Rescuers can administer naloxone in three ways: as a nasal spray, a manual intramuscular injection, or an auto-injector into the thigh. No medical training is required for any of these methods, and all 50 states plus Washington, D.C. have laws that protect people who use naloxone in an emergency. The steps differ slightly depending on the form you have, but the core process is the same: recognize the overdose, give the dose, call 911, and monitor breathing.
Recognizing an Opioid Overdose
Before reaching for naloxone, you need to confirm that the person is showing signs of an opioid overdose rather than simply being asleep or intoxicated from something else. The key indicators are:
- Pinpoint pupils that are unusually small, even in dim lighting
- Slow, shallow breathing or breathing that has stopped entirely
- Skin color changes: bluish-purple lips, fingernails, or skin on lighter-skinned people, or a grayish, ashen tone on darker-skinned people
- Unresponsiveness to loud voices, sternal rubs, or pain
If someone shows these signs and won’t wake up when you shout their name or rub your knuckles hard on their breastbone, treat it as an overdose. Naloxone only affects opioids, so giving it to someone who hasn’t taken opioids won’t cause harm.
Using a Nasal Spray
The nasal spray is the most common form of naloxone carried by bystanders. Each device is preloaded with a single 4 mg dose in a tiny 0.1 mL volume, so there’s nothing to measure or assemble. Here’s the process:
Lay the person on their back. Peel the packaging open and hold the device with your thumb on the bottom of the plunger and two fingers on the nozzle. Tilt the person’s head back slightly, insert the nozzle into one nostril until your fingers touch the bottom of their nose, and press the plunger firmly. That single press delivers the full dose. You don’t need to check which nostril or worry about which side, just pick one.
After spraying, immediately roll the person onto their side into the recovery position. This prevents choking if they vomit, which is common when naloxone takes effect. Bend their top knee forward to keep them stable.
Giving an Intramuscular Injection
Some naloxone kits come as a vial of liquid and a separate syringe. This requires a few more steps but works just as well. Pop the orange cap off the vial and push the needle through the rubber stopper at the top. Turn the vial upside down and pull back on the plunger to draw all the liquid into the syringe. Make sure you’re drawing fluid, not air. If you see air bubbles, tap the syringe and push them back out before injecting.
The two recommended injection sites are the outer shoulder (the same spot where you’d get a flu shot) and the front of the thigh. Push the needle straight in at a 90-degree angle. You can inject through clothing if needed, so don’t waste time rolling up sleeves or removing pants. Press the plunger all the way down, withdraw the needle, and place the person in the recovery position.
Using an Auto-Injector
Auto-injectors are designed to be as simple as possible. Pull off the safety guard, place the device firmly against the outer thigh, and press down. Push the plunger all the way until it clicks, then hold it in place for 2 seconds before removing. Like the manual injection, this can go through clothing and targets the thigh muscle.
What Happens After the First Dose
Naloxone works fast. When injected into muscle, it takes effect within 2 to 5 minutes. The nasal spray follows a similar timeline. Once it kicks in, naloxone competes with opioid molecules for the same receptor sites in the brain, essentially shouldering the opioids aside and restoring normal breathing.
Here’s the critical problem: naloxone wears off much faster than most opioids do. It blocks opioid receptors for only 20 to 90 minutes, while drugs like fentanyl, heroin, and morphine remain active in the body far longer. This means a person can slip back into overdose after the naloxone fades. That gap is the reason you call 911 even if the person wakes up and seems fine.
When and How to Give a Second Dose
If the person hasn’t responded within 2 to 3 minutes of the first dose, give a second one. For nasal spray, use a new device and spray into the other nostril. For injections, use a fresh syringe and vial if available. You can continue giving additional doses every 2 to 3 minutes until emergency help arrives, as long as you have supplies.
High-potency opioids like fentanyl sometimes require multiple doses because they bind tightly to receptors and are present in larger quantities. If one dose doesn’t restore breathing, don’t assume the naloxone isn’t working. Keep going.
Caring for the Person While You Wait
Between doses, keep the person in the recovery position on their side with their mouth angled toward the ground. If they’re not breathing at all and you’re trained in rescue breathing, give one breath every 5 seconds. Stay with them until paramedics arrive, even if they wake up. People revived with naloxone often feel confused or agitated, and some experience withdrawal symptoms like nausea, sweating, and rapid heartbeat. These are uncomfortable but not dangerous, and they typically fade within 30 to 60 minutes as the naloxone leaves the body.
The person may want to leave or refuse further help. Try to keep them nearby and explain that the overdose can return once the naloxone wears off. If you absolutely must leave before help arrives, make sure they’re on their side so they won’t choke.
Legal Protections for Rescuers
All 50 states and Washington, D.C. have naloxone access laws that protect people who administer the drug in good faith during an emergency. Forty-seven states and D.C. also have Good Samaritan laws that extend additional legal protection to bystanders who help during a drug overdose, including some degree of protection for the person experiencing the overdose. Kansas, Texas, and Wyoming lack a specific Good Samaritan overdose law but still have naloxone access protections in place. You do not need a prescription to carry or use naloxone in any U.S. state.