Administer Narcan

Watching someone you care about struggle with addiction can be devastating, but knowing how to administer Narcan may save their life and can help you feel more in control. The use of legal or illegal opiate (narcotic) drugs can easily cause an overdose that makes the victim stop breathing, but Narcan (naloxone, also branded Evzio) can often reverse opiate overdose. Now that the public has access to Narcan, the fight against addiction may get easier. When trying to help, it’s important to monitor the victim closely, call for emergency services, give CPR if needed, and administer the Narcan effectively whether it's a nasal spray or injection.

Steps

Giving Intranasal Narcan

1. Remove the yellow caps from the syringe. Prepare the nasal syringe immediately after giving several rescue breaths (if necessary). Pry or pull off the yellow caps. There are usually two – one at each end of the syringe.
   • A syringe is not a needle, it’s a plastic device that holds the needle – or in this case, what the Narcan screws onto.
   • You can find Narcan through the getnaloxonenow.org website.
2. Take the red cap off the Narcan. The tube of Narcan (also labeled naloxone) may have a red cap. Pry this off and discard it.
3. Put the three pieces together. Grip the clear plastic wings of the nasal atomizer (the cone-shaped applicator), and insert it onto the syringe. Gently screw the Narcan container onto the barrel of the syringe.
   • Do not prime or test the spray. It is single-use and can’t be reused.
   • Some Narcan nasal sprays come in single-use, pre-assembled packages. They contain two needle-free devices, one to use in each nostril.
4. Administer the Narcan half in each nostril. Lay the victim on their back and tilt their head back. Place the white cone applicator into one nostril of the victim’s nose. Give a short, hard push onto the end of the capsule to spray the Narcan. Deliver half of the container (1cc).
   • Repeat the process immediately in the victim’s other nostril.

Giving Narcan by Needle

1. Assemble a 1-1.5 inch needle. After giving a few quick rescue breaths, assemble your needle. Use a 1” or 1.5” needle, called an IM or intramuscular needle. You can get these at needle exchange programs and pharmacies. Always have these on hand if you carry non-nasal Narcan.
2. Prepare 1cc of Narcan. Pop the orange top off the vial of liquid Narcan. Insert the needle into the bottle. Pull back on the plunger until the liquid line reaches the 1cc mark.
   • 1cc = 1ml = 100U
   • Injectable Narcan comes in several different sized bottles – a 1cc bottle and a 10cc bottle. Only use 1cc of Narcan, not the whole 10cc’s. Giving too much Narcan too fast can cause the victim severe pain and other health problems.
3. Select the injection site. Choose a large muscle to inject the Narcan into. The best sites are the thigh, the upper, outer part of the buttock, or the upper arm (deltoid muscle). Generally, choose the outer thigh.
   • You can inject it through clothing if you need to.
4. Inject the Narcan. Insert the needle into the muscle at a 90° angle. Jab the needle into the muscle at a moderately quick speed. Go straight in and aim for the center of the big muscle. Press the plunger down at a moderate speed until all the Narcan has been injected.
   • If you only have a small needle, inject the Narcan under the skin instead of into the muscle. Pinch a tent of skin in a somewhat fatty area, and insert the smaller needle at a 45° angle to their body.
5. Monitor the victim for 3-5 minutes. As with nasal Narcan, continue to monitor the victim and provide rescue breathing if necessary. Give another dose if there are no changes in 3-5 minutes.

