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Narcan Nasal Spray

Narcan nasal spray is used to reverse an opioid overdose.

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Almost 70,000 people died from an opioid overdose in 2020. Opioids are central nervous system depressants that can cause life-sustaining functions like breathing and heart rate to drop dangerously low very quickly, especially when opioids are misused.

In 2023, the U.S. Food and Drug Administration approved the 4 mg Narcan nasal spray as an over-the-counter medication. That means people can go into a pharmacy and purchase this life-saving medication without a prescription.

Other forms of naloxone (such as injections) aren’t available without a prescription.

What Is Narcan Nasal Spray?

Narcan is a potentially life-saving medication that is designed to reverse the effects of an opioid overdose within two to three minutes. It is the most dispensed naloxone brand.

It is dispensed in a two-pack of 4 mg doses each. It does not require needles, and it is easy to administer without specialized training.

Recognizing Opioid Overdose

An opioid overdose can be fatal. It is a medical emergency with the following symptoms:

  •       Trouble breathing
  •       Extreme drowsiness or loss of consciousness
  •       Mental confusion
  •       Slow heart rate and blood pressure
  •       Limp muscles and weakness
  •       Cool, clammy skin that has a bluish tint
  •       Pinpoint pupils

Narcan can reverse an opioid overdose, restoring breathing rates and consciousness in minutes.

Key Statistics About Narcan

  •  Bystanders are present in more than one out of three opioid overdoses. A bystander carrying Narcan nasal spray has the ability to save a life in this situation.
  • Naloxone spray is an approved OTC medication, so anyone can walk into a pharmacy and buy it without a prescription.
  • State-run overdose prevention programs may also have free forms of naloxone available for people to use.
  • Naloxone is effective in reversing an opioid overdose and saving lives nearly 94% of the time.

How Does It Work?

Naloxone, the active substance in Narcan, is an opioid antagonist, which means that it blocks opioid drugs from binding to the opioid receptors in the brain. When dispensed when opioids are already present, it kicks these drugs off the opioid receptors. Since these drugs are acting to suppress the central nervous system, it stops that action.

An opioid overdose commonly causes breathing issues and loss of consciousness. Narcan can effectively restore breathing and consciousness within a few minutes of being administered. 

How Do You Administer Narcan Nasal Spray?

Narcan nasal spray is quick and easy to administer. Follow the instructions contained in the prescribing information and instructions for use, which are as follows:

  1. As soon as you recognize any sign of an opioid overdose, act quickly to administer Narcan as every minute counts.
  2. Lay the person flat on their back.
  3. Peel back the packaging and remove the device.
  4. Hold the device with your thumb on the bottom of the red plunger and your first and third fingers on either side of the nozzle.
  5. Tilt the person’s head back, and support the back of the head with your other hand.
  6. Put the tip of the nozzle into either nostril, and insert it up to the point where your fingers touch the bottom of the person’s nose.
  7. Press the plunger firmly to release the entire dose at once into the person’s nose.
  8. Remove the device.
  9. Move them onto their side into the recovery position.
  10.  Call 911 if you have not already.
  11.  If they do not respond within a few minutes, repeat steps 2 through 8. Additional doses can be administered every two to three minutes as needed.
  12.  Properly dispose of used Narcan container.

What Are the Possible Side Effects?

Narcan is a safe and effective medication for opioid overdose reversal, but it can cause opioid withdrawal side effects to start, especially in people who have been using opioids regularly and have developed a physical dependence on these drugs. These withdrawal side effects can include the following:

  • Body aches
  • Nausea and vomiting
  • Diarrhea
  • Fever
  • Runny nose 
  • Teary eyes
  • Irregular heart rate
  • Stomach cramps
  • Weakness
  • Nervousness
  • Goosebumps
  • Sweating
  • Shivering 
  • Restlessness
  • Irritability
  • Heightened blood pressure

How Long Does Narcan Stay in Your System?

Narcan will stay in the body for about 30 to 90 minutes. Many opioid drugs can remain active in the system for much longer than this, which can mean that multiple doses of Narcan will be necessary. 

It is important to still seek professional medical care even after a successful opioid overdose reversal with Narcan. The person can then be monitored for long enough to ensure that their breathing remains stable and regulated. 

Medical care is also important at this point because opioid withdrawal symptoms can start within minutes of receiving Narcan. Emergency medical professionals are capable of helping manage these side effects right away. They can also provide referrals to treatment for long-term withdrawal management.

Where Can You Find Narcan Nasal Spray?

In 2023, the FDA approved Narcan 4 mg nasal spray as an over-the-counter medication. You can walk into a pharmacy like Walgreens to buy Narcan, or you can buy it online without a prescription.

If you or a loved one is prescribed high-dose opioids, keeping naloxone with you at all times is a great way to stay safe.

Many states also have community-based programs where you can get Narcan, often for free, to have on hand if you fear that someone you love may suffer from an opioid overdose at some point.

Does Narcan Nasal Spray Work on All Drugs?

Narcan is specifically an opioid antagonist medication, which means that it will not be effective in reversing overdoses from other drugs. Narcan will work to reverse an overdose on narcotic prescription pain medications containing opioids, such as OxyContin (oxycodone) and Vicodin (hydrocodone/acetaminophen) as well as on illicit opioids like heroin and fentanyl. 

Narcan will not be effective on benzodiazepines or barbiturates, even though these drugs are also central nervous system depressant substances. Narcan will not usually further harm someone if they are overdosing on a drug that is not an opioid, however. If you are not sure what substance is involved, you can always administer Narcan after calling 911 just in case an opioid might be involved.

Other Forms of Naloxone

The FDA approved just one form of Narcan as an over-the-counter drug. Other versions are available, and they require a prescription.

One type of naloxone, typically sold as Zimhi, contains a single dose of naloxone in a prefilled syringe. People can use this medication to inject the medication into a person’s muscle or under the skin. Currently, you need a prescription for this medication.

Generic naloxone is also sold in glass vials. People who use a lot of naloxone (like doctors in emergency rooms) can give several doses of the drug from one bottle, reducing medical waste and allowing for accurate dosing. You’ll need a prescription for this drug too, if you want to carry it to help other people.

Narcan spray is very easy for people to use, even if they don’t have medical training. This ease of use can be ideal during a stressful overdose situation, when you’re nervous and under a lot of pressure. In general, it’s best for people without medical training to use Narcan spray instead of seeking out injectable forms of the drug.

Updated February 15, 2024
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  5. Naloxone for Opioid Overdose: Life-Saving Science. (June 2021). National Institute on Drug Abuse.
  6. Naloxone Reverses 93% of Overdoses, But Many Recipients Don’t Survive a Year. (October 2017). CNN.
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  10. Intranasal Naloxone and Related Strategies for Opioid Overdose Intervention by Nonmedical Personnel: A Review. (October 2017). Substance Abuse and Rehabilitation.
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