How to Use Narcan: Step-by-Step Naloxone Guide for Opioid Overdose

Narcan (naloxone) is an opioid antagonist that reverses opioid overdose by blocking opioid receptors in the brain. It works within 2 to 5 minutes when sprayed into the nose. Anyone can administer it. You do not need medical training. Narcan is available without a prescription at most pharmacies and through many community health programs at no cost.

In 2023, the FDA approved Narcan nasal spray for over-the-counter sale. This means you can buy it off the shelf without asking a pharmacist. Given that opioid overdoses killed over 81,000 people in the US in 2023 alone, carrying naloxone is as practical as carrying a first aid kit.

Recognizing an Opioid Overdose

Before using Narcan, recognize the signs of opioid overdose:

Unresponsive to voice or touch
Slow, shallow, or stopped breathing (fewer than 8 breaths per minute)
Blue or grayish lips, fingertips, or skin
Pinpoint pupils
Limp body
Choking, gurgling, or snoring sounds

If you are unsure whether someone is overdosing, administer Narcan anyway. It will not harm someone who has not taken opioids. It only affects opioid receptors.

Step-by-Step: How to Give Narcan Nasal Spray

Call 911 first. Naloxone is temporary. The person needs medical follow-up.
Open the Narcan package. Peel back the packaging to remove the device. Do not test or prime it.
Tilt the person’s head back slightly. This optimizes nasal absorption.
Insert the nozzle into one nostril. Push it in until your fingers touch the bottom of the person’s nose.
Press the plunger firmly. One press delivers the full dose. You will hear a click.
Wait 2 to 3 minutes. If the person does not respond (still not breathing, still unresponsive), administer a second dose in the other nostril.
Place the person in the recovery position (on their side) to prevent choking.
Stay with them until help arrives. Monitor breathing continuously.

Naloxone wears off in 30 to 90 minutes. Opioids, especially fentanyl and methadone, last longer. The person can slip back into overdose after Narcan wears off. This is why calling 911 is essential even if Narcan appears to work immediately.

What Happens After Narcan Is Administered

If naloxone works, the person may wake up confused, agitated, or in withdrawal. They may experience nausea, vomiting, sweating, and rapid heartbeat. Do not be alarmed. These are expected signs that the opioids have been displaced from receptors.

Important things to know after administering:

The person may be combative or upset. Stay calm. Tell them what happened.
Do not let them use more opioids to counteract the withdrawal feelings. This can cause another overdose once the Narcan wears off.
Stay until paramedics arrive or for at least 4 hours if they refuse transport.

Where to Get Narcan for Free

NextDistro.org: Ships free naloxone by mail anywhere in the US.
Local health departments: Many distribute naloxone kits at no cost.
Syringe services programs: Provide naloxone alongside other harm reduction supplies.
Pharmacies: Available OTC without prescription. Some insurance plans cover it.
SAMHSA Opioid Treatment Locator: findtreatment.gov lists naloxone distribution sites.

Who Should Carry Narcan

Anyone in proximity to opioid use should carry naloxone: family members of people who use opioids, people prescribed high-dose opioids for chronic pain, first responders, teachers, social workers, and anyone who wants to be prepared in a public emergency. Naloxone saves lives. There is no downside to carrying it.