Key Takeaways
- Fentanyl overdoses kill within 2–5 minutes — faster than EMS can typically respond. Bystander naloxone saves lives.
- Narcan (naloxone) nasal spray is available without a prescription at CVS, Walgreens, Walmart, and most major pharmacies nationwide.
- A single dose may not be enough for fentanyl overdoses — multiple doses are often required. Always have at least 2 doses.
- Giving Narcan to someone not overdosing on opioids is safe — it has no effect on someone without opioids in their system.
- After giving Narcan, call 911 immediately. Narcan wears off in 30–90 minutes — the person may re-enter overdose.
In This Article
Every minute without oxygen during an opioid overdose causes irreversible brain damage. Fentanyl overdoses can be fatal within 2–5 minutes. Knowing how to use Narcan is now a life skill — like knowing CPR — for anyone with a loved one who uses opioids or lives in a community affected by the overdose crisis.
How to Recognize an Opioid Overdose
Look for all three of these signs:
The Three Signs of Opioid Overdose
- Unresponsive — won’t wake up when you rub knuckles hard on their sternum (breastbone)
- Slow, shallow, or stopped breathing — fewer than 1 breath per 5 seconds, or no breathing
- Pinpoint pupils — very small pupils even in low light
Blue or gray lips, gurgling or snoring sounds (“death rattle”), and limp body are additional signs. If you’re unsure — give Narcan. It cannot harm someone who isn’t overdosing on opioids.
Step-by-Step: How to Give Narcan Nasal Spray
- Call 911 — do this first or simultaneously. Good Samaritan laws in most states protect you from prosecution when calling for help.
- Try to wake them — rub your knuckles hard on their sternum. Shout their name. If no response, proceed.
- Position them — lay flat on their back. Tilt the head back slightly to open the airway.
- Peel back the foil on the Narcan package and remove the nasal spray device.
- Support the head with one hand. Place your thumb on the bottom of the plunger and two fingers on either side of the nozzle.
- Insert the nozzle into one nostril until your fingers touch the bottom of the nose.
- Press the plunger firmly with your thumb to release the full dose.
- Wait 2–3 minutes. If no response, give a second dose in the other nostril.
- Rescue breathing — if the person is not breathing, give 1 breath every 5 seconds while waiting for response.
- Recovery position — once breathing, turn them onto their side to prevent choking if they vomit.
Never Leave Them Alone
Narcan wears off in 30–90 minutes. The person may re-enter overdose if the opioid is still in their system. Stay with them until EMS arrives.
What to Do After Giving Narcan
When the person regains consciousness, they will likely be confused and may be in acute opioid withdrawal — agitated, nauseous, and craving opioids. Do not allow them to use more opioids to relieve withdrawal — this is extremely dangerous as Narcan may still be active.
- Stay calm and reassure them
- Explain what happened
- Keep them still — movement increases withdrawal symptoms
- Do not leave until EMS arrives
- When stable, call (844) 561-0606 — overdose is the right moment to connect someone with treatment
Special Considerations for Fentanyl Overdoses
Fentanyl Overdoses Often Require Multiple Doses of Narcan
Fentanyl is 50–100 times more potent than morphine. Standard Narcan doses (4mg) may not be sufficient. Always have at least 2 doses of Narcan. If no response after 2 doses, continue rescue breathing and wait for EMS — do not give more than 4 doses.
Higher-dose naloxone (8mg Kloxxado) is now available and recommended in communities with high fentanyl prevalence. Ask your pharmacist about availability.
Where to Get Narcan Without a Prescription
- CVS, Walgreens, Walmart, Rite Aid — available over the counter nationwide
- NEXT Distro (nextdistro.org) — free mail-order naloxone in many states
- Local harm reduction programs — often free, with training
- Your doctor or pharmacist — may prescribe Kloxxado (8mg) or injectable naloxone
- SAMHSA naloxone locator — findtreatment.gov
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Sources
- CDC. (2024). Understanding the Opioid Overdose Epidemic.
- SAMHSA. (2023). Opioid Overdose Prevention Toolkit.
- FDA. (2023). FDA Approves First Over-the-Counter Naloxone Nasal Spray.
- Harm Reduction International. (2023). Naloxone: The Medication That Reverses Opioid Overdose.
Addiction Helpline America Clinical Team
All content reviewed by licensed addiction medicine specialists following SAMHSA, NIDA, and ASAM guidelines. Learn about our editorial process.