Naloxone is a medication that reverses opioid overdoses, and anyone can administer it without medical training. It comes in two main forms available without a prescription: a nasal spray and an injectable. Both work by blocking opioids from binding to receptors in the brain, restoring normal breathing within minutes. Here’s exactly how to use each form and what to do before, during, and after.
Recognizing an Opioid Overdose
Before reaching for naloxone, you need to know what an overdose looks like. The most dangerous sign is slowed or stopped breathing. A person who has overdosed on opioids will typically be unresponsive or extremely difficult to wake. Their pupils will shrink to tiny pinpoints. Their skin may feel cold and clammy, and their lips or fingernails may turn blue or purple. If someone shows these signs, call 911 immediately, then administer naloxone. Don’t wait to see if they “sleep it off.”
How to Use the Nasal Spray
The nasal spray (sold as Narcan and generic versions) is the most common form carried by bystanders, and it requires no assembly or dosing decisions. Each device contains a single pre-measured dose and cannot be reused.
Start by removing the nasal spray from its box and peeling back the tab with the circle to open the packaging. Do not prime or test the device, as this will waste the only dose inside. Lay the person on their back. Support the back of their neck with one hand and let their head tilt slightly backward.
Hold the device with your thumb on the bottom of the plunger and your index and middle fingers on either side of the nozzle. Gently insert the tip of the nozzle into one nostril until your fingers touch the base of the person’s nose. Press the plunger firmly to release the full dose. Then remove the device from the nostril.
That’s it. The entire process takes about 10 seconds once the packaging is open.
How to Use the Injectable Form
Injectable naloxone comes as either a prefilled auto-injector or a prefilled syringe. The auto-injector version includes a built-in speaker that gives step-by-step voice instructions as you use it, which is helpful under stress.
For both injectable forms, the target site is the outer thigh. You can inject directly through clothing if needed, so there’s no reason to delay by removing pants or jeans. Remove the safety guard only when you’re ready to inject. Press the device firmly against the outer thigh and hold it in place until you hear or feel the click confirming the dose has been delivered.
For infants under one year old, pinch the thigh muscle before injecting to ensure the medication reaches muscle tissue rather than just fat.
How Quickly Naloxone Works
The nasal spray typically takes effect within 3 to 5 minutes. Injectable naloxone given into muscle works in 2 to 5 minutes. Intravenous naloxone, used in hospital settings, acts within 1 to 2 minutes. For bystander use, expect to wait a few minutes before seeing signs of improvement like resumed breathing, increased alertness, or movement.
The critical limitation of naloxone is that its effects are short-lived. It blocks opioid receptors for roughly 20 to 90 minutes, while most opioids stay active in the body far longer. This means a person can slip back into overdose after naloxone wears off. This is why calling 911 is essential even if the person initially wakes up.
When to Give a Second Dose
If the person doesn’t respond within 2 to 3 minutes, give a second dose. Use a new nasal spray device in the other nostril, or administer another injection. Overdoses involving fentanyl and other potent synthetic opioids often require multiple doses because these drugs bind to opioid receptors more aggressively.
Even after the person responds, watch them closely. Repeat doses may be needed within one to two hours depending on the type and amount of opioid involved. Fentanyl and long-acting opioids are especially likely to outlast naloxone’s window of protection, so stay with the person until emergency medical services arrive.
What to Do After Giving Naloxone
Once the person begins breathing on their own, place them in the recovery position: on their side with their top leg bent at the knee. This prevents choking if they vomit, which is common as the opioids are rapidly displaced from their receptors. If you need to leave the person for any reason, make sure they are in this position first.
Be prepared for the person to wake up confused, agitated, or in withdrawal. Naloxone strips opioids from brain receptors almost instantly, which can trigger symptoms like nausea, sweating, and body aches. These withdrawal effects typically fade within 30 to 60 minutes. The person may not understand what happened or may resist help. Stay calm, explain that they overdosed, and keep them from using more opioids, which could trigger another overdose once the naloxone wears off.
Storing Naloxone Properly
Naloxone nasal spray has a shelf life of four years from the date of manufacture for currently produced units. Store it at room temperature and out of direct sunlight. Don’t keep it in a car glovebox during summer or anywhere it might be exposed to extreme heat or freezing cold for prolonged periods. Check the expiration date periodically and replace expired kits. Even expired naloxone is better than no naloxone in an emergency, but a fresh supply is more reliable.
Legal Protections for Bystanders
Good Samaritan laws in most states protect both the person experiencing an overdose and anyone who helps them from criminal penalties. These laws exist specifically to encourage bystanders to call 911 and administer naloxone without fear of legal consequences. Naloxone is available without a prescription at most pharmacies, and many community organizations distribute it for free.