Narcan
Narcan can reverse an opioid overdose. Give it promptly, call 911 and stay with the person. More than one dose may be needed.
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Narcan Can Reverse an Opioid Overdose
If someone cannot be awakened or is not breathing normally, call 911 and give naloxone if available. Follow the dispatcher’s instructions. If the person is unresponsive and not breathing normally, begin cardiopulmonary resuscitation (CPR), using chest compressions and breaths. Do not wait for naloxone to work before helping them breathe.[12][15]
Narcan® is a brand of naloxone nasal spray. It temporarily blocks opioid effects and can restore breathing during an overdose. Anyone can carry and use it. If an opioid overdose is suspected, give naloxone even if you are not certain what the person took.[11][12][13]
Keep naloxone accessible if someone around you uses prescription painkillers, heroin or fentanyl. Over-the-counter sprays are available, and local health departments or community programs may offer them free or at low cost.[13]
- Narcan can reverse opioid-related breathing problems within minutes. It does not replace calling emergency services or providing CPR when needed.[11][15]
- Each Narcan device delivers one dose. If the person does not wake up after two to three minutes, give another dose using a new device. Follow the package directions and dispatcher instructions.[11]
- Breathing problems can return after naloxone. Stay until emergency help arrives, even if the person wakes up.[11][12]
How to Recognize an Opioid Overdose
You are looking for a person you cannot wake who is not breathing normally. An overdose is not a deep sleep, it is suffocation. Opioids switch off the body’s drive to breathe, so the clearest signs are all about air and color.
Shout to the person and gently shake them. If they still do not respond, treat it as an overdose.
- Will not wake up, when you shout and gently shake them
- Slow, shallow, or stopped breathing
- Choking, gurgling, gasping, or snoring sounds as the body struggles for air
- Blue or grayish lips, fingertips, or face
- Limp body, cannot stand, sit up, or talk
- Pinpoint pupils shrunk to dots
When you cannot tell whether someone is just very high or actually overdosing, act as if it is an overdose. Give naloxone if available and call 911. Do not leave an unresponsive person to sleep it off.[12]
What to Do in an Overdose, Step by Step
Act promptly. Call for emergency help, support breathing and give naloxone. These actions work together, rather than waiting to finish one before arranging the others.[15]
- Check responsiveness and breathing. Shout and gently shake the person. If they will not wake up or are not breathing normally, call 911. Give your location and describe what you see.[11][12]
- Start CPR with breaths if they are unresponsive and not breathing normally. Follow your training and the dispatcher’s instructions. Do not delay CPR to check a pulse or wait for naloxone to work. If another person is present, have them get naloxone and an automated external defibrillator (AED), a device that checks heart rhythm and gives a shock when needed, while you provide care.[15]
- Give Narcan as soon as it is available. Insert the nozzle into one nostril and press the plunger firmly. Do not test the device first. Each device sprays once and contains one dose.[11]
- Use a new device for every repeat dose. If the person does not wake up after two to three minutes, give another dose. Continue doses at that interval as the label directs while awaiting help. Do not interrupt needed CPR to wait between doses.[11][15]
- Stay and watch their breathing. If they are breathing normally, place them on their side to help prevent choking. Give another dose if they become very sleepy again, and follow the dispatcher’s instructions if breathing becomes abnormal. Stay until emergency responders arrive.[11][12]
Do not decide it is too late based on elapsed minutes. A 2025 computer model predicted that delaying treatment reduced reversal effectiveness in simulated fentanyl and carfentanil overdoses. Those modeled results do not establish a universal time limit for helping a real person.[3]
The practical lesson is to act quickly and continue emergency care. Current Narcan directions tell people to repeat doses when needed and stay until the ambulance arrives. Keep responding rather than using a stopwatch cutoff.[11]
Why More Than One Naloxone Dose May Be Needed
A person may need more than one dose, including when fentanyl is involved. The amount needed varies. Start with the product’s recommended dose, watch the response and repeat as directed. Do not delay using the naloxone available to search for a stronger product.[11][13]
The studies describe different settings, rather than one universal dosing rule:
- In a survey of 125 U.S. adults who had given 4 mg Narcan, 78% reported using at least two doses in their most recent overdose response and 30% reported at least three.[2] These were bystander reports, not a measured rate for every fentanyl overdose.
- A review found multiple-dose rates ranging from 9% to 53% in emergency-service studies and 16% to 89% in bystander studies.[4] Differences in setting, geography and study methods matter.
