Naloxone: how to reverse an opioid overdose

In March 2023 the FDA approved a 4 mg naloxone nasal spray for sale without a prescription. CDC says you can now find naloxone at pharmacies, and at some grocery stores, convenience stores and gas stations.

The price depends on where you get it and which product you pick. Before you pay, check the free routes:

• Your local or state health department. SAMHSA says many give naloxone out free of charge.
• Community programs, including syringe services programs.
• Your health plan. CDC suggests checking whether your insurance covers it.

The state resources page explains how to find your state agency and health department.

CDC lists these signs:

• They are unconscious or you cannot wake them.
• Breathing is slow, shallow or has stopped.
• They make choking, gurgling or snoring sounds.
• Their lips or fingernails are discolored, often blue or purple.
• Their pupils are very small, like pinpoints.

It can be hard to tell a heavy high from an overdose. CDC’s advice is to treat it like an overdose if you are not sure. The page on overdose risk covers who is most in danger and when.

1. Check for a response. Say their name loudly and rub the middle of their chest firmly. If they do not wake, treat it as an overdose.
2. Lay the person on their back.
3. Open the spray. Take it out of the box and peel back the tab. Do not test or prime it. Each device holds one dose.
4. Hold it the right way. Put your thumb on the bottom of the plunger and your first and middle fingers on either side of the nozzle.
5. Tilt the head back. Support the back of the neck with your other hand. Gently put the tip of the nozzle into one nostril until your fingers touch the bottom of the nose.
6. Press the plunger firmly to release the dose, then take the nozzle out.
7. Call 911. If someone else is with you, have them call while you give the spray.
8. Turn the person onto their side. This is the recovery position. It helps stop them from choking.
9. Watch their breathing. If they do not wake up or breathe normally after 2 to 3 minutes, give another dose with a new spray in the other nostril.
10. Stay with them until emergency help arrives.

These steps follow public instructions from MedlinePlus and CDC. Read the leaflet in your own box too.

If they are not breathing

SAMHSA’s guidance is to begin CPR if the person has stopped breathing or breathing is very weak, and notes it is best done by someone with training. If you have learned rescue breathing or CPR, use it while you wait for the ambulance. If you have not, give the naloxone, keep them on their side and stay with them.

Naloxone is temporary. SAMHSA notes that its effects do not last long, and strong opioids such as fentanyl can outlast it. A person can wake up and then slip back into overdose. That is why 911 matters even when the spray works.

CDC says to stay with the person until emergency help arrives, or for at least four hours, to be sure their breathing stays normal.

Someone whose body is used to opioids may wake up in sudden withdrawal. FDA lists body aches, sweating, vomiting, shaking and irritability. It is miserable, and it is far safer than not breathing. Tell them calmly what happened and keep them with you.

Once things are calm, you can look at treatment programs in your state together, or call SAMHSA’s National Helpline at 1-800-662-4357 for free referral. If the overdose may have been on purpose, call or text 988.

Fear of police stops some people from calling. CDC says most states have laws that may protect a person who is overdosing, and the person who called for help, from some criminal penalties.

These laws vary by state, both in what they cover and who they cover. Whatever the rule where you live, a person who is not breathing needs an ambulance.

Keeping naloxone ready

• Keep it somewhere easy to reach, and tell everyone in the house where it is.
• Store it at room temperature, away from light. Do not freeze it.
• Check the expiration date and replace it when the date passes.

For more on what families can do, see helping someone with opiate addiction and help right now.