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

When someone overdoses on opioids, every second counts. Their breathing slows, stops, or becomes dangerously shallow. Their skin turns blue or gray. They don’t respond to shouts or shaking. In these moments, naloxone nasal spray can bring them back - if you know how to use it.

Naloxone, sold under the brand name NARCAN, isn’t a cure. It doesn’t treat addiction. But it does one vital thing: it reverses the life-threatening effects of an opioid overdose. Since March 2023, you no longer need a prescription to buy it. You can find it on pharmacy shelves next to pain relievers. That means anyone - a parent, a friend, a stranger - can have it ready when it matters most.

What Naloxone Does (And What It Doesn’t)

Naloxone works by kicking opioids off the brain’s receptors. Opioids like heroin, fentanyl, oxycodone, and morphine bind to these receptors and slow breathing. Naloxone is stronger. It pushes them aside, letting the person breathe again. It kicks in within 2 to 5 minutes. But here’s the catch: its effects last only 30 to 90 minutes. Fentanyl and other synthetic opioids? They stick around much longer. That’s why a single dose often isn’t enough.

Naloxone doesn’t work on alcohol, benzodiazepines, or stimulants like cocaine. If someone overdoses on those, naloxone won’t help. But if you’re unsure - if you suspect opioids are involved - give it anyway. It’s safe. It won’t hurt someone who didn’t take opioids.

Recognizing an Opioid Overdose

You don’t need medical training to spot the signs. Look for these three key indicators:

• Slow or stopped breathing - fewer than 12 breaths per minute, or no chest movement for 15 seconds.
• Unresponsiveness - yelling their name, shaking their shoulders, or rubbing their sternum with your knuckles for 5-10 seconds gets no reaction.
• Pinpoint pupils and blue or pale skin, especially around the lips or fingernails.

If you see even one of these, assume it’s an overdose. Don’t wait. Don’t second-guess. Act.

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

Each spray delivers 4 mg of naloxone in a single, pre-filled, easy-to-use device. No needles. No assembly. Just follow these steps.

1. Call 911 immediately. Even if you give naloxone, the person still needs emergency care. Overdose can return after naloxone wears off. Tell dispatch you’re dealing with a possible opioid overdose.
2. Position the person on their back. Tilt their head back slightly to open the airway. This helps them breathe more easily.
3. Remove the spray from its package. Hold it with your thumb on the bottom and your fingers on either side of the nozzle. Don’t press the plunger yet. You’ll waste the dose if you do.
4. Insert the nozzle into one nostril. Gently slide it in until your fingers touch the bottom of their nose. About half an inch to one inch deep.
5. Press the plunger firmly. Push all the way down until you hear a click. This delivers the full dose. Don’t let go until it’s done. Studies show 18% of first-time users don’t press fully - and that can mean the difference between life and death.
6. Remove the device. Don’t reuse it. Throw it away. You’ll need a new one if you need a second dose.
7. Wait 2 to 3 minutes. Watch for signs of breathing returning. If they start breathing normally - 12 to 20 breaths per minute - you’re on the right track. If not, give a second dose in the other nostril with a new spray.
8. Place them in the recovery position. If they’re breathing but still unconscious, roll them gently onto their side. This keeps their airway clear. Don’t leave them alone.
9. Keep monitoring for at least 4 hours. Synthetic opioids like fentanyl can last longer than naloxone. Many overdoses require two or even three doses. The CDC reports 32% of fentanyl overdoses need more than one spray. Stay with them until EMS arrives.

Why Two Doses Often Aren’t Enough

Fentanyl is 50 to 100 times stronger than morphine. A tiny amount can stop breathing. And it doesn’t leave the body quickly. Naloxone’s effect fades before the opioid does. That’s why multiple doses are common. In fact, 41% of fentanyl overdoses require two or more doses, according to the National Institute on Drug Abuse. If the person doesn’t respond after the first spray, don’t panic. Give the second one. And if they still don’t respond? Call 911 again. Ask for advanced help.

What to Do If Naloxone Doesn’t Work

There are two possibilities: either you didn’t give enough, or opioids weren’t the cause. If you gave one or two doses and there’s still no response, start rescue breathing. Tilt the head back, pinch the nose, and give one breath every 5 seconds. Don’t stop until help arrives. The American College of Emergency Physicians says basic life support is more critical than waiting for naloxone to kick in. 22% of overdose deaths happen because people delay breathing support.

Training and Practice Make a Difference

You don’t need to be a paramedic. But practice helps. Many pharmacies offer free 10-minute training sessions. Watch a 2-minute video on YouTube - the CDC and SAMHSA have clear ones. Use a training device (they’re often free) to practice the motion. People who practice with a dummy spray are 98% likely to get it right in a real emergency. Those who don’t? Only 87% get it right after watching a video.

Common Mistakes and How to Avoid Them

• Waiting too long to act - If you’re unsure, act anyway. Delay costs lives.
• Not calling 911 - Naloxone is temporary. Medical help is permanent.
• Not giving enough spray - One dose isn’t always enough. Always have a second spray ready.
• Leaving the person alone - Even if they wake up, they can slip back into overdose. Stay with them.
• Using expired spray - Check the expiration date. Naloxone lasts 24 months if stored at room temperature (68°F-77°F).

Where to Get It and How Much It Costs

You can buy NARCAN Nasal Spray over the counter at CVS, Walgreens, Rite Aid, and many independent pharmacies. Two sprays usually cost $40-$80 without insurance. Some states offer free kits through public health programs. The Harm Reduction Coalition lists over 12,000 organizations that give them away for free - including syringe exchanges, community centers, and churches.

Amazon and online retailers sell it too, but be careful. Counterfeit products exist. Buy only from trusted pharmacies. Look for the FDA-approved label: NARCAN Nasal Spray 4 mg.

Legal Protection

Forty-seven states have Good Samaritan laws that protect you if you give naloxone in good faith. You won’t be charged for drug possession or overdose-related crimes if you call for help. The law is on your side.

Real Stories

A woman in Ohio used her first naloxone spray on her son after he stopped breathing following a fentanyl-laced pill. She gave one dose. No response. She gave a second. Three minutes later, he gasped. EMS arrived 10 minutes after that. He’s alive today.

A man in Chicago used naloxone on a stranger in an alley. He didn’t know the man. He just saw him not breathing. He gave one spray. Nothing. A second. Still nothing. He started rescue breathing while waiting for EMS. When they arrived, the man was breathing on his own. He later learned the man had taken fentanyl.

These aren’t rare. In 2022, naloxone reversed more than 27,000 overdoses in the U.S. Community programs saved lives. You can too.

What’s Next?

New versions are coming. A 12-hour extended-release naloxone spray is in clinical trials. But right now, the 4 mg nasal spray is what works. And it’s within reach.

Keep one in your car. Your bag. Your home. If you know someone who uses opioids - or if you’ve ever used them yourself - have it ready. You don’t need permission. You don’t need a prescription. You just need to know how to use it.