How Is Narcan Administered? Steps, Dosage & Safe Use

Knowing how to use Narcan is critical for those who know someone who uses opioids. It is safe and easy to use and can save a life. Read on to learn more about what Narcan is and how to administer it.

What’s Narcan®? Why is it Essential?

Narcan® (naloxone) is a life-saving medication used to rapidly reverse the effects of opioid overdose from drugs such as fentanyl, heroin, oxycodone, and morphine, among others. It is designed for use by laypersons and medical professionals. It can be safely administered to adults and children. 

Narcan is an opioid antagonist. As such it binds to opioid receptors in the brain, blocking the effects of opioids. It restores normal respiration in someone whose breathing has slowed or stopped due to opioid intoxication.

It is the only FDA-approved opioid antagonist for acute overdose reversal due to its rapid action.

The Mechanism of Action of Narcan

Naloxone competitively displaces opioids from mu-opioid receptors in the Central Nervous System.

It has a higher affinity for opioid receptors than most opioids but does not activate them, effectively reversing respiratory depression and sedation (sleepiness).

Is Narcan a Controlled Substance?

No. Narcan cannot produce euphoria or dependence and has no abuse potential. It is not a Controlled Substance under the US Controlled Substances Act. It is unscheduled under the DEA and has been FDA-approved for opioid overdose reversal. It has widespread distribution to reduce overdose deaths. All 50 states allow it to be dispensed without a prescription. 

When to Use Narcan

Here are common signs of an opioid overdose and when to use Narcan.

• Unresponsiveness or inability to wake up from a deep nod (sleep)
• Slow, irregular, or stopped breathing
• Blue or grayish lips or fingertips
• Pinpoint pupils

What Drugs Does Narcan Work On?

Narcan works on the opiates heroin, methadone, fentanyl (Duragesic®), oxycodone (Percocet®, OxyContin®), morphine (MS Contin®), oxymorphone (Opana®), codeine, hydrocodone (Vicodin®, Norco®), hydromorphone (Dilaudid®) [1].  

Good Samaritan Laws

Some states have a Good Samaritan Overdose Prevention Law that protects people who overdose or seek help for someone overdosing from being charged or prosecuted for drug possession as long as they act in good faith and without gross negligence. Protection does not extend to drug trafficking or distribution charges.

Recommended Narcan Dose

The dose of this medicine will be different depending on the patient. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine.

Intranasal: At first, 4 milligrams (mg) (1 spray into one nostril). Another spray may be given into the other nostril every 2 to 3 minutes until the patient responds or until emergency medical assistance becomes available [2].

Intramuscular: Naloxone (Evzio®) is available in 2 dosage strengths: 0.4 milligram (mg)/0.4 milliliter (mL) autoinjector or 2 mg/0.4 mL autoinjector. Zimhi™ is available in 5 mg/0.5 mL prefilled syringe [3].

Intravenous: Vials in Naloxone Kits contain 1 mL of 0.4 mg/mL solution of injectable naloxone hydrochloride. For children age 1 year to adult: Initial dose of 0.4 mg to 2 mg followed by repeated doses of 0.4 mg at 2 to 3 minute intervals until desired improvement [4].

How to Administer Narcan: Step-By-Step

In each case, do these things:

• Know the signs of overdose.
• Check for a response; shake them and shout to wake the person up.  
• If no response, grind your knuckles into their chest bone for 5-10 seconds.
• If the person still does not respond, call 911 and say “I think someone has overdosed”.

Each method has a different way of administering Narcan.

Intranasal (Nasal Spray) [5]: 

1. Take Narcan® Nasal Spray out of box. 
2. Peel back tab with the circle to open the Narcan® Nasal Spray. 
3. IMPORTANT: Do not remove Narcan® until ready to use and do NOT test the device.
4. Hold the Narcan® Nasal Spray  with your thumb on the bottom of  the plunger and your first and middle fingers on either side of the nozzle.
5. Tilt the person’s head back and provide support under the neck with your hand.
6. Gently insert the tip of the nozzle into one nostril until your fingers on either side of the nozzle are against the bottom of the person’s nose.
7. Press the plunger firmly to give the dose of Narcan® Nasal Spray.
8. Remove the Narcan® Nasal Spray from the nostril after giving the dose.
9. Wait and watch the person closely. If the person does not respond in 2 minutes, repeat the steps and give the second dose of Narcan® Nasal Spray in the box.
10. Call 911 right away, if you have not done so already.
11. Roll the person on their side and place them in the ‘recovery position’. Hand supports head. Knee bent prevents them from rolling onto the stomach.

