How to Use Narcan: A Step-by-Step Guide from an ER Nurse

Narcan is one of the most important over-the-counter tools available to families right now. After 30 years in the ER at Emory Healthcare, I believe every household should have it. Here is everything you need to know: what it is, how to recognize when to use it, and exactly how to use it.

What Is Narcan?

Narcan is the brand name for naloxone, an opioid antagonist. It works by binding to opioid receptors in the brain and reversing the effects of opioids, including heroin, fentanyl, oxycodone, hydrocodone, methadone, and others. When administered during an opioid overdose, it can restore normal breathing within 2 to 5 minutes.

Narcan nasal spray became available over the counter in 2023 in the United States. The 4mg nasal spray is the form most relevant for home and community use.

Key Fact

Narcan does nothing if opioids are not present. It is safe to use even if you are not certain opioids were involved. If they weren't, the drug simply has no effect. If they were, it can save a life. When in doubt, use it.

Recognizing an Opioid Overdose

Before using Narcan, you need to recognize the signs. These are the three I tell families to know:

Breathing rate below 8 per minute. Count the chest rising. Slow, shallow, or no breathing is the primary indicator.
Pinpoint pupils. Even in a dark room, the pupils are very small. Combined with unconsciousness and slow breathing, this is an opioid overdose until proven otherwise.
Gurgling or snoring sounds from someone who cannot be woken. This indicates airway obstruction. Act immediately.

If someone is unresponsive and you cannot rule out opioids, proceed with Narcan and call 911.

7-Step Narcan Administration Guide

Call 911 first. Make the call before or while administering Narcan. EMS needs to be on the way regardless. Stay on the line and follow dispatcher instructions.
Recovery position. Lay the person on their side (recovery position). This keeps the airway open and prevents aspiration if they vomit. Tilt the chin slightly up.
Remove the Narcan nasal spray from packaging. Peel back the foil or open the box. Hold the device with your thumb on the bottom and two fingers on the nozzle.
Tilt the head back slightly and support the neck. This opens the nasal passage and allows the spray to reach the nasal mucosa where absorption occurs.
Insert the nozzle into one nostril and press firmly. One press delivers the full dose into one nostril. Do not tilt the bottle or the person's head too far.
Wait 2 to 3 minutes and observe. Watch for improvement in breathing and responsiveness. If there is no response after 2 to 3 minutes, administer a second dose into the other nostril.
Stay with them. Do not leave. Narcan's effects last 30 to 90 minutes. If opioids with longer duration are involved (fentanyl analogues, long-acting opioids), the overdose can return when Narcan wears off. EMS needs to evaluate the patient.

Where to Get Narcan

Narcan 4mg nasal spray is available without a prescription at all major pharmacies. Here are some options:

CVS Pharmacy (available without asking)
Walgreens
Walmart
Rite Aid
Kroger and affiliated pharmacies
State harm reduction programs (some offer it free)
Local health departments and community organizations

Narcan is covered by many health insurance plans and health benefit cards. Some states offer it at no cost through public health programs. Call 211 or check your state health department's website to find free resources in your area.

Frequently Asked Questions

What if the person wakes up and wants to leave?

This is common. When Narcan reverses an overdose, the person may wake up in withdrawal, which can be uncomfortable and disorienting. They may be agitated or want to leave. Calmly explain what happened. Do not restrain them, but strongly encourage them to stay for EMS evaluation. The overdose can return when Narcan wears off.

Can Narcan be used on children?

Yes. Narcan can be used on children if opioid exposure is suspected. The same nasal spray formulation is used. Call 911 immediately for any pediatric overdose emergency.

Does Narcan have side effects?

In a person with opioids in their system, Narcan can trigger acute withdrawal symptoms: agitation, sweating, rapid heart rate, nausea. These are uncomfortable but not life-threatening. In a person without opioids, Narcan has no effect. There is no meaningful harm from giving it when opioids are not present.

How should I store Narcan?

Store at room temperature, away from direct sunlight and heat. Check the expiration date periodically and replace as needed. Keep it somewhere accessible, not locked away: a drawer, a bag, a medicine cabinet you can reach quickly.

What if I only have one dose and it doesn't work?

Stay on the line with 911. Continue rescue breathing if trained. Do not leave the person alone. EMS carries additional doses. One dose of Narcan may not be sufficient for high-potency opioids like fentanyl, which is why having multiple doses available is recommended and why calling 911 immediately is critical.

Bottom Line

Narcan is not a complex medication to use. It is a nasal spray. The barrier is not the skill required to administer it. The barrier is not having it, not knowing you need it, and not knowing the signs that mean you should reach for it.

Get it before you need it. Know where it is. Tell someone else in your household. The 4 minutes before EMS arrives are yours. Be ready for them.