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 respond to shouting or shaking. In these moments, naloxone nasal spray can bring them back - if you know how to use it. No medical degree is needed. No special tools. Just the right steps, done quickly and correctly.

What Naloxone Nasal Spray Does

Naloxone nasal spray - sold under the brand name NARCAN - is a medication that blocks opioids from binding to brain receptors. It doesn’t work on alcohol, benzodiazepines, or stimulants. But if someone has taken heroin, fentanyl, oxycodone, or any other opioid, naloxone can reverse the overdose in minutes. The FDA approved it for over-the-counter sale in 2023, meaning you can buy it at pharmacies without a prescription. Each spray delivers 4 mg of naloxone in a single, easy-to-use device. It’s small, lightweight, and designed to be used by anyone - a parent, a friend, a stranger.

Recognizing an Opioid Overdose

You don’t need to be sure someone has taken opioids to act. If they show these signs, assume it’s an overdose:

• Slow, shallow, or stopped breathing (fewer than 12 breaths per minute, or no chest movement for 15 seconds)
• 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, gray, or pale lips and fingernails
• Limp body, snoring, or gurgling sounds

Don’t wait for all these signs. If someone is unresponsive and breathing poorly, act now. Fentanyl - the most common cause of overdose deaths today - can kill in under two minutes. Waiting for EMS to arrive is not an option.

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

Follow these nine steps exactly. There’s no room for guesswork.

1. Call 911 immediately. Before you do anything else, call emergency services. Tell them it’s a suspected opioid overdose. Even if you give naloxone, the person still needs medical care. Naloxone wears off in 30-90 minutes, but opioids like fentanyl can stay in the body much longer.
2. Position the person on their back. Gently lay them flat. Tilt their head back slightly by lifting the chin. This opens the airway. Don’t waste time trying to sit them up or move them unnecessarily.
3. Remove the nasal spray from its package. Hold the device with your thumb on the bottom and two fingers on the nozzle. Don’t press the plunger yet. Some people accidentally trigger the spray while opening the package - that wastes the dose. If this happens, you’ll need a second spray.
4. Insert the nozzle into one nostril. Gently slide the tip into one nostril until your fingers touch the bottom of the nose. It should go in about half an inch to one inch. Don’t force it. The device is designed to fit snugly.
5. Press the plunger all the way down. Push firmly and steadily until you hear a click. Make sure the entire dose is delivered. Studies show 18% of first-time users don’t press the plunger fully, which means less medication gets in. Don’t pull the device out until the plunger is fully depressed.
6. Remove the spray and wait 2-3 minutes. Watch the person closely. Are they breathing normally? Is color returning to their skin? Do they start to move or groan? Naloxone usually starts working in 2-5 minutes. Don’t shake them or yell - just watch.
7. If no response, give a second dose. If the person hasn’t improved after 2-3 minutes, use a new nasal spray in the other nostril. Don’t wait longer. Fentanyl overdoses often need two or even three doses. The CDC reports that 32% of fentanyl-related overdoses require multiple doses.
8. Place them in the recovery position if they’re breathing. If they start breathing on their own but are still unconscious, roll them onto their side. Bend the top knee to stabilize them. This keeps their airway open and prevents choking if they vomit.
9. Stay with them for at least 4 hours. Naloxone wears off faster than many opioids. A person can slip back into overdose after the naloxone wears off. Even if they seem fine, they need to be monitored by medical professionals. If they’re not breathing again, start CPR and give another dose if you have it.

What to Expect After Giving Naloxone

Some people wake up suddenly, confused, angry, or even violent. That’s because naloxone removes the opioid high - and the sudden withdrawal can be painful. They may scream, cry, or try to hit you. Stay calm. You did the right thing. They’re not mad at you - their body is in shock.

Don’t assume they’re out of danger just because they woke up. Many people who survive an overdose with naloxone end up back in the hospital because they didn’t get monitored long enough. That’s why EMS is non-negotiable.

Common Mistakes and How to Avoid Them

Even with clear instructions, people make errors under stress. Here are the most common ones:

• Waiting too long to call 911. Always call first. Naloxone buys time, but it’s not a cure.
• Not giving enough doses. If they don’t respond after 3 minutes, give another spray. Don’t assume one dose is enough.
• Incorrect placement. The nozzle must go deep enough into the nostril. If it’s too shallow, the spray won’t be absorbed properly.
• Not holding the plunger long enough. You need to press all the way down until you hear the click. Half-pressure = half-dose.
• Thinking naloxone works on everything. It only reverses opioids. If someone overdosed on cocaine or Xanax, naloxone won’t help. But if you’re unsure - give it anyway. It’s safe.

How to Prepare Before an Emergency

Don’t wait for a crisis to learn this. Practice now:

• Keep naloxone in your car, bag, or home - not locked away.
• Carry a printed step-by-step card (the VA has free ones you can print).
• Use a training device (available free from many health departments) to practice the motions.
• Watch a 2-minute video from SAMHSA or the CDC on YouTube. Repeat it once a month.
• Ask your pharmacist to show you how to use it when you buy it.

Training isn’t required to use naloxone - but it makes you 11% more likely to act correctly in a real emergency, according to CDC data.

Where to Get Naloxone Nasal Spray

You can buy NARCAN Nasal Spray at any pharmacy - Walgreens, CVS, Walmart, Rite Aid - without a prescription. A two-pack costs about $45-$70 with insurance, or $140 without. Many community health centers, harm reduction programs, and local health departments give it out for free. Search online for “free naloxone near me” or call the National Overdose Response Service at 1-800-222-4357.

Why This Matters

In 2022, over 81,000 Americans died from opioid overdoses - most from fentanyl. But naloxone has already saved an estimated 27,000 lives in the U.S. since 2017. Every time someone learns how to use it, that number grows. You don’t have to be a doctor, a first responder, or a hero. You just have to be willing to act.

That’s all it takes.

Next Steps: What to Do After Saving a Life

If you’ve used naloxone successfully:

• Stay with the person until EMS arrives.
• Tell the paramedics exactly what you did - how many doses, when, and how they responded.
• Ask if they want help connecting to addiction treatment. Many people who survive overdoses are ready to change - but they need support.
• Replace your used naloxone spray. Keep a fresh one on hand.
• Consider training others. Teach a friend, family member, or coworker how to use it. One more person who knows how to act could save another life.

Overdose doesn’t always look like a movie. Sometimes it’s quiet. Sometimes it’s someone you know. But now you know what to do. And that changes everything.