Intramuscular Injection [1]: 

Needle-Syringe and Vial:

1. Open cap of naloxone vial.
2. Remove cap of needle, and insert into vial.
3. With the vial upside down, pull back the plunger and draw up 1mL (1cc) of naloxone. The naloxone vial may only have one dose, or may be a multi-dose vial.
4. Using a needle at least 1 inch long, inject into the muscle in the upper arm.

OR

Auto-injector: 

1. Follow visual and voice instructions. Package contains instructions and a training device.

Intravenous Injection: 

• It may be given through an IV catheter that is placed into one of your veins by a healthcare provider or a trained person.

How Fast Does Narcan Work?

Naloxone starts working in 2 to 5 minutes. It works for about 20 to 90 minutes. Poisoning can happen again once naloxone wears off.

How Often Can You Administer Naloxone?

If no response after 2–3 minutes, give a second dose (and more as needed). Up to 3–4 doses may be required in severe overdoses (e.g., fentanyl).

What to do After Administering Narcan

1. Stay with the person until they go to the hospital, or until the naloxone wears off, to make sure they do not overdose again.
2. If you do not seek medical care, stay with the person for at least 3 hours and watch for signs of returning overdose. Call 911 if the person is not OK when they wake up.
3. When the ambulance arrives, tell them that naloxone has been given.
4. If you need to leave, turn the person on their side (recovery position) to prevent them from choking.
5. Go back to the program that trained you or to a pharmacy, tell them you used the kit, and get more naloxone.

Where to Purchase Narcan?

Naloxone is widely available in pharmacies across the US. No prescription is required.

Is Expired Narcan Okay to Use?

Expired Narcan (naloxone) may still work, but its effectiveness cannot be guaranteed. Studies suggest that many medications, including naloxone, remain potent years after expiration, but degradation depends on storage conditions.

FDA & Manufacturer Stance:

• Expired Narcan is not officially recommended because its potency may decline over time.
• However, in an emergency with no alternative, use it anyway—some effect is better than none.

Some studies such as from JAMA Internal Medicine found that certain liquid naloxone formulations retained 90%+ potency up to 10–15 years post-expiry when stored properly.

Nasal sprays (Narcan) may be less stable than injectable forms due to the delivery system.

Storage Matters:

• If stored in extreme heat, cold, or sunlight, degradation is more likely.
• Ideal storage: Room temperature (59°F–77°F / 15°C–25°C), away from light.

The Importance of Drug Addiction Treatment

If someone is overdosing on opioids, then they have a serious, and potentially life-threatening, substance abuse problem. They can benefit from entering a residential treatment program (rehab) to address this issue as well as any underlying mental health conditions. 

In a structured, safe environment with 24/7 supervision, they can withdraw from opioids in medically-supervised detox, followed by individual, group, and family therapy with licensed professionals. In addition, holistic treatments such as yoga, movement, and expressive arts complement the program. 

Aftercare planning is a key part of the process to help learn about triggers and how to manage them. Support groups such as Narcotics Anonymous (NA) with peers who are also in recovery play an essential role. 

Drug Rehab in Southern California

For more than 30 years, Northbound Treatment Services in California has been at the forefront of providing lifesaving, compassionate residential care, and specialized services to help people from all walks of life feel better, discover themselves, and live free from addiction. We have facilities throughout California. Reach out to our admissions team now. 

Sources

[1] Government of Massachusetts. Steps of Naloxone Administration. 

[2] Mayo Clinic. Naloxone (nasal route).

[3] Mayo Clinic. Naloxone (injection route).

[4] Alberta Health Services. Injectable Naloxone Information. 

[5] New York State Department of Health. How to use Narcan® Nasal Spray for an opioid overdose.