What Happens During an Opioid Overdose?
When someone overdoses on opioids-whether it’s heroin, fentanyl, oxycodone, or prescription painkillers-their breathing slows down or stops completely. Their skin turns blue or gray, they can’t wake up, and their pupils shrink to pinpoints. Without help, they can die within minutes. Naloxone nasal spray, like NARCAN, can reverse this in under 3 minutes by kicking opioids off brain receptors and restoring normal breathing. It’s not a cure, but it buys time-time for emergency help to arrive.
Why Naloxone Nasal Spray Matters Now
In 2022, over 81,000 people in the U.S. died from opioid overdoses. Fentanyl, a synthetic opioid 50 to 100 times stronger than morphine, is behind most of those deaths. The good news? Naloxone works against fentanyl too. Since March 2023, you don’t need a prescription to buy it. You can find it on store shelves at pharmacies like CVS, Walgreens, and even some grocery stores. It’s no longer just for paramedics or doctors-it’s for anyone who might be around someone at risk.
How Naloxone Nasal Spray Works
NARCAN Nasal Spray delivers 4 mg of naloxone in a single puff-3.8 mg of the active drug in 0.1 mL of liquid. It’s designed to be simple: no needles, no mixing, no assembly. Just pull it out of the package and spray. The spray goes into one nostril and starts working in 2 to 5 minutes. Its effects last 30 to 90 minutes, but many opioids, especially fentanyl, stick around longer. That’s why you might need a second dose.
Step-by-Step: How to Use Naloxone Nasal Spray
- Call 911 first. Even if you’re sure naloxone will work, emergency responders need to come. The person might need more help after the spray wears off.
- Check for signs of overdose. Look for: no breathing or very slow breathing (fewer than 12 breaths per minute), unresponsiveness to loud voice or sternum rub (press knuckles hard on the chest bone), blue or ashen skin, and pinpoint pupils.
- Position the person on their back. Tilt their head back slightly to open the airway. This helps them breathe easier once naloxone kicks in.
- Remove the spray from its packaging. Don’t press the plunger yet. Hold the device like a pen, with your thumb on the plunger and your fingers around the nozzle.
- Insert the nozzle into one nostril. Gently slide it in until your fingers touch the bottom of their nose. Don’t force it. You’re aiming for about half an inch to one inch deep.
- Press the plunger all the way down. Push firmly until you hear a click and feel resistance. This delivers the full dose. Many people don’t press hard enough-don’t be one of them.
- Remove the spray and call out to the person. Say their name. Shake their shoulder. See if they respond.
- Wait 2 to 3 minutes. Watch for breathing to return. If they start breathing normally, keep monitoring. If nothing changes, get ready for a second dose.
- Give a second dose if needed. Use a new spray in the other nostril. Don’t wait longer than 3 minutes. Fentanyl overdoses often need two or three doses. CDC data shows 32% of fentanyl cases require more than one spray.
- Turn them onto their side. If they’re breathing but still unconscious, place them in the recovery position. This keeps their airway clear and prevents choking if they vomit.
- Stay with them for at least 4 hours. Naloxone wears off faster than many opioids. They could slip back into overdose. Don’t assume one spray means they’re safe.
What If Naloxone Doesn’t Work?
If you’ve given two doses and there’s still no response, keep trying. Don’t give up. Sometimes, especially with ultra-potent opioids like carfentanil, people need three or even four doses. While you wait for EMS, start rescue breathing if they’re not breathing on their own. Put your mouth over theirs, pinch their nose, and give one breath every 5 seconds. Don’t wait for naloxone to act-help their lungs breathe.
Common Mistakes and How to Avoid Them
- Waiting too long to act. People often think they’re just asleep. If someone won’t wake up and isn’t breathing normally, treat it as an overdose.
- Not pressing the plunger fully. Studies show 18% of first-time users don’t depress the plunger completely. Push until it clicks.
- Using the same nostril twice. Always use the second spray in the opposite nostril. It ensures even delivery.
- Assuming naloxone works on all drugs. It only reverses opioids. It won’t help with alcohol, benzodiazepines, or stimulants like cocaine. But if you’re unsure, give it anyway-it’s safe.
- Leaving the person alone after one spray. Even if they wake up, they can crash again. Stay with them until EMS arrives.
Where to Get Naloxone Nasal Spray
You can buy NARCAN Nasal Spray over the counter at most pharmacies without a prescription. Two sprays usually cost between $45 and $140, depending on the store and insurance. Many community centers, health clinics, and harm reduction organizations give it out for free. If you’re worried about cost, call your local health department or search for free naloxone programs near you. Some states even mail it out for free.
Training and Practice
You don’t need to be a medic to use it. After watching a 3-minute video, 87% of people can use it correctly. But practicing with a training device makes it even easier. Some pharmacies offer free 10-minute demos. If you’re someone who might be around people using opioids-whether a friend, family member, or coworker-take 15 minutes to learn. Keep a spray in your car, your bag, or your home. It’s like having a fire extinguisher: you hope you never need it, but you’re glad it’s there.
Real Stories, Real Impact
One Reddit user shared how they saved their brother using two doses of NARCAN at 8:17 p.m. and 8:20 p.m. He started breathing again at 8:23 p.m. EMS arrived at 8:28 p.m. Another user, a harm reduction worker, reported giving three doses to someone overdosing on fentanyl-with only partial response. Paramedics had to give 400 micrograms intravenously to fully reverse it. These stories show that naloxone saves lives, but it’s not magic. It’s a tool. And tools work best when you know how to use them.
What to Do After a Reversal
After naloxone works, the person may feel sick, anxious, or angry. That’s normal. Naloxone pulls opioids out of their system fast, which can cause sudden withdrawal. Don’t argue with them. Stay calm. Reassure them that help is coming. Don’t let them leave until EMS arrives. Even if they insist they’re fine, they’re not out of danger yet.
Legal Protection
Forty-seven states have Good Samaritan laws that protect people who give naloxone in good faith. You won’t get in trouble for helping. And if you call 911, you’re protected from drug possession charges in most places. These laws exist so people don’t hesitate to act.
What’s Next for Naloxone?
Researchers are already working on longer-lasting versions. One extended-release nasal spray is in clinical trials and could last up to 12 hours. That would mean fewer doses and less risk of rebound overdose. But right now, the 4 mg spray is the most reliable tool we have. And it’s available to you.
Final Thought: You Can Save a Life
You don’t need to be a hero. You just need to know what to do. Keep a naloxone spray handy. Know the steps. Practice if you can. And if you ever see someone not breathing, don’t wait. Act. One spray could be the difference between life and death.
