You do not need medical training to use Narcan nasal spray. It was specifically designed for bystander use.
Step 1: Recognize an Opioid Overdose
Signs of opioid overdose: unresponsive or unconscious (won't wake up when called or stimulated), slow, shallow, or stopped breathing, blue or grayish lips or fingertips (cyanosis), gurgling or snoring sounds (death rattle), pinpoint pupils, pale, clammy skin. If you see these signs, act immediately. Every minute matters.
Step 2: Call 911 Immediately
Call 911 before administering Narcan. Naloxone wears off in 30–90 minutes, shorter than most opioids, meaning the overdose can return. Emergency services are needed regardless. Most states have Good Samaritan laws protecting callers from arrest. Tell the dispatcher 'someone is unresponsive and I think it's an opioid overdose.'
Step 3: Try to Rouse the Person
Try to wake them: call their name loudly, perform a sternal rub (knuckles pressed firmly against the breastbone). If there is no response, proceed to administer Narcan.
Step 4: Administer Narcan Nasal Spray
Remove the Narcan device from packaging. Lay the person on their back. Hold the device with your thumb on the bottom and two fingers on the nozzle. Tilt their head back slightly, support the neck. Insert the nozzle into one nostril until your fingers touch the bottom of the nose. Press the plunger firmly to release the full dose.
Step 5: Recovery Position
Place the person in the recovery position (on their side) to prevent choking if they vomit. Stay with them and monitor breathing.
Step 6: Give a Second Dose if Needed
If there is no response (no improvement in breathing, no waking) within 2–3 minutes, give a second dose in the other nostril. With high-potency fentanyl, multiple doses may be needed. Repeat every 2–3 minutes until the person responds or emergency services arrive.
Step 7: After Naloxone Works
When naloxone works, the person may wake up confused, agitated, or in withdrawal. Explain calmly: 'You overdosed. I gave you Narcan. Help is coming.' Don't leave them alone, the overdose can return as naloxone wears off before the opioids do. They need emergency evaluation even if they feel okay.
Rescue Breathing
If the person is not breathing after stimulation and before Narcan takes effect, provide rescue breathing: tilt the head back, lift the chin, give one breath every 5 seconds. Continue until Narcan takes effect or emergency services arrive.
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Download Forge FreeFrequently Asked Questions
How do you use Narcan nasal spray?
Insert the nozzle into one nostril, press firmly to deliver the full dose. If no response in 2–3 minutes, give a second dose in the other nostril. Always call 911 first and stay with the person.
How fast does Narcan work?
Narcan typically takes effect within 2–5 minutes. If there's no response after 2–3 minutes, administer a second dose.
What happens after you give Narcan?
The person may wake up confused, agitated, or in withdrawal. They may not remember what happened. Stay with them, the overdose can return as Narcan wears off. Emergency services are still needed.
Can you give too much Narcan?
No. You cannot overdose on naloxone. It's safe to give multiple doses. With fentanyl, 2–3 or more doses may be necessary.
What is the recovery position?
Lay the person on their side with their top knee bent forward to prevent rolling. This position prevents choking if they vomit. Use it after administering Narcan while waiting for emergency services.
Does Narcan work if swallowed?
Narcan nasal spray is not effective if swallowed, it's not absorbed through the digestive system in meaningful quantities. It must be administered as a nasal spray (absorbed through the nasal mucosa) or by injection.
What if I don't have Narcan during an overdose?
Call 911 immediately. Perform rescue breathing if the person is not breathing (one breath every 5 seconds). Keep them on their side if breathing. Try to rouse them. Stay with them. Without naloxone, survival depends on emergency services arriving in time.
Is it safe to use Narcan on a child?
Yes, Narcan is safe for children who have taken opioids. Use the same technique. For children under 1 year, emergency medical care is urgent, call 911 immediately.
How do you use Narcan nasal spray step by step?
Narcan nasal spray, step-by-step: step 1: recognize the signs of overdose, person is unresponsive, breathing is slow, shallow, or absent, lips or fingertips are blue or gray, pinpoint (tiny) pupils, snoring or gurgling sounds. Step 2: call 911 immediately. Step 3: lay the person on their back, support the neck and tilt the head back slightly to open the airway. Step 4: peel back the foil on the Narcan package. Hold device with thumb on bottom, two fingers on nozzle. Insert nozzle into one nostril. Press plunger firmly with your thumb. This releases the full dose. Step 5: place the person in the recovery position (on their side, upper knee bent forward) to prevent choking if they vomit. Step 6: if no response in 2-3 minutes, administer a second dose into the other nostril. Step 7: when the person responds, they may wake confused, agitated, in withdrawal, stay calm, stay with them, don't let them use more opioids. Step 8: wait for emergency services, naloxone wears off in 30-90 minutes.
How do you recognize an opioid overdose?