- Maryland poison-center data from 2015–2017 showed increasing average naloxone doses and a decline in initial reversal from about 82% to 76%.[5] That regional historical trend is not proof that naloxone now fails in a fixed share of overdoses.
- A small emergency-department comparison found more in-hospital naloxone doses in nine patients with novel potent opioids than in eleven patients with fentanyl alone.[6] The authors called the findings preliminary.
- A case report described two patients with suspected carfentanil exposure who received totals of 10 mg and 12 mg during hospital resuscitation.[7] These are clinical case details, not instructions to give those amounts at once.
Higher strength is not automatically better. In a New York law-enforcement comparison, researchers found no significant survival difference between 8 mg and 4 mg nasal naloxone.[14] Symptoms of withdrawal, the body’s reaction when opioid effects are suddenly blocked, were more common in the 8 mg group.[14] The study was limited to that setting and could not account for all differences in drug exposure.[14]
Route comparisons also depend on the formulation. One trial found an injection into muscle more efficient than an older, low-concentration nasal dose.[8] It did not compare today’s 4 mg Narcan spray with that injection.[8][11] Keep naloxone available and follow the directions for the product you have.
| Study Context | Finding |
|---|---|
| Earlier studies of programs serving people who use drugs | 98.3% survival after naloxone. Other program groups had different survival proportions.[1] |
| Survey of 125 adults who had given 4 mg Narcan[2] | 78% reported at least two doses and 30% at least three in their most recent response.[2] |
| Maryland poison-center reports, 2015–2017 | Initial reversal decreased from about 82% to 76% as average doses increased.[5] |
| Fatal opioid overdoses in 38 U.S. jurisdictions, 2019 | 77.3% of 33,084 deaths had no evidence of naloxone administration. This does not establish why it was not recorded or given.[9] |
What Naloxone Is and How It Works
Opioids such as heroin, fentanyl and oxycodone attach to receptors, which act like docking points in the brain. An overdose can slow or stop breathing and deprive the brain of oxygen.[18]
Naloxone attaches to those opioid receptors and blocks opioid effects. This can restore breathing that has slowed or stopped because of an opioid overdose. Naloxone is an emergency medicine, not a treatment for opioid use disorder.[18]
You do not have to be certain opioids are involved before giving naloxone. Treat suspected overdose as an emergency and call 911. Naloxone does not replace emergency care for other causes of unconsciousness.[12][13]
Naloxone is temporary. Opioid effects can return after it wears off, so emergency medical care is needed even if the person wakes up.[11][12]
A controlled study found that a single nasal dose restored breathing volume within two to four minutes, while exhaled carbon dioxide took 11–17 minutes to improve and did not fully recover in some participants.[10] The study involved continuous opioid infusions under controlled conditions, not ordinary community overdoses. A rapid visible response is not proof that all breathing problems have resolved.
In an American Red Cross interview, emergency physician Nathan Charlton emphasized that waking up after naloxone does not end the emergency. Its effects are temporary and breathing problems may return. That is why staying with the person and arranging emergency evaluation remain part of the response.[16]
How to Get Naloxone, Often for Free
Naloxone nasal spray is available over the counter. Prices and availability vary. Ask a pharmacy, your local health department or a community harm-reduction program about nearby options.[13]
- Pharmacies: Check stock and price, and ask how to use the product.
- Health departments and community programs: Ask whether they provide free or low-cost naloxone and training.
- Insurance: Check whether your plan covers naloxone and what you would pay.
- Your clinician: Discuss keeping naloxone available if you take opioids or live with someone at risk.[13]
Community distribution programs help naloxone reach people who may need it. A review found high survival after use, with results differing by the population each program served.[1] A separate study found no evidence of naloxone administration in 77.3% of 33,084 fatal opioid overdoses in 38 jurisdictions in 2019.[9] That supports improving access and response, without proving that lack of a nearby kit caused every death.
Calling for Help and Good Samaritan Laws
Most states have laws that may protect the person calling for help or the person overdosing from some criminal penalties. The protections vary by state and are not a blanket guarantee.[12] During a suspected overdose, call 911 and tell the dispatcher your location and what is happening.
What to Do After Someone Wakes Up
Reversing the overdose is the start, not the end. Because naloxone wears off first, the danger can come back. Stay with the person and keep these in mind:
- They can re-overdose. Opioid effects can return after naloxone wears off.[11] Do not leave them alone.
