How to Use Narcan (Naloxone)

What naloxone and Narcan are and how they work

Naloxone is an opioid antagonist, meaning it works by binding to the same receptors in the brain that opioids attach to and rapidly displacing those opioids. This mechanism is what makes it effective: by knocking opioids off the receptor, naloxone reverses the most dangerous effects of an overdose, particularly the respiratory depression that causes a person to stop breathing. According to the National Institute on Drug Abuse, naloxone begins working within two to five minutes when administered as a nasal spray.

Narcan is the most widely recognized brand of naloxone nasal spray. It comes in a prefilled device with no assembly required: the user inserts the nozzle into one nostril and presses the plunger. Naloxone is also available as an injectable formulation. Both are designed for use by family members and bystanders without medical training, which is why federal health agencies have worked to expand access significantly over the past decade.

Naloxone is safe and carries no potential for misuse or recreational use. The National Institute on Drug Abuse is explicit that naloxone has no effect on someone who does not have opioids in their system, so administering it to a person who turns out not to be overdosing on opioids will not harm them. Because naloxone's effects typically last only 30 to 90 minutes and many opioids remain active in the body longer than that, a person who responds to naloxone may still need additional doses and always requires emergency medical care. Fentanyl and fentanyl analogs are particularly concerning because of their potency; two or more doses of naloxone may be needed.

How to recognize an opioid overdose

Knowing the warning signs of an opioid overdose is what makes it possible to act in the minutes that matter. The Substance Abuse and Mental Health Services Administration describes the key signs and the steps to take when they appear. When in doubt, administer naloxone. The risk of giving it unnecessarily is essentially zero; the risk of waiting when an overdose is occurring is death.

The most critical sign is unresponsiveness. A person experiencing an opioid overdose cannot be roused by calling their name, shaking their shoulder, or applying firm pressure with a knuckle to the sternum. Slow or stopped breathing, defined as fewer than eight breaths per minute or no visible chest movement, is the mechanism by which opioid overdose kills. Blue or gray discoloration of the lips or fingertips indicates oxygen deprivation.

A choking or gurgling sound sometimes called the death rattle, constricted pupils that appear very small even in dim light, complete muscle laxity, and cold or clammy skin are additional signs. A person who is simply very intoxicated may be difficult to wake but will respond with persistent stimulation, will have a normal or near-normal breathing rate, and will not have the bluish discoloration that indicates oxygen deprivation.

• Unresponsiveness to voice, touch, or sternal pressure
• Fewer than 8 breaths per minute or no visible breathing at all
• Blue, gray, or purplish discoloration of the lips, face, or fingertips
• Choking or gurgling sounds
• Pupils that are very small and constricted
• Complete muscle limpness
• Cold, clammy, or pale skin

How to administer naloxone: a step-by-step guide

Administering naloxone correctly in an emergency requires knowing the steps before the emergency occurs. Reading these steps now and reviewing them occasionally is what makes them accessible in a high-stress moment.

Call 911 before or immediately while preparing to give naloxone. This is non-negotiable. The Substance Abuse and Mental Health Services Administration is clear that naloxone is not a substitute for emergency medical care; it is a bridge to it. After calling 911, position the person on their back with their head tilted back slightly to open the airway. Insert the nozzle of the Narcan device fully into one nostril and press the plunger firmly to release the dose.

If the person does not respond within two to three minutes, give a second dose in the other nostril. After giving naloxone and if the person is breathing, place them in the recovery position on their side with their mouth facing down and their top knee bent to prevent choking if they vomit. Stay with them until emergency responders arrive. Do not leave the person alone, even if they appear to wake up and become agitated, because the naloxone can wear off before the opioid does and the overdose can return.

• Call 911 first, before or while preparing the naloxone
• Position person on their back with head tilted slightly back
• Insert the Narcan nozzle fully into one nostril and press the plunger firmly
• Wait two to three minutes; if no response, give a second dose in the other nostril
• After breathing resumes, place person on their side in the recovery position
• Stay with the person until emergency responders arrive
• Do not leave them alone even if they appear to wake up

What to expect after naloxone is administered

A person who responds to naloxone may experience a range of reactions, some of which are startling for family members who have not been warned. Understanding these reactions in advance reduces the chance of a family member inadvertently making the situation more dangerous.

Naloxone precipitates withdrawal in people who are physically dependent on opioids, which means the person may wake up confused, disoriented, frightened, or agitated. They may be in physical discomfort from withdrawal. Some people become angry when they wake up and realize what happened. Some have an immediate strong urge to use again to relieve the withdrawal discomfort. All of these reactions are expected and do not mean the naloxone failed.

Because the person may resist staying until emergency services arrive, it is important to calmly explain that the medication is wearing off and that emergency care is still needed even though they feel more awake. Do not leave them alone. Keep the environment calm. The post-overdose period represents a critical intervention window, and clinical evidence consistently shows that connecting to treatment or medication-assisted treatment immediately following an overdose reversal dramatically reduces the risk of a subsequent fatal event.

How to get naloxone in New Jersey

Access to naloxone has expanded significantly in New Jersey in recent years, and families often discover that obtaining it is easier than they expected. The Food and Drug Administration approved Narcan nasal spray for over-the-counter sale in 2023, meaning it can now be purchased directly at many pharmacies and retail stores without a prescription. Out-of-pocket cost for a two-dose box typically runs 30 to 50 dollars, and most health insurance plans cover it with a minimal copay.

