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

By Lindsey Smith On 27 Nov, 2025 Comments (8)

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

What Naloxone Nasal Spray Does

Naloxone nasal spray, commonly known by the brand name NARCAN, reverses opioid overdoses by kicking opioids off brain receptors. It doesn’t work on alcohol, benzodiazepines, or stimulants - only opioids like heroin, fentanyl, oxycodone, and morphine. It starts working in 2 to 5 minutes, and most people begin breathing again within 3 minutes. But it only lasts 30 to 90 minutes. Many opioids, especially fentanyl, stick around longer. That’s why you might need to give a second dose - or even a third.

It’s safe to use even if you’re not sure what the person took. If they’re not breathing and look like they’ve overdosed, give naloxone. It won’t hurt them if opioids aren’t involved.

How to Recognize an Opioid Overdose

You don’t need medical training to spot an overdose. Look for these signs:

Slow, shallow, or stopped breathing (fewer than 12 breaths per minute, or no chest movement for 15 seconds)
Unresponsive to loud voice or sternum rub (press your knuckles hard into the center of their chest for 5-10 seconds)
Pinpoint pupils (very small black circles in the center of the eyes)
Blue, gray, or pale lips and fingernails
Limp body, snoring or gurgling sounds

If you see even two of these, assume it’s an opioid overdose. Don’t wait. Don’t hesitate.

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

Here’s exactly what to do - in order. This is the protocol used by the CDC, SAMHSA, and the Mayo Clinic.

Call 911 immediately. Even if you give naloxone, they still need emergency help. Opioids can come back after naloxone wears off. Paramedics can give more doses, oxygen, and advanced care. Say: “Someone has overdosed on opioids. I’ve given naloxone.”
Position the person on their back. Tilt their head back slightly to open the airway. If they’re lying on their side, gently roll them onto their back. Don’t waste time trying to sit them up.
Remove the nasal spray from its package. Don’t press the plunger yet. The device is ready to use - no assembly needed. Some people panic and break the spray or drop it. Keep it steady.
Insert the nozzle into one nostril. Gently slide the tip in until your fingers touch the bottom of their nose. That’s about half an inch to one inch deep. Don’t force it.
Press the plunger all the way down. Push firmly until you hear a click and feel the spray go in. Hold it there for a second. If you don’t push all the way, you’ll only give half the dose - and that’s not enough for fentanyl. Studies show 18% of first-time users don’t fully depress the plunger.
Remove the spray and check for response. Watch their chest. Are they breathing? Are they moving? Do their lips turn pink? If they wake up and start breathing normally, they’re responding. But don’t assume they’re out of danger.
If no response after 2-3 minutes, give a second dose. Use a new nasal spray in the other nostril. Don’t wait. Fentanyl overdoses often need two or more doses. CDC data shows 32% of fentanyl overdoses require multiple doses.
Place them in the recovery position. If they start breathing but stay unconscious, roll them onto their side. Bend the top knee and arm to stabilize them. This keeps their airway open and prevents choking if they vomit.
Stay with them for at least 4 hours. Naloxone wears off faster than many opioids. Someone might seem fine after 15 minutes - then slip back into overdose. Keep monitoring their breathing. If they stop again, give another dose.

Two naloxone nasal sprays on a counter, one used and one sealed, next to a ticking clock.

What Happens After Naloxone?

When naloxone kicks in, the person may wake up confused, angry, or in pain. They might feel like they’re being attacked - because opioid withdrawal hits fast. They could yell, kick, or try to run. Don’t take it personally. This isn’t them - it’s the drug leaving their system.

They still need medical care. Naloxone doesn’t fix the overdose - it just buys time. They might need more treatment for heart issues, lung damage, or brain oxygen loss. And they’ll need help afterward. Many people who survive overdoses don’t want to go to the hospital. But they need follow-up care.

Common Mistakes and How to Avoid Them

Most people who use naloxone correctly save lives. But mistakes happen - especially under stress.

Mistake: Waiting to call 911 until after giving naloxone. Solution: Call first. Always. Emergency responders carry more naloxone and can handle complications.
Mistake: Only giving one dose. Solution: Have at least two sprays ready. Fentanyl is strong. Don’t assume one is enough.
Mistake: Not checking breathing after giving the spray. Solution: Watch their chest. Count breaths. If they’re not breathing normally after 3 minutes, give another dose.
Mistake: Assuming naloxone works on everything. Solution: It only reverses opioids. If someone overdosed on Xanax or cocaine, naloxone won’t help. But if you’re unsure, give it anyway - it’s safe.

