Naloxone is a fast-acting opioid antagonist that can reverse respiratory depression during an opioid overdose. For patients receiving opioids, whether for acute pain, chronic pain, or opioid use disorder, the nurse is often the person who turns a prescription into something a patient and family can actually use under stress. Good naloxone education is concrete, calm, and non-stigmatizing.
Who should be offered naloxone, and how to frame it
Offering naloxone is not an accusation. The CDC Naloxone Toolkit frames it as a routine safety step and emphasizes communicating in a way that is caring, compassionate, and non-stigmatizing, with explicit attention to reducing the stigma some patients feel about carrying it. A useful comparison for patients: naloxone is like a fire extinguisher or an EpiPen. You hope never to need it, and you keep it on hand anyway.
Within your facility's policy, naloxone is generally appropriate to discuss for patients who have one or more overdose risk factors. Common considerations include higher opioid doses, concurrent benzodiazepine or other sedative use, a history of overdose or substance use disorder, respiratory conditions such as sleep apnea or COPD, and a return to opioids after a period of reduced tolerance. Rather than memorizing thresholds, use your assessment to identify patients at elevated risk and follow your prescriber and pharmacy workflow for co-dispensing.
A critical teaching point: the patient is rarely the person who administers naloxone to themselves during an overdose. Bystanders give it. So the education has to reach a household member, partner, caregiver, or roommate. The toolkit specifically supports teaching family members how to identify an overdose and use naloxone. Document who was present for teaching and that household members were included.
What patients and families need to recognize and do
Teach the signs of an opioid overdose plainly. Per patient instructions on MedlinePlus, warning signs include excessive sleepiness, not awakening when spoken to loudly or when the middle of the chest is rubbed firmly, shallow or stopped breathing, and very small pupils. Tell families: when in doubt, treat it as an overdose. As CDC notes, naloxone will not harm someone who is overdosing on something other than opioids, so it is always best to give it if an opioid overdose is suspected.
Walk through the response steps in order, ideally with a trainer device:
- 1Try to wake the person and check breathing.
- 2Call 911 immediately, or have someone else call.
- 3For nasal spray, lay the person on their back, insert the device, and press the plunger firmly to release the dose.
- 4After giving it, turn the person on their side into the recovery position.
- 5If there is no response or the person responds and then relapses, give another dose every 2 to 3 minutes, using a new device in the alternate nostril each time, until emergency help arrives.
Reinforce two points families often miss. First, naloxone works quickly, restoring normal breathing within about 2 to 3 minutes, but it is not a cure. Its effect can wear off before the opioid does, so symptoms can return and repeat dosing or continued monitoring is needed. Stronger opioids such as fentanyl may require more than one dose. Second, stay with the person. CDC advises remaining with them until emergency help arrives, or for at least four hours, to confirm breathing stays normal.
Naloxone buys time. It does not replace the 911 call