How to Use Narcan (Naloxone): A Step-by-Step Guide

How to recognize an opioid overdose

An opioid overdose slows or stops breathing, which starves the brain of oxygen. That is what makes it deadly, and it is also what naloxone reverses. The signs are usually clear once you know what to look for.

• The person cannot be woken up or does not respond to voice or touch.
• Breathing is very slow, shallow, irregular, or has stopped completely.
• Gurgling, choking or snore-like sounds come from the airway.
• Lips or fingertips look blue, grey or ashen.
• Pupils are pinpoint small.
• The skin feels cold or clammy.

A reliable check is a sternum rub: press your knuckles firmly into the center of the person's chest and rub hard. Someone who is simply asleep will stir. Someone overdosing will not. When in doubt, treat it as an overdose. Naloxone will not hurt them if you are wrong.

How to give Narcan nasal spray, step by step

The steps below apply to the standard 4 mg Narcan nasal spray, the most common form of naloxone in the US. Other brands and higher-strength sprays work the same way.

1. Call 911. Say someone is unresponsive and not breathing normally. Give your exact location. If someone else is present, have them call while you move to the next step.
2. Lay the person on their back and tilt their head back slightly.
3. Peel back the package and hold the device with your thumb on the plunger and two fingers around the nozzle. Do not test-spray it; each device holds one dose only.
4. Gently insert the tip into one nostril until your fingers touch the person's nose.
5. Press the plunger firmly to release the full dose.
6. Roll the person onto their side into the recovery position and bend their top knee forward to keep them stable.
7. Stay with them. If there is no response after two to three minutes, give a second spray from a new device into the other nostril.
8. Keep giving doses every two to three minutes if more spray is available and there is still no response, until help arrives.

If you know CPR and the person has no pulse or is not breathing after naloxone, start chest compressions and rescue breaths. The 911 dispatcher can coach you through it.

What happens after the dose works

When naloxone works, breathing and responsiveness usually return within two to three minutes. The person may wake confused, agitated or physically sick. That is acute opioid withdrawal, caused by naloxone suddenly displacing opioids from their receptors. It is miserable but temporary.

Two things matter most after a successful reversal. First, naloxone wears off in 30 to 90 minutes, while many opioids, especially fentanyl, methadone and extended-release pills, last far longer. The person can slip back into overdose once the naloxone fades. This is why 911 must be called even when the person wakes up and says they feel fine. Second, their next few days carry the highest risk: opioid tolerance drops quickly, and using again at the old dose can be fatal.

• Keep them in the recovery position and do not leave them alone.
• Do not let them take more drugs to ease the withdrawal.
• Expect vomiting; the side-lying position protects the airway.
• Tell paramedics what was taken if you know, and how many doses of naloxone were given.
• Stay calm and reassuring. Many people wake frightened and want to leave.

How to get Narcan, and what it costs

Narcan nasal spray is sold over the counter at most US pharmacies, typically for around 45 dollars for a two-dose pack. Every state has a standing order or similar arrangement, so you never need your own prescription. Many insurance plans, including Medicaid, cover it at low or no cost.

Free naloxone is widely available if you know where to look. Local and county health departments, syringe service programs, harm reduction organizations, many public libraries and some fire stations distribute it at no charge. Several mail-order programs ship free kits anywhere in their state. Calling 211 or searching your county health department website usually finds the nearest option within minutes.

Naloxone keeps for years at room temperature, though heat and freezing shorten its life. Check the expiration date once or twice a year and replace expired devices; expired naloxone often still works in an emergency, but at reduced strength. Keep a kit where you or your loved one actually spend time: a bag, a glovebox, a kitchen drawer. A kit in a closet you never open helps no one.

Narcan saves a life. What comes next matters too.

Surviving an overdose is a turning point, and the days afterward are when many people are most open to treatment. Medications like buprenorphine and methadone cut the risk of a fatal overdose by more than half, and they can often be started quickly, sometimes the same day.

If someone you love uses opioids, carrying naloxone is part of caring for them, not a sign you have given up hope. Our naloxone vs naltrexone guide explains how the overdose reversal medicine differs from the relapse prevention medicine, and our Suboxone treatment guide and methadone vs Suboxone comparison cover the two main treatment options.

You can find treatment and local support through FindTreatment.gov, the SAMHSA National Helpline at 1-800-662-4357 (free, confidential, 24/7), or the resources on our help page. If you or someone near you is in crisis right now, call or text 988 any time.

Frequently asked questions