires no assembly, no medical training, and no prescription. Each device is pre-loaded and ready to use straight out of the box. If you suspect someone is experiencing an opioid overdose, here’s exactly how to use it and what to do afterward.
Recognizing an Opioid Overdose
Before reaching for Narcan, you need to know what you’re looking at. An opioid overdose shows a combination of three key signs: pinpoint pupils (unusually small, even in dim light), unconsciousness or unresponsiveness, and slow, shallow, or stopped breathing. The person’s skin may also look pale, bluish, or feel cold and clammy. If someone is unresponsive and breathing abnormally after known or suspected opioid use, treat it as an overdose.
Step-by-Step Instructions
First, call 911. Even if Narcan works perfectly, the person still needs emergency medical care. While you wait, or while someone else makes the call, follow these steps:
- Step 1: Peel back the packaging and remove the Narcan device. It comes ready to use with no caps to remove and no parts to assemble.
- Step 2: Lay the person on their back. Tilt their head back slightly and support the neck.
- Step 3: Hold the device with your thumb on the bottom of the plunger and your first and middle fingers on either side of the nozzle.
- Step 4: Insert the tip of the nozzle into one nostril until your fingers touch the bottom of the person’s nose.
- Step 5: Press the plunger firmly. This releases the entire 4 mg dose in a single spray. You do not need the person to inhale.
Each Narcan device contains only one dose and cannot be reused. After you spray it, remove the device and set it aside.
If the Person Doesn’t Respond
Narcan typically reaches its peak effect around 20 to 30 minutes after nasal administration, but you should see some initial response sooner. If the person shows no improvement after 2 to 3 minutes, give a second dose using a new device in the other nostril. Continue giving additional doses every 2 to 3 minutes, alternating nostrils, until the person responds or emergency help arrives.
If you only have one device and the person isn’t responding, focus on rescue breathing (one breath every 5 seconds) while waiting for paramedics. No response after multiple doses could mean the overdose involves something other than opioids, or involves an extremely potent synthetic opioid like fentanyl that may require more naloxone to reverse.
What Happens After Narcan Works
Naloxone works by blocking opioid receptors in the brain. It essentially pushes opioids off the receptors they’ve latched onto, which restores normal breathing and consciousness. This reversal happens fast, but it doesn’t last as long as most opioids do. The nasal spray has a half-life of roughly 2 hours, meaning the drug’s effects steadily fade over that window. Many opioids, especially long-acting ones and fentanyl, outlast naloxone in the body.
This creates a real danger: the person can slip back into overdose once the Narcan wears off. That’s why emergency medical care is critical, even if the person wakes up and seems fine.
Recovery Position and Monitoring
Once the person is breathing, roll them onto their side with their top knee bent forward to stabilize them. This is called the recovery position, and it prevents choking if they vomit. Stay with the person until paramedics arrive.
If for any reason you don’t seek emergency medical care, stay with the person for at least 3 hours and watch closely for signs of a returning overdose: slowed breathing, loss of consciousness, or blue-tinted lips and fingertips. If you absolutely must leave before that window is up, place the person in the recovery position before you go.
Withdrawal Symptoms to Expect
Because Narcan strips opioids from their receptors so abruptly, it can trigger immediate withdrawal symptoms in someone who is opioid-dependent. This is uncomfortable but not life-threatening. The person may experience irritability, anxiety, yawning, abdominal cramping, nausea, vomiting, flushing, or sweating. They may also be confused, agitated, or combative when they regain consciousness.
This is a normal response to the drug doing its job. The person may not understand what happened and might resist help. Stay calm, explain that they may have overdosed, and encourage them to stay put until medical help arrives. Some people will want to use opioids again immediately to stop the withdrawal discomfort, which is extremely dangerous while Narcan is still active and wearing off unpredictably.
How to Get and Store Narcan
Narcan 4 mg nasal spray is the first naloxone product approved by the FDA for over-the-counter sale, meaning you can buy it at pharmacies and many retailers without a prescription. It’s also widely available through community health organizations and harm reduction programs, often for free.
Store it at room temperature and out of direct light. Check the expiration date printed on the package periodically. While expired Narcan may still have some effectiveness and is better than nothing in an emergency, the FDA advises following the expiration date on the packaging. Many people keep one kit at home and another in a bag, car, or workplace, replacing them as they expire.
Narcan is safe to give even if you’re wrong about the cause. If the person hasn’t taken opioids, naloxone won’t harm them. There is no risk of abuse, no high, and no dangerous side effects in someone without opioids in their system. When in doubt, use it.