GuidelinesSaving Lives: A Nurse's Guide to Administering Narcan for Opioid Overdoses

Saving Lives: A Nurse’s Guide to Administering Narcan for Opioid Overdoses

Opioid overdoses have become an epidemic in many communities, with overdose deaths quadrupling since 1999. As nurses, we are on the front lines of this crisis and can help save lives by quickly recognizing signs of overdose and administering naloxone, sold under the brand name Narcan. This comprehensive guide will provide nurses with vital information on using Narcan nasal spray to reverse opioid overdoses.

Recognizing the Signs of Opioid Overdose

The first step in responding to overdoses is recognizing when one may be occurring. Signs of opioid overdose include:

  • Extreme drowsiness, inability to wake up, or loss of consciousness
  • Slow, weak, or no breathing
  • Small “pinpoint” pupils
  • Slow heartbeat and low blood pressure
  • Skin that is pale, clammy, cool to the touch
  • Choking sounds or a gurgling noise
  • Blue lips, fingers, or toes

An individual exhibiting these signs should be treated as a suspected overdose, even if there is no evidence of drug use. It is essential to act fast, as respiratory arrest can occur within 3-5 minutes. Without oxygen, permanent brain damage or death can occur in as little as 4-6 minutes.

Understanding How Narcan Works

Narcan contains naloxone, an opioid antagonist drug that reverses the effects of opioid overdose. It works by blocking opioid receptors in the brain, displacing opioids and essentially “kicking off” the opioids that are causing the person’s respiratory depression and unconsciousness.

Narcan is extremely safe and has no potential for abuse. It only blocks opioids and has essentially no effect on an individual if opioids are absent. It is impossible to overdose on Narcan alone. The only side effect may be precipitating immediate opioid withdrawal symptoms in those with high physical dependence.Importantly, Narcan only lasts 30-90 minutes, while many opioids last much longer.

So it is vital to get emergency medical treatment after revival with Narcan to prevent the person from slipping back into overdose as the Narcan wears off.

Administering Narcan Nasal Spray

Narcan nasal spray makes it easy for anyone to administer a life-saving dose of naloxone. No assembly is required – simply remove, aim, and push the plunger.To administer Narcan:

  1. Call 911 immediately if you encounter an unresponsive victim. Narcan buys time but more treatment is likely needed.
  2. Remove Narcan from the box. Peel back the tab with the circle to open the nasal spray.
  3. Hold the Narcan spray with your thumb on the bottom of the plunger and your first and middle fingers on either side of the nozzle.
  4. Tilt the person’s head back and provide support under the neck with your hand. Gently insert the tip of the nozzle into one nostril until your fingers on either side of the nozzle are against the bottom of the person’s nose.
  5. Press the plunger firmly to release the dose of Narcan nasal spray.
  6. If there is no response after 2-3 minutes, administer a second dose of Narcan in the other nostril.
  7. Place the person in the recovery position, on their side with their mouth facing the ground to prevent choking. Continue monitoring breathing until emergency medical assistance arrives.
  8. Inform emergency responders that Narcan was administered, the time, and the current condition of the victim. Overdose victims should be transported to the ER even after revival with Narcan.

Nursing Abroad imageNarcan Administration Image source: Narcan Quick Start Guide

Special Considerations

  • Pregnancy: Narcan is safe to administer to pregnant women showing signs of overdose. Untreated overdose poses severe risks to the mother and fetus.
  • Fentanyl overdoses: Fentanyl is an extremely potent opioid that may require multiple doses of Narcan or higher doses to reverse respiratory depression. Continue rescue breathing and administer additional Narcan every 2-3 minutes if needed.
  • Partial/temporary response: Some patients may only respond partially to Narcan at first before later slipping back into overdose. Monitor closely for at least a few hours and give additional Narcan doses if needed.
  • Violent/aggressive behavior: Some patients revived with Narcan experience immediate opioid withdrawal, which may cause agitation, vomiting, sweating, and fast heart rate. Protect yourself and the patient, but do not withhold Narcan out of fear of this possibility. Most patients will not become aggressive.
  • No response: If there is no response to Narcan, consider causes other than opioid overdose and continue proper BLS protocols. However, fentanyl or extremely high doses of opioids may require higher or repeated doses of Narcan.


Equipping nurses to recognize overdose signs and administer Narcan nasal spray empowers us to immediately help save lives right when minutes matter most.

While Narcan is not a substitute for emergency medical care, it buys precious time until help can arrive. By quickly and effectively utilizing this tool, nurses can make a real difference in reversing the devastating impacts of the opioid epidemic.

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