Naloxone is one of the few tools available to families and bystanders that can directly reverse an opioid overdose in progress. Some nasal-spray products are available over the counter without a prescription; other products may still require a prescription.
What is naloxone and how does it work?
Naloxone is an opioid antagonist: it binds to the same receptors in the brain that opioids (including fentanyl, heroin, oxycodone, and others) attach to, and it temporarily blocks and reverses their effects. When someone is overdosing, opioids suppress the body’s drive to breathe. Naloxone can restore breathing within two to three minutes, according to CDC guidance.
Naloxone is available as nasal spray and injectable formulations. Product dose, access, and prescription status vary.
Naloxone works on opioids, not on overdoses caused only by stimulants or alcohol. CDC guidance says it will not harm someone who is overdosing on opioids or other drugs, though it can cause withdrawal symptoms in a person who is physically dependent on opioids. If an opioid overdose is suspected, administer naloxone if available and call 911.
Recognizing an opioid overdose
Signs that someone may be experiencing an opioid overdose include:
- Slow, shallow, or stopped breathing
- Choking, gurgling, or snoring sounds
- Blue or gray lips, fingertips, or skin
- Small, “pinpoint” pupils
- Being unresponsive to shouting or a sternal rub (firm knuckle pressure on the chest bone)
If you observe these signs, treat it as a medical emergency.
How to use naloxone nasal spray, step by step
- Call 911 first, or have someone else call while you prepare to administer naloxone. Naloxone is not a substitute for emergency medical care — its effects can wear off before the opioid does, causing the person to stop breathing again.
- Lay the person on their back.
- Peel back the package and remove the device. Do not test or prime the nasal spray beforehand — it is pre-filled and ready to use.
- Insert the nozzle into one nostril until your fingers touch the bottom of the person’s nose.
- Press the plunger firmly to release the full dose.
- Move the person into the recovery position (on their side) to prevent choking if they vomit.
- Watch closely. If there is no response within 2 to 3 minutes, and a second dose is available, administer it in the other nostril.
- Stay until emergency responders arrive. Continue to monitor breathing; be prepared to perform rescue breathing or CPR if trained to do so.
Naloxone’s effects are temporary — typically 30 to 90 minutes — while many opioids, especially fentanyl, remain active in the body longer. This is why calling 911 and staying with the person is essential even after naloxone appears to work.
How to get naloxone
Over the counter: The FDA first approved a naloxone nasal spray for nonprescription sale in 2023. Additional nonprescription products have since been approved. Ask a local pharmacy which products it stocks and what they cost.
Free distribution programs: Many state and county health departments, harm-reduction organizations, and community coalitions distribute naloxone free of charge, often by mail or at community events. Search your state health department’s website or visit FindTreatment.gov to locate distribution programs near you.
Through the MAD AF resource directory: Our resource directory includes verified naloxone access points by state and city, including free distribution sites where available.
Why every household should consider having it on hand
You do not need to know or suspect that someone in your home uses drugs to justify keeping naloxone available. Counterfeit pills circulate widely (see our guide on fentanyl-laced pills), and an overdose can happen to a first-time user, a guest in your home, or a stranger in a public place. Naloxone is designed for bystander use; check each product’s expiration date and instructions.
Frequently Asked Questions
Can you get Narcan without a prescription?
Yes. Some naloxone nasal sprays are available over the counter. Stock and cost vary; pharmacies, health departments, and community organizations are common access points.
Is it safe to give naloxone to someone if you’re not sure they’re overdosing on opioids?
CDC guidance says naloxone will not harm someone who is overdosing on opioids or other drugs. When an opioid overdose is suspected, administer it if available and call 911.
Does naloxone work on fentanyl overdoses?
Yes, though fentanyl’s potency may require more than one dose, and emergency medical help should always be called immediately.