How to Use Naloxone Nasal Spray for Opioid Overdose: A Step-by-Step Guide

What Naloxone Nasal Spray Does in an Opioid Overdose

Naloxone nasal spray, commonly known by the brand name NARCAN, is the fastest way to reverse an opioid overdose. It doesn’t cure addiction. It doesn’t treat pain. It doesn’t work on alcohol, benzodiazepines, or cocaine. But when someone stops breathing because of opioids - heroin, fentanyl, oxycodone, or any other opioid - naloxone can bring them back to life in minutes.

It works by kicking opioids off the brain’s receptors. Opioids bind to these receptors and slow down breathing until it stops. Naloxone is stronger than most opioids in binding to those same spots. When you spray it up the nose, it rushes into the bloodstream and starts working in 2 to 5 minutes. That’s often enough time to get someone breathing again before emergency help arrives.

In 2022, over 81,000 people in the U.S. died from opioid overdoses. Fentanyl was involved in nearly 90% of those deaths. And fentanyl is so powerful that one tiny dose can kill. That’s why having naloxone on hand isn’t just smart - it’s life-or-death.

Recognizing an Opioid Overdose

You don’t need to be a doctor to spot an overdose. Look for three clear signs:

• Slow or stopped breathing - fewer than 12 breaths per minute, or no chest movement for 15 seconds
• Unresponsive - shaking their shoulder, yelling their name, or rubbing your knuckles hard on their sternum (center of chest) won’t wake them up
• Pinpoint pupils - pupils so small they look like pinpricks, even in dim light

Blue or gray lips and fingernails mean oxygen isn’t reaching the skin. Cold, clammy skin is another red flag. If you see any of these, assume it’s an opioid overdose - even if you’re not sure. Naloxone is safe to use even if opioids aren’t the cause. It won’t hurt someone who didn’t take opioids.

Step-by-Step: How to Use Naloxone Nasal Spray

Here’s exactly what to do. Do this in order. Don’t skip steps.

1. Call 911 immediately. Don’t wait. Don’t think you can handle it alone. Emergency responders need to come. Naloxone wears off in 30 to 90 minutes. Fentanyl can stay in the body for hours. The person could stop breathing again after naloxone wears off.
2. Position the person on their back. Tilt their head back slightly to open the airway. This helps them breathe easier once naloxone kicks in.
3. Take the nasal spray out of the box. Don’t press the plunger yet. The device is ready to use - no assembly needed. If you accidentally press it before use, you’ve wasted the dose.
4. Insert the nozzle into one nostril. Gently slide the tip in until your fingers touch the bottom of the nose. Don’t jam it in. About half an inch to one inch is enough.
5. Press the plunger firmly. Push all the way down until you hear a click. This delivers the full 4 mg dose. If you don’t press all the way, you won’t get the full dose. Studies show 18% of first-time users don’t press hard enough.
6. Remove the spray and wait 2 to 3 minutes. Watch for signs of breathing. Is their chest rising? Are they moaning or moving? If they start breathing normally, you’re on the right track.
7. If there’s no response, give a second dose. Use a new spray and put it in the other nostril. Don’t wait longer than 3 minutes. Fentanyl overdoses often need two or even three doses. CDC data shows 32% of fentanyl overdoses require more than one dose.
8. Place them in the recovery position. If they start breathing but stay unconscious, roll them gently onto their side. Bend the top knee to keep them stable. This keeps their airway open and prevents choking if they vomit.
9. Stay with them for at least 4 hours. Even if they wake up, don’t leave. Opioids like fentanyl or carfentanil last longer than naloxone. They can slip back into overdose. Emergency services will monitor them, but you need to stay until they arrive.

What Happens After You Give Naloxone

Some people wake up angry. They might yell, hit, or try to run. That’s not because they’re mean - it’s because naloxone pulls opioids out of their system fast. It causes sudden, intense withdrawal. Symptoms include nausea, vomiting, sweating, shaking, and extreme pain. They’re terrified. Don’t take it personally. Stay calm. Keep them safe.

They may say, “I’m fine now.” Don’t believe them. Naloxone only lasts 30 to 90 minutes. Fentanyl can stay active for 4 to 6 hours. Without medical care, they could die again.

Paramedics will likely give more naloxone, oxygen, or IV fluids. They may also give other medications to stabilize heart rate and breathing. That’s why calling 911 is non-negotiable.

Common Mistakes and How to Avoid Them

Even with clear instructions, people make mistakes in high-stress moments.

• Mistake: Waiting to call 911 until after giving naloxone. Solution: Call first. Always. Even if you think you’re alone, someone else can call while you administer the spray.
• Mistake: Not pressing the plunger all the way. Solution: Practice with a training device. Many pharmacies and community centers give free practice sprays that don’t contain medicine.
• Mistake: Assuming one dose is enough. Solution: Always have two sprays ready. If the first doesn’t work, use the second - and be ready for a third.
• Mistake: Leaving the person alone after they wake up. Solution: Stay until EMS arrives. Even if they seem fine, they’re not out of danger.

Where to Get Naloxone Nasal Spray

Since August 2023, NARCAN Nasal Spray has been available over-the-counter at pharmacies across the U.S. - no prescription needed. You can buy it at CVS, Walgreens, Rite Aid, Walmart, and many independent drugstores. Look for it next to the pain relievers or first aid section.

Cost varies. A two-pack usually runs $45 to $140 without insurance. Some states offer free kits through public health programs. Check with your local health department. Many community centers, needle exchanges, and harm reduction groups give them away for free.

Keep one in your car. One in your bag. One at work. One with your loved ones. If you know someone who uses opioids - even if they’re in recovery - keep naloxone nearby.

Why This Matters

Naloxone isn’t just a drug. It’s a tool for saving lives. In communities where naloxone is widely available, overdose deaths drop by 14%. In 2022, naloxone reversed over 27,000 overdoses in the U.S. That’s 27,000 people who went home to their families because someone knew how to use it.

You don’t need to be a medic. You don’t need to be brave. You just need to know what to do. And now you do.

What to Do If Naloxone Doesn’t Work

If you’ve given two doses and there’s still no response, keep doing what you can:

• Continue rescue breathing - pinch the nose, seal your mouth over theirs, give one breath every 5 seconds.
• Keep checking for a pulse. If there’s none, start chest compressions.
• Don’t stop until help arrives.

Naloxone isn’t magic. It only works on opioids. If someone overdosed on something else - like a high dose of benzodiazepines or alcohol - naloxone won’t help. But if they took opioids, even mixed with other drugs, it still works. And if you’re unsure? Give it anyway. It’s safe.

Training and Practice

Watching a 5-minute video can get you 87% of the way to using naloxone correctly. But practicing with a trainer device makes you 98% confident. Many local health departments, pharmacies, and nonprofits offer free 15-minute trainings. Ask for one. Bring a friend. Practice the steps out loud: Call. Position. Insert. Press. Wait. Repeat.

There’s no shame in needing to rehearse. Firefighters train for fires. Police train for gunshots. You’re training to save a life. That’s worth 15 minutes of your time.