For families who need naloxone at no cost, New Jersey operates multiple free distribution channels. Community naloxone distribution programs through county health departments, hospital emergency departments, and harm reduction organizations across the state provide naloxone at no cost, often with brief training. The online program NEXT Distro ships naloxone free to New Jersey addresses. New Jersey also maintains a standing order allowing pharmacists to dispense naloxone without an individual prescription from a physician.

Both New Jersey and North Carolina have enacted Good Samaritan laws that protect a person who calls 911 during an overdose from prosecution for low-level drug possession. This protection is specifically designed to remove the fear of legal consequences as a barrier to calling for help.

• Over-the-counter Narcan nasal spray now available at many pharmacies without a prescription
• NJ Department of Human Services: free distribution through county programs
• Harm reduction coalitions and community health centers: free distribution with training
• Hospital emergency departments: often dispense naloxone after overdose-related visits
• NEXT Distro: ships free naloxone nationally, including to New Jersey addresses
• New Jersey Good Samaritan Law protects callers from prosecution for low-level possession

How to get naloxone in North Carolina

North Carolina has similarly expanded naloxone access through multiple channels. Over-the-counter Narcan is available at most major pharmacy chains without a prescription. State-run programs and community organizations distribute naloxone free of charge throughout the state, including through the NC Department of Health and Human Services, the NC Harm Reduction Coalition, and local health departments in counties including Mecklenburg.

The North Carolina standing order allows pharmacists to dispense naloxone without an individual prescription, and the state's Good Samaritan statute provides legal protection for people who call 911 during an overdose emergency. As with New Jersey, NEXT Distro ships free naloxone to North Carolina addresses for families who cannot access a local distribution point.

The Archangel Centers Charlotte location, serving the Mecklenburg County area, can connect families with local naloxone resources and provides overdose response training as part of its outpatient programming. Our admissions team at (888) 464-2144 can help identify the most accessible options for families in the Charlotte region.

• Over-the-counter Narcan available at major pharmacy chains without a prescription
• NC Department of Health and Human Services: local health department coordination
• NC Harm Reduction Coalition: free distribution programs across the state
• Mecklenburg County Public Health: community distribution events in the Charlotte area
• NEXT Distro: ships free naloxone to North Carolina addresses
• North Carolina Good Samaritan Law protects callers during overdose emergencies

Storing and carrying naloxone

Naloxone nasal spray should be stored at room temperature, away from direct sunlight and away from extreme cold or heat. Most formulations have a shelf life of approximately two years from the date of manufacture, which is printed on the packaging. Expired naloxone retains partial potency and should be used in an emergency when nothing else is available, but should be replaced with unexpired supply as soon as possible.

The most important storage decision is location: naloxone should be where it can be found quickly in a crisis. Standard recommendations include keeping one unit in the home in an accessible place all household members know, one in the glove box or center console of a vehicle, and one in a backpack, purse, or bag that travels regularly. If other people in the household know where the naloxone is and how to use it, the protection extends beyond a single family member's presence.

Letting the person who uses opioids know that naloxone is available, and teaching everyone who might be present in an emergency how to use it, is the other half of readiness. A supply of naloxone in a drawer that only one person knows about and no one has practiced using provides far less protection than one that is known, accessible, and reviewed periodically.

Talking with your loved one about naloxone

Many families feel uncertain about how to have the conversation with their loved one about keeping naloxone in the home. The most direct approach is also often the most effective: I love you, and I want us to be prepared. Having naloxone on hand means I can help you if something goes wrong.

Framing naloxone as a practical safeguard rather than an expression of low expectations or a sign of assuming relapse is more likely to be received well. The analogy that is most useful is that keeping naloxone in the home is like keeping a smoke detector on the wall. It does not mean you expect a fire; it means you want to survive one if it happens.

For some families, the person who uses is resistant to discussing overdose preparedness. In those cases, families may carry and store naloxone independently without requiring the loved one's agreement. The most important outcome is having the medication available if it is ever needed, regardless of how the conversation about it goes.

How naloxone fits into outpatient recovery

Keeping naloxone on hand is not a sign that you expect a loved one to relapse. It is a recognition that the risk of overdose is elevated during certain periods in recovery, particularly early recovery and after any return to use, and that being prepared is part of supporting long-term safety.

The period immediately following an overdose is one of the highest-risk periods for a fatal subsequent event, because tolerance is reduced after a period of abstinence, and a dose that was used safely before treatment may now be lethal. This is why the post-overdose window is also recognized as a critical opportunity for initiating or returning to treatment. Medication-assisted treatment using buprenorphine or naltrexone, started during or immediately after an overdose event, dramatically reduces the risk of subsequent fatal overdose.

Overdose readiness works best alongside professional care that addresses the underlying substance use disorder. The Archangel Centers provides naloxone education and overdose-response training as part of its outpatient programming in New Jersey and North Carolina. We offer partial hospitalization, intensive outpatient, and standard outpatient levels of care. We do not provide medical detox or residential treatment directly, but our admissions team coordinates placement with trusted partners when a higher level of care is needed first. Call us at (888) 464-2144 any time.