Where to Get Naloxone Nasal Spray

Since August 2023, NARCAN nasal spray has been available over the counter in the U.S. at pharmacies like CVS, Walgreens, Rite Aid, and Walmart. You don’t need a prescription. The two-pack usually costs around $45-$70 without insurance. Some community centers, clinics, and harm reduction programs give it away for free.

Keep it in your bag, car, or home - not tucked away in a drawer. If you know someone who uses opioids, keep a spray with them. If you’re a parent, friend, or neighbor to someone at risk, having one nearby is one of the most important things you can do.

Someone picks up naloxone nasal spray from a pharmacy shelf in a 90s-style setting.

Training and Practice

You don’t need a class to use naloxone - but it helps. Many organizations offer free 15-minute training sessions. Watch a 2-minute video on YouTube (search “NARCAN nasal spray demonstration”) and practice on a dummy spray if you can. Some pharmacies give out practice devices.

Studies show 92% of people can use it correctly after just 15 minutes of training. Even without training, 87% get it right after watching a video. You don’t have to be perfect - you just have to act.

Why This Matters

In 2022, over 81,000 people in the U.S. died from opioid overdoses. Fentanyl was involved in nearly 90% of those deaths. But naloxone has already saved tens of thousands of lives. Community programs that hand out naloxone reduce overdose deaths by 14% in the areas they serve.

This isn’t about judgment. It’s about survival. Someone you know - a sibling, a coworker, a neighbor - could need this tomorrow. And you might be the only person there to help.

Naloxone doesn’t cure addiction. But it gives people a second chance. And sometimes, that’s all it takes.

Can naloxone nasal spray be used on children?

Yes. Naloxone nasal spray is safe for children and infants who have overdosed on opioids. The dose is the same regardless of age or weight - one spray (4 mg) per nostril. If there’s no response after 2-3 minutes, give a second dose. Emergency care is still required.

Does naloxone work on fentanyl?

Yes, but it often takes more than one dose. Fentanyl is 50 to 100 times stronger than morphine, so it binds tightly to opioid receptors. One 4 mg dose may not be enough. CDC data shows 32% of fentanyl overdoses require two or more doses of naloxone. Always be ready with a second spray.

What if I give naloxone to someone who didn’t overdose?

It’s safe. Naloxone has no effect on people who haven’t taken opioids. It won’t cause harm, addiction, or withdrawal in someone who hasn’t used opioids. If you’re unsure whether it’s an overdose, give it anyway.

How long does naloxone last?

Naloxone lasts 30 to 90 minutes. But many opioids - especially fentanyl, carfentanil, or oxycodone - stay in the body much longer. That’s why someone can overdose again after seeming to recover. Monitor them for at least 4 hours after the last dose.

Is it legal to carry naloxone?

Yes. All 50 U.S. states and the District of Columbia have laws protecting people who carry or administer naloxone in good faith. You can’t be arrested or sued for giving it. Many states also allow pharmacies to dispense it without a prescription.

Where should I store naloxone?

Store it at room temperature (68°F-77°F / 20°C-25°C). Avoid extreme heat or cold - don’t leave it in a hot car or freezing glove compartment. Keep it in its original packaging. It has a 24-month shelf life. Check the expiration date every few months.

Can I reuse a naloxone spray?

No. Each nasal spray is single-use. Once you press the plunger, the device is empty. Even if you think you didn’t give the full dose, you can’t refill it. Always carry at least two sprays in case you need more than one.

What if the person doesn’t wake up after two doses?

Keep giving rescue breaths and wait for EMS. Naloxone may not reverse all overdoses - especially if the person took a very high dose of fentanyl or another synthetic opioid. Continue CPR if you’re trained. Don’t give up. Paramedics can give IV naloxone, which works faster and stronger.

What to Do Next

If you’ve never held a naloxone nasal spray before, get one today. Walk into any pharmacy. Ask for NARCAN. Pay with cash or insurance. Take it home. Put it where you can find it fast - your jacket pocket, your car console, next to your keys.

Watch a 2-minute video. Practice the steps. Talk to someone you care about. Ask them if they’ve ever thought about what they’d do if someone overdosed.

Because the next time someone stops breathing - it might be your turn to act.