Narcan (naloxone) is a life-saving medication used to rapidly reverse an opioid overdose. It works by "knocking" opioids off the brain's receptors and temporarily blocking them, which restores normal breathing. Because Narcan only affects opioids, it is safe to use even if you aren't 100% sure an overdose is occurring—it will not harm someone who does not have opioids in their system. 1. How to Identify an Opioid Overdose Common signs that someone may need Narcan include: * Breathing is slow, shallow, or has stopped entirely. * Blue or grayish tint to the lips, skin, or fingernails. * Pinpoint pupils (very small). * Unresponsiveness to shouting or a firm "sternum rub" (rubbing your knuckles hard on their chest). * Choking or gurgling sounds (often called the "death rattle"). 2. How to Use Narcan Nasal Spray If you suspect an overdose, call 911 immediately, then follow these steps: * Peel back the tab to remove the device from the packaging. * Hold the device with your thumb on the bottom of the plunger and two fingers on either side of the nozzle. Do not test/prime the spray. * Insert the tip of the nozzle into one nostril until your fingers touch the bottom of the person's nose. * Press the plunger firmly to release the dose. * Place the person in the "Recovery Position" (on their side) to prevent choking if they vomit. * Repeat: If they do not wake up or breathe normally within 2–3 minutes, give a second dose (using a new device) in the other nostril. 3. Important Safety Facts * **It is temporary: Narcan wears off in 30 to 90 minutes. Because many opioids stay in the body longer than that, a person can fall back into an overdose once the Narcan fades. This is why emergency medical help is essential. * Withdrawal: If the person is physically dependent on opioids, they may wake up feeling very sick (nausea, agitation, body aches). This is uncomfortable but generally not life-threatening. * Effectiveness: It works on heroin, fentanyl, and prescription painkillers (oxycodone, morphine). It does not reverse overdoses from cocaine, meth, or alcohol unless opioids are also present.

This SAMHSA toolkit provides comprehensive guidance on overdose prevention and response, addressing the ongoing crisis in the United States, where overdose deaths remain historically high. While projecting a decline, over 105,000 people died from overdose in 2023, predominantly involving opioids like illicitly manufactured fentanyl, often combined with stimulants or adulterants like xylazine. The toolkit aims to educate a broad audience—including people who use drugs, their families, practitioners, health systems, and first responders—on overdose causes, risks, signs, and effective response strategies. It details the basics of opioid and stimulant overdoses, explaining how drugs like opioids can cause fatal respiratory depression. Key risk factors include reduced tolerance after abstinence, using stronger drugs, combining substances (e.g., opioids with alcohol or benzodiazepines), and using drugs alone. A central component of the toolkit is information on Opioid Overdose Reversal Medications (OORM), such as naloxone and nalmefene. These life-saving medications reverse the effects of opioid overdose and are available to the public. The toolkit provides a Q&A on OORM, including where to obtain them, their effectiveness against fentanyl, and considerations regarding dosage and potential withdrawal symptoms. It also highlights that while OORMs do not reverse stimulant overdoses, managing acute symptoms is crucial. For responding to an overdose, the toolkit outlines clear steps: recognizing signs (unconsciousness, shallow breathing, discolored skin/lips, pinpoint pupils), administering OORM, calling 911, and supporting breathing through rescue breaths or placing the person in a recovery position. It emphasizes that OORM can be given without harm even if an opioid overdose is not confirmed. Post-overdose, it stresses offering treatment options, peer support, and understanding Good Samaritan laws. The document also integrates "treatment as prevention," advocating for evidence-based medications for Opioid Use Disorder (MOUD) like buprenorphine, methadone, and naltrexone, which significantly reduce overdose risk. Appendices offer tailored advice for specific groups: