Stimulation — are they responsive? Try the sternum rub. If the person responds, they are not overdosing at that moment, but they might still fall into an overdose and therefore need to be monitored. If they don't respond to a sternum rub, continue to the next step.

Call for help — call 911. The person may need additional medical attention or more naloxone than you have on you.
 

Airway — Visually check to make sure their airways are clear. If necessary, try a two-finger sweep.
 

Rescue breathing — To begin rescue breathing, slightly tilt the unconscious person's head back and chin up. Plug their nose and place your mouth over theirs then administer 2 quick breaths. After that, administer one breath every 5 seconds for 3-5 minutes. If you are not able to open the person's mouth, keep their mouth closed and breathe through their nose instead.
 

Evaluation — After rescue breathing, evaluate their condition. Is their skin returning to their normal color? Are they breathing on their own or regaining consciousness? If not, they need a dose of Naloxone.
 

Mucosal Atomization (Nasal Spray) or Muscular Injection — unpackage nasal Narcan and gently insert the nasal tip into one of the the unconscious person's nostrils. Press the plunger to dispense the medication then return to rescue breathing.
OR
For intramuscular injection naloxone - Take the orange cap off the naloxone vial. Stick the tip of the needle into the liquid and draw the entire contents into the syringe. Push out any air until the liquid begins to drip out of the syringe. Inject the naloxone into a large muscle mass like the thigh, deltoid (upper arm), or buttocks. Return to rescue breathing.
 

Evaluation — Is the person getting better? If they have not regained consciousness after 3-5 minutes, with continued rescue breathing, give them another dose of nasal naloxone in the other nostril (or another injection of intramuscular naloxone) and continue rescue breathing. After 3-5 more minutes repeat with more naloxone as needed.

Naloxone takes approximately 3-5 minutes to work and wears off after 60-90 minutes. When the naloxone wears off, it's possible the person can fall back into another overdose therefore they should be monitored for the next few hours. To the best of your ability, do not let the person use more opioids for the next few hours while the naloxone is still in their system or while they are at risk of overdosing again.

When someone wakes up from an overdose, they may be confused and disoriented. They may also begin experiencing symptoms of precipitated withdrawal including agitation. If you do not know the person you revived, gently introduce yourself and communicate to the person that you had to give them Narcan. If you cannot stay with the person, communicate to them that they are at risk of falling into an overdose again when the naloxone wears off and that using more opioids will only further increase that risk. Ask if you can help them find somewhere to go or someone who can stay with them. Hand them the resource cards in your kit or communicate resource information if you have it. Understand that overdosing may not discourage someone from continuing to use drugs or motivate them to enter recovery treatment. When you are able, report the overdose to COPE at 269-580-8290 and arrange to receive a replacement naloxone kit.