Recognizing opioid overdose: classic signs: unresponsive, won't wake up when you call their name or shake them firmly, slow, shallow, or absent breathing, fewer than one breath every 5 seconds, pinpoint pupils, very small, even in a dark room, blue, purple, or gray lips, fingertips, or face (cyanosis), pale, cool, and clammy skin, snoring, gurgling, or choking sounds (the 'death rattle' sound). Test for responsiveness: call their name loudly, rub knuckles firmly on the sternum (breastbone), flick the earlobe, pinch the skin. If no response to these stimuli, treat as an overdose. What overdose is NOT: overdose is not simply being very intoxicated (slurred speech, unsteady walking), an overdose is a medical emergency where breathing is compromised. Time is critical: brain damage from oxygen deprivation begins within 4-6 minutes of stopped breathing. Fentanyl overdoses can progress from apparent intoxication to stopped breathing very rapidly, act quickly.
What are the signs that Narcan is working?
Signs that naloxone is working: onset: naloxone typically begins working within 2-5 minutes of administration. Signs of reversal: the person begins to breathe more normally (watch the chest rise and fall, listen for breath sounds), skin color improves from blue/gray to pink, the person may start to move, moan, or respond to stimulation, pupils may enlarge (less pinpoint). Full reversal: the person regains consciousness, is confused or agitated, may be in withdrawal (nausea, vomiting, muscle cramps, sweating). What happens after reversal: the person may be combative or try to leave, stay with them and explain what happened. They will likely not want emergency care but transport is important. Important: do not let them use more opioids, additional opioid use with naloxone active will either precipitate more withdrawal or, when the naloxone wears off, cause re-overdose. If no response in 2-3 minutes: administer a second dose, continue rescue breathing.
How many times can you give Narcan?
Naloxone repeat dosing: there is no ceiling dose for naloxone. You can administer multiple doses as needed without risk of overdose from naloxone itself. Standard approach: administer one dose (one nasal spray), wait 2-3 minutes, if no response, administer second dose in the other nostril. For fentanyl overdoses: multiple doses are often required, give second dose immediately after the first (per updated guidance for fentanyl). Continue administering doses every 2-3 minutes until the person responds or emergency services arrive. How many to have: standard 2-dose packs are the minimum, 4 doses is recommended for suspected fentanyl overdoses. Safety: additional doses cause no harm if the person doesn't have opioids in their system (no effect) or accelerate withdrawal reversal if they do. The practical limit: the number of doses you have available. Replenish immediately after use through pharmacies, NEXT Distro, or local health programs.
What do you do after giving Narcan?
After administering naloxone: monitor breathing: watch chest rise and fall, listen for breath sounds, normal rate is 12-20 breaths/minute. Recovery position: keep the person on their side (recovery position) to prevent aspiration if vomiting occurs. Stay with them: do not leave the person alone. Communicating with the person when they wake: they will likely be confused, frightened, or agitated. Say clearly: 'You had an overdose. This is naloxone. It saved your life. Please don't use any more drugs right now. It will make you overdose again.' Manage agitation: speak calmly, don't restrain unless necessary for safety, explain repeatedly what happened. Do not let them leave: naloxone wears off in 30-90 minutes, if fentanyl was involved, re-overdose is very likely. Wait for EMS: ensure emergency services arrive and transport the person to an emergency department for monitoring. After the event: this is a significant opportunity for treatment engagement. Many overdose survivors are open to help in the days immediately following.
Can you give Narcan if you're not sure it's an overdose?
Naloxone when unsure of overdose: yes, if you suspect an opioid overdose and the person is unresponsive, administer naloxone. The safety logic: naloxone has essentially no effect on people without opioids in their system. The risk of not giving it to someone who IS overdosing is death or brain damage from oxygen deprivation. The risk of giving it to someone who is NOT overdosing is essentially zero (no clinical effect in opioid-naive individuals, withdrawal precipitation in opioid-dependent conscious individuals, which is unpleasant but not life-threatening). The rule: if in doubt, give it. The FDA's OTC approval was based on this principle, lay people can and should administer naloxone whenever opioid overdose is possible without requiring certainty. Practical signs pointing to overdose: unresponsiveness that cannot be roused, slow, shallow, or absent breathing, pinpoint pupils, blue or pale lips. Any combination of these warrants naloxone administration.
What is the difference between Narcan and Evzio?
Narcan vs. Evzio: both are naloxone products for community use, they differ in delivery method. Narcan (4mg nasal spray): nasal spray device, no needles, easy to use, most widely distributed, the standard community naloxone product. Kloxxado (8mg nasal spray): higher-concentration nasal spray, designed for fentanyl, growing in use. Evzio (0.4mg auto-injector): auto-injector with audio voice instructions ('Pull off the red safety guard.. Inject into outer thigh.. You may inject through clothing'), designed for people who have never used it before, the voice instructions guide them through the process, delivers naloxone intramuscularly. Evzio advantages: voice guidance is particularly useful in a panic situation, IM injection may be faster-acting than intranasal in some cases. Evzio disadvantages: more expensive than Narcan, needle-based (though auto-injector). Availability: Narcan is far more widely available OTC, Evzio is prescription. For most community members: Narcan nasal spray is the recommended choice.