Monitoring the Victim and Giving Aftercare

1. Administer Narcan only if the victim meets the criteria. Only administer Narcan if the victim exhibits the following signs of overdose:
   • They are unconscious, unresponsive, and you cannot wake them
   • They have pinpoint (constricted) pupils
   • Their breathing is slow and shallow, breathing fewer than 8 times per minute
2. Provide supportive care until help arrives. When you find a loved one unconscious, yell and rub your knuckles on the center of their breastbone to try to wake them. If they wake up, they do not need Narcan. If not, call emergency services immediately and tell them that someone may have overdosed. Before giving Narcan, see if the victim needs CPR - this may save their life! Follow these guidelines:
   • Count their breaths: Listening at their mouth while watching to see whether their chest is rising and falling for 5-10 seconds. If they are not breathing or are breathing fewer than 8 times per minute, give them a few rescue breaths before adminstering Narcan.
   • Check for a pulse for 30 seconds by placing your middle and forefingers on the victim's neck just off to the side a little, under the jaw line. If they don't have a pulse, start CPR chest compressions.
3. Be prepared to administer more Narcan. Narcan acts quickly – within about 2 minutes – but it also only lasts for about 30 minutes. Keep constant watch on the victim’s alertness and breathing. Administer more Narcan if they meet the criteria for it. Continue this until emergency services arrive.
   • If you do not have more Narcan and the victim’s breathing slows below 8 breaths per minute, administer rescue breathing until help arrives.
4. Be sure the victim gets to the hospital. Emergency services should immediately take the victim to intensive care for monitoring. If you are unable to access emergency services, get the person to the hospital as soon as they can breathe on their own. They need medical care even if their overdose is reversed by Narcan.
5. Encourage the victim not to use again that day. Narcan can cause symptoms of withdrawal, making the victim want to use their drug again. Doing so can cause another overdose. These cravings may be difficult for both of you to deal with. Try to support the victim emotionally, and encourage them not to use drugs again that day.
6. Store the Narcan appropriately. Store any Narcan you have tightly closed in its original container. Store it at room temperature in a dark place. Dispose of the Narcan and get a new one if the red safety guard has been removed, it is expired, it looks cloudy or you can see particles floating in it.
   • Keep it safely out of reach of children. Do not let anyone else use your medication.

Obtaining and Using Narcan Appropriately

1. Know the victim’s drug of abuse. If a loved one uses illegal drugs or takes prescription medications inappropriately, try to find out what they take. Ask them outright and let them know you’re concerned about their safety. Narcan can reverse the effects of opiate drugs such as:
   • Heroin
   • Prescription pain medicine like fentanyl, morphine, methadone, buprenorphine, hydrocone, and oxycodone
   • Some common brand name medications such as Percocet, OxyContin, Vicodin, Percodan, Tylox, and Demerol
2. Get Narcan from a doctor. If you or a loved one suffer from opiate addiction, talk to your doctor about getting Narcan to keep on hand. You may be able to obtain liquid Narcan that can be injected into a vein, muscle, or under the skin, or a nasal spray. You need a prescription to get Narcan in some states but not others.
   • Automatic injection devices (Evzio) are sometimes available. These have voice guidance that can direct you or another on how to use the device. Use it once then throw it away. This is the BEST OPTION if you do not have medical training.
   • You will probably not be able to administer Narcan to yourself if you are overdosing. Friends, family, and loved ones should know how to use the Narcan and where to find it.
3. Do a quick scan for signs of opiate overdose. You may not always know what drug someone has overdosed on, or if they’ve used drugs at all. Don’t waste time, but look very quickly for some signs that the victim may have overdosed on opiates. Scan quickly for prescription drug bottles lying around, a morphine or fentanyl patch on their body (remove it!) or visible drug paraphernalia like syringes, spoons, and tourniquets.

Tips

• If you know someone struggling with opiate addiction, alert them to community and national services such as the Harm Reduction Coalition and other recovery resources.
• Check the expiration date of Narcan you keep, and replace it if it expires.
• To give rescue breaths, tilt the victim’s head back slightly and lift their chin to open the airway. Pinch their nose closed with one hand. Put your mouth over the victim’s mouth to make a seal and blow into their mouth. Watch to be sure their chest rises when you give a breath – if not, exhale more forcefully.

Warnings

• Giving too much Narcan too quickly can cause the victim severe pain, high blood pressure, and heart problems.

Sources and Citations

See also

• Handle Caffeine Withdrawal
• Use HALT in Addiction Recovery
• Stop Looking at Pornography
• Control Your Urge to Masturbate
• Stop a Masturbation Addiction
• Pass a Drug Test
• Stop Internet Addiction
• Get Sober with a 12 Step Program
• Quit Chewing Tobacco
• Overcome an Addiction to Porn As a Teenager

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