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

When someone overdoses on opioids, every second counts. Their breathing slows, then stops. Their skin turns blue. They don’t wake up, no matter how much you shake them. This isn’t a dream-it’s real, and it’s happening more often than most people realize. In 2022, over 81,000 people in the U.S. died from opioid overdoses. Most of those deaths involved synthetic opioids like fentanyl, which are so powerful that even a tiny amount can shut down breathing. But here’s the good news: naloxone nasal spray can reverse an overdose in minutes. And you don’t need to be a doctor to use it.

What Naloxone Nasal Spray Does

Naloxone nasal spray, commonly known by the brand name NARCAN, works by kicking opioids off the brain’s receptors. It doesn’t cause a high. It doesn’t work on alcohol, benzodiazepines, or cocaine. It only reverses the effects of opioids-heroin, fentanyl, oxycodone, methadone, and others. Within 2 to 5 minutes, it can bring someone back to breathing normally. That’s the window you need to keep them alive until emergency help arrives.

The spray delivers exactly 4 mg of naloxone in a single puff. It’s pre-filled, no assembly needed. It’s designed to be used by anyone-even someone who’s never seen it before. The FDA approved it for over-the-counter sale in March 2023, and since then, pharmacies like CVS and Walgreens have made it widely available without a prescription.

Recognizing an Opioid Overdose

You can’t wait for someone to pass out before acting. By then, it might be too late. Look for these signs:

• Slow, shallow, or stopped breathing (fewer than 12 breaths per minute)
• Unresponsive to loud voices or physical stimulation (try rubbing your knuckles hard on their sternum for 5-10 seconds)
• Pinpoint pupils (very small, dark circles in the center of the eyes)
• Blue or gray lips and fingernails
• Limp body, snoring or gurgling sounds

If you see even one or two of these, assume it’s an opioid overdose. Don’t wait for all of them. Don’t worry if you’re not sure. Naloxone is safe-even if the person didn’t take opioids, it won’t hurt them.

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

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

1. Call 911 immediately. Even if you’re about to give naloxone, call first. Emergency responders need to know what’s happening. Tell them: “Someone has overdosed on opioids. I’ve given naloxone.”
2. Position the person on their back. Tilt their head back slightly to open the airway. This helps them breathe easier after the naloxone kicks in.
3. Remove the spray from its packaging. Don’t press the plunger yet. Hold it like a pen, with your thumb on the plunger and your fingers around the nozzle. The device is single-use-only one spray per device.
4. Insert the nozzle into one nostril. Gently slide it in until your fingers touch the bottom of their nose. Don’t force it. About half an inch to one inch is enough.
5. Press the plunger all the way down. Give one full, firm push. You should hear a click. This means the full dose was delivered. Don’t pull it out until you’ve pressed all the way.
6. Remove the device and wait 2-3 minutes. Watch their chest. Are they breathing? Is color returning to their lips? If they start breathing on their own, turn them onto their side into the recovery position.
7. If no response after 3 minutes, give a second dose. Use a new nasal spray in the other nostril. Fentanyl and other strong opioids often require more than one dose. The CDC says 32% of fentanyl overdoses need two or more doses.
8. Place them in the recovery position. If they’re breathing but still unconscious, roll them gently onto their side. Bend the top knee and rest their head on their arm. This keeps their airway open and prevents choking if they vomit.
9. Stay with them for at least 4 hours. Naloxone wears off in 30 to 90 minutes. Opioids like fentanyl can stay in the body much longer. They could stop breathing again. Don’t leave them alone. Keep monitoring their breathing. If they stop again, give another dose.

What Happens After Naloxone?

Once naloxone works, the person may wake up confused, scared, or angry. They might feel sick. That’s normal. The sudden withdrawal from opioids can cause nausea, vomiting, sweating, and agitation. Don’t argue with them. Stay calm. Reassure them that help is coming.

Some people refuse to go to the hospital after being revived. That’s dangerous. Even if they seem fine, they’re at risk of re-overdosing once the naloxone wears off. Paramedics can give them more naloxone, monitor their breathing, and connect them to treatment resources.

Common Mistakes and How to Avoid Them

Most people who use naloxone for the first time get it right-but some don’t. Here’s what goes wrong:

• Not calling 911 first. Naloxone isn’t a cure. It’s a bridge. Emergency services are still needed.
• Not pressing the plunger fully. If you only push halfway, you might give less than half the dose. Practice with a training device if you can.
• Delaying because you’re unsure. If someone is unresponsive and breathing poorly, give naloxone. It’s safe. It won’t hurt them if they didn’t take opioids.
• Stopping after one dose. Fentanyl is strong. You might need two or even three doses. Don’t assume one spray is enough.
• Leaving them alone after they wake up. They’re not out of danger yet. Stay with them until EMS arrives.

How to Keep Naloxone Ready

Naloxone works best when it’s ready to go. Store it at room temperature-between 68°F and 77°F (20°C-25°C). Don’t leave it in a hot car or freezing glove compartment. It lasts 2 years if stored properly.

Keep it in an easy-to-reach place: your coat pocket, your car’s glove box, your work bag. Don’t tuck it away in a drawer. If you’re someone who uses opioids, or if you know someone who does, carry two doses. One might not be enough.

Some pharmacies give out free naloxone kits. Community centers, needle exchanges, and even some libraries in cities across the U.S. offer them. Ask for them. No questions asked.

Real Stories, Real Results

In September 2023, a man in Ohio used NARCAN to save his brother after finding him unresponsive. He gave the first spray, waited 3 minutes, saw no change, then gave a second dose in the other nostril. His brother started breathing at 8:23 p.m. EMS arrived at 8:28 p.m. He’s alive today because two doses were used when one wasn’t enough.

Another person in Oregon gave three doses of naloxone over 10 minutes to someone overdosing on fentanyl. The person didn’t respond fully until paramedics arrived and gave IV naloxone. That’s why emergency help is still critical-even after naloxone.

Amazon reviews show 4.5 out of 5 stars. Most people say it’s simple to use. But some complain about the cost-around $140 for a two-pack without insurance. Still, many states offer free naloxone through public health programs. Call your local health department. Ask for it. It’s your right.

Why This Matters

Naloxone nasal spray isn’t magic. It doesn’t fix addiction. But it gives people a second chance. Community programs that hand out naloxone have been shown to reduce overdose deaths by 14% in the areas where they’re used. In 2022, naloxone saved an estimated 27,000 lives in the U.S. The CDC says universal access could save 23,000 to 30,000 more every year.

And it’s not just for drug users. It’s for parents, teachers, friends, coworkers. Anyone who might be around someone who uses opioids-even once. You don’t need to be brave. You just need to know what to do.

What to Do Next

If you’ve never held a naloxone nasal spray, get one. Go to your local pharmacy. Ask for NARCAN. If they say you need a prescription, tell them it’s available over the counter. If they don’t have it, ask them to order it. Most will.

Watch a 2-minute video on how to use it. The CDC and SAMHSA have free ones online. Practice with a trainer device if you can find one. Some harm reduction groups give them out for free.

Carry two doses. Teach one person how to use it. Keep it accessible. And if you ever see someone who looks like they’ve overdosed-don’t hesitate. Call 911. Give the spray. Stay with them. You could be the reason they live to see tomorrow.