Narcan (Naloxone) for Families

What naloxone does, and what it does not do

Naloxone is an opioid antagonist. It binds to opioid receptors in the brain and displaces opioids that are sitting there, blocking their effect. In an overdose, the displaced opioid loses its ability to suppress breathing, and the person starts breathing again. Naloxone works in 2 to 5 minutes after intranasal administration.

What naloxone does not do: it does not work on overdoses from non-opioid drugs (alcohol, benzodiazepines alone, cocaine alone, methamphetamine alone). It does not produce a high or have any pleasant effect; it produces opioid withdrawal in someone who is opioid-dependent. It does not eliminate the need for emergency medical attention, the underlying overdose can re-emerge as naloxone wears off (30 to 90 minutes), so calling 911 is always part of the response.

Most overdose deaths in the United States now involve fentanyl, often without the user's knowledge, fentanyl is in the heroin supply, in pressed pills sold as oxycodone or alprazolam, and increasingly in the cocaine and methamphetamine supplies. This is why every family with a loved one using any street drug should carry naloxone, not just families with a loved one using opioids specifically.

How to recognize an opioid overdose

The signs of an opioid overdose are specific and recognizable:

• Unresponsive, does not wake up to voice or shaking
• Slow or stopped breathing, fewer than 8 breaths per minute, or pauses between breaths longer than 10 seconds
• Blue or gray lips, fingertips, or face, sign of low oxygen (cyanosis)
• Choking or gurgling sounds, sometimes called the "death rattle"
• Pinpoint pupils, pupils constricted to small dots
• Limp body, no muscle tone
• Cold or clammy skin

If you are unsure

Give the naloxone anyway. Naloxone has no effect on someone who is not opioid-overdosed, it will not harm them. The risk of withholding naloxone in a true overdose is death; the risk of giving it when it was not needed is essentially zero. The clinical guidance is: when in doubt, administer.

How to administer naloxone

The most common form of naloxone is intranasal, a small spray device that goes into one nostril. It is designed to be used by anyone, no medical training required.

Step-by-step

• 1. Call 911 first. Naloxone wears off in 30 to 90 minutes; the underlying opioid can re-emerge. Emergency medical response is part of the rescue, not optional.
• 2. Place the person on their back. Tilt their head back slightly to open the airway.
• 3. Insert the nozzle into one nostril until your fingers touch the bottom of the person's nose.
• 4. Press the plunger firmly. A single full dose is delivered.
• 5. Begin rescue breathing if you are trained, or wait for first responders if you are not.
• 6. Place the person in the recovery position (on their side) once they begin breathing, they may vomit when they regain consciousness.
• 7. Give a second dose if there is no response after 2 to 3 minutes. Fentanyl overdoses often require multiple doses because of the strength and quantity of the opioid involved.
• 8. Stay with the person until EMS arrives. Naloxone can wear off and the overdose can return.

What to expect after naloxone

If the overdose was opioid-driven and the naloxone worked, the person will start breathing within 2 to 5 minutes. They will often be confused, frightened, and in immediate opioid withdrawal, uncomfortable but not dangerous. They may be angry that you reversed the overdose; this is not personal. They may try to use again immediately to relieve the withdrawal; this is dangerous because the naloxone will still be active, and an additional opioid dose can produce a delayed overdose when the naloxone wears off. EMS will manage the medical follow-up.

How to get naloxone in New Jersey

Naloxone is available without a prescription in New Jersey under a standing order. Several free and low-cost paths:

• Pharmacies, Naloxone is available behind the counter at most NJ pharmacies (CVS, Walgreens, Rite Aid, independents) without a prescription. Many commercial insurance plans cover it; out-of-pocket cost is typically $30 to $50 for a two-dose box.
• NJ Department of Human Services, distributes free naloxone through county Mental Health/Addiction programs and at participating events. See your county Human Services office.
• NJ Harm Reduction Coalition + local syringe service programs, distribute free naloxone with training. Programs operate in several NJ counties.
• Hospital emergency departments, many NJ hospitals dispense naloxone at discharge after an overdose-related visit; some dispense it on request for family members of opioid users.
• Online order, NEXT Distro and similar national programs ship naloxone free to NJ addresses for individuals and families who cannot access it locally.

How to get naloxone in North Carolina

Naloxone is available without a prescription in North Carolina under a statewide standing order. Several access points:

• Pharmacies, Available behind the counter at most NC pharmacies (CVS, Walgreens, Harris Teeter, Publix, Walmart, independents) without a prescription. Insurance coverage is similar to NJ; out-of-pocket typically $30 to $50.
• NC Department of Health and Human Services, coordinates naloxone distribution through local health departments and community programs.
• NC Harm Reduction Coalition, distributes free naloxone with training. Operates programs in Charlotte and across the state.
• Mecklenburg County Public Health, community distribution programs and overdose-prevention events; check the Public Health website for upcoming events.
• Hospital emergency departments, many NC hospitals dispense naloxone after overdose-related visits or on request from family members.
• Online order, NEXT Distro and similar national programs ship naloxone free to NC addresses.

Storing and carrying naloxone

Naloxone should be stored at room temperature, out of direct sunlight. It does not require refrigeration. The shelf life is approximately 2 years, with the expiration date printed on the package. Expired naloxone is still partially effective and should be used in an emergency if no in-date supply is available.

Where to keep it:

• One in the home in an accessible, known location, not locked away
• One in the car if you spend significant time driving with the person
• One in a bag or backpack if you are out together regularly
• Tell anyone who might be present in an overdose where the naloxone is and how to use it, friends, roommates, other family members

The conversation with your loved one

Many families struggle with the conversation about naloxone. Bringing it into the house can feel like "giving permission" or "expecting the worst." The reverse is true: families who have naloxone in the house and have practiced the conversation about overdose prevention have better outcomes for the person using and better mental health for themselves.

Suggested framing:

• "I love you. I have naloxone. I do not want to use it, but I will if I need to.", direct, non-judgmental, names the love and the readiness in the same breath.
• "This is not me thinking you will die. This is me being prepared because I love you.", addresses the most common pushback.
• "Here is where it is. Here is how to use it. Please make sure the people you spend time with also know how to use it.", keeps the practical step in focus.
• Avoid: lectures about quitting, ultimatums tied to overdose risk, conditional language ("if you keep using"). The naloxone conversation is not the moment for those conversations.

After an overdose, what comes next

If you have used naloxone on your loved one, the immediate medical event is resolved when EMS arrives and confirms stability. The clinical opportunity opens immediately after. A reversed overdose is a moment when many people are willing to engage with treatment in a way they were not before, partly the medical reality of having almost died, partly the shock value of having needed reversal.

The Archangel Centers admissions line is available 24/7 at (888) 464-2144 for clients and families in this window. The intake assessment can happen by phone the same day. For clients near Tinton Falls, NJ, see opioid rehab in Tinton Falls and fentanyl rehab in Tinton Falls. For clients near Charlotte, NC, see opioid rehab in Charlotte and fentanyl rehab in Charlotte.

Continued MAT after an overdose dramatically reduces the risk of a second event. The clinical literature on this is consistent, buprenorphine-based MAT after overdose cuts re-overdose mortality substantially.