- Place them on their side if they are breathing normally to help reduce choking risk if they vomit. If they become unresponsive and stop breathing normally, resume CPR and follow the dispatcher’s instructions.[12][15]
- Expect them to feel rough. Naloxone can trigger sudden withdrawal, including sweating, nausea, vomiting and agitation. Tell emergency responders about these symptoms and keep watching breathing. Possible withdrawal is not a reason to delay naloxone during a suspected overdose.[11][13][14]
- Let the paramedics take over. Tell them what was taken if you know, when naloxone was given and how the person responded.
- Talk about treatment when they are ready, not in the heat of the moment. Surviving once is the opening.
Naloxone Is Not Naltrexone, and It Is Not Addiction Treatment
These two get mixed up because the names look alike and both act on opioid receptors, but they do completely different jobs:
- Naloxone (Narcan) is the emergency reversal, the thing you give right now to someone who is overdosing. Its effect is temporary, and further doses may be needed.[11]
- Naltrexone (the monthly Vivitrol injection or a daily pill) is a long-term treatment for opioid use disorder that blocks opioid effects. A clinician must confirm an adequate opioid-free interval before starting it.[17]
Carrying naloxone is not the same as being in treatment, and one does not replace the other. Naloxone can reverse an opioid overdose. It does not treat opioid use disorder.[11][17]
Medical care can help manage withdrawal, and medications for opioid use disorder like buprenorphine (Suboxone) and methadone can ease withdrawal and are associated with lower overdose and death risk. Continuing treatment matters after withdrawal settles.[17] For the wider family of pills behind so many overdoses, prescription opioids lays out how that dependence takes hold and how people get free of it. Survival is step one. A life on the other side is the point.
Carry Narcan, and Know How to Use It
Community naloxone distribution can help prevent overdose deaths.[1] Making naloxone available and teaching people how to respond can help it reach someone during an emergency.[12][13]
You can be the person who does:
- Get naloxone from a pharmacy or ask a local program about free or low-cost supplies.[13]
- Keep it where you would reach it in the dark, and tell the people around you it is there.
- Carry more than one dose if fentanyl is in your area.
- Replace it after it expires.
If you or someone you love is using opioids, keeping naloxone nearby and seeking treatment can both help. Explore treatment options or call the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-HELP (4357) for treatment information and referrals.[19]
Call 911 for a suspected overdose or another medical emergency. For a mental health or suicide crisis, call or text 988.[19]
Frequently Asked Questions
Can Narcan Hurt Someone Who Is Not Overdosing?
If an opioid overdose is suspected, give naloxone even if you are not certain what the person took, and call 911. Naloxone can trigger withdrawal in someone physically dependent on opioids, including nausea, vomiting, sweating or agitation. That is not a reason to delay emergency treatment. It does not replace care for other causes of unconsciousness.[11][12][13]
How Do I Give Narcan Nasal Spray?
Insert the nozzle into one nostril and press the plunger firmly. Do not test the device first. Each device contains one dose and sprays once. Call 911 immediately. If the person does not wake up after two to three minutes, give another dose with a new device. Follow the package directions and dispatcher instructions.[11]
If the person is unresponsive and not breathing normally, start CPR with breaths. Do not wait for naloxone to work. Stay until emergency help arrives, even if they wake up.[12][15]
How Many Narcan Doses Might Be Needed?
The amount of naloxone needed varies with the opioid exposure and the person’s response. Some overdoses require more than one dose, but a single survey cannot tell you how many doses every fentanyl overdose needs.[2][4] Use the product as directed and repeat with a new device if the person does not wake up after two to three minutes. Keep providing needed CPR and follow the emergency dispatcher’s instructions.[11][15]
Where Can I Get Narcan?
Naloxone nasal spray is available over the counter. Local health departments and community programs may offer it free or at low cost. Prices, stock and eligibility vary, so check the program or pharmacy directly. Ask your insurance provider whether your plan covers it.[13]
Can I Get in Trouble for Calling for Help?
Is Narcan the Same as Opioid Addiction Treatment?
Naloxone is emergency overdose treatment, not continuing treatment for opioid use disorder. Medications such as buprenorphine and methadone can reduce withdrawal and cravings and are associated with lower overdose and death risk. Naltrexone is another treatment option, started after a clinician confirms an adequate opioid-free interval. Ask about ongoing care after an overdose.[17] You can find opioid treatment options here.
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