Can Narcan be used on someone who is unconscious?
Narcan for unconscious person: yes, administering naloxone to an unconscious person is appropriate and the primary scenario for which it is designed. The unconscious person is the standard overdose presentation. They cannot consent, but administration is clearly warranted under the implied consent doctrine for medical emergencies. Technique for unconscious person: lay on back, support neck, tilt head back to open airway, insert nozzle into nostril, depress plunger. No ability to hold the nose: unlike some intranasal medications, Narcan is designed to work with normal breathing or even in the absence of active breathing. If person is not breathing: begin rescue breathing while naloxone takes effect. This is the most important concurrent action. Recovery position: once breathing returns, immediately move to recovery position (on side, upper knee forward) to prevent aspiration. The unconscious opioid-overdose person is the core use case for community naloxone, the product was designed and tested specifically for this scenario.
What should I tell someone after they recover from an overdose?
Communicating with an overdose survivor: what to say: keep it clear, calm, and brief, the person is confused and may be in withdrawal. 'You had an overdose. I gave you Narcan. You stopped breathing. Please don't use any more drugs right now. You could overdose again when the Narcan wears off.' Key messages: explain what happened (many people have no memory of overdosing). The danger of using more: naloxone is wearing off, using more opioids while naloxone is present is dangerous. Tolerance reset: if they hadn't used for any period (prison, hospital, treatment), their tolerance is lower than they think, the same amount that was 'normal' before may now be fatal. Treatment: 'I'd like to help you get some support if you want it. Can I help you call someone?' What NOT to say: don't lecture, shame, or make the moment about your feelings. This is a brief window of openness, non-judgmental, practical communication is most likely to result in treatment engagement. Crisis line: if they're open to talking, 988 (Substance Use and Mental Health Crisis Line) is available.
Does Narcan wear off and what happens then?
Naloxone wearing off: naloxone has a half-life of approximately 60-90 minutes. As it wears off: the opioid receptors become available again, if opioids are still present in the system (which they are with fentanyl, long-acting opioids, or when the person used more after the first dose), the person can re-enter an overdose state. Re-overdose risk: this is one of the most important post-naloxone concerns. Fentanyl is a major risk. It lasts 4-8 hours, standard naloxone lasts 1-2 hours. Timeline: re-overdose can occur 30-90 minutes after initial naloxone administration. Monitoring: this is why continuous monitoring and EMS transport are critical, an emergency room can administer repeated naloxone doses IV if needed. The patient's behavior: an overdose survivor who feels better after naloxone may want to leave immediately, including to use more. This is extremely dangerous. The goal: transport to emergency care or maintain monitoring for at least 2-4 hours after the last naloxone dose with re-dosing available.
What is fentanyl test strips and how do they relate to Narcan?
Fentanyl test strips and naloxone, harm reduction pairing: fentanyl test strips (FTS) are a harm reduction tool used to detect fentanyl in drugs before use. How they work: dissolve a small amount of the drug in water, dip the test strip, one line = fentanyl detected, two lines = no fentanyl detected. Why they matter alongside naloxone: fentanyl's presence in diverse drug supplies means that overdose risk is present even for people using 'non-opioid' drugs. FTS allow people to make informed decisions. However: FTS cannot detect all fentanyl analogs (carfentanil and some novel analogs), a negative test does not eliminate risk. Naloxone as backup: even with negative FTS, carrying naloxone is still recommended, FTS are not 100% sensitive. The combined approach: FTS + naloxone + a person who knows to administer it + 911 access = the most comprehensive individual-level overdose prevention. Legal status: FTS are legal in most US states now, some states still classify them as drug paraphernalia, check your state's law.
What resources exist for getting naloxone training?
Naloxone training resources: online training (free, 10-30 minutes): NEXT Distro (nextdistro.org), video training on overdose recognition and naloxone administration, Harm Reduction Coalition (harmreduction.org), comprehensive overdose prevention training, GetNaloxone.org, straightforward naloxone use guide and state-specific access information. In-person training: local health departments often offer free 30-60 minute trainings, harm reduction programs and needle exchanges, Recovery Community Organizations (RCOs), many fire departments and community organizations now offer trainings. Professional training: EMS and first responder naloxone training, medical and nursing schools, pharmacies (CVS and Walgreens offer brief training at point of purchase). App-based: the Harm Reduction Coalition has resources, several state health departments have app-based guides. After training: carry your naloxone with you, know where it is, tell people you're with that you have it. Refresh training annually or if you haven't reviewed the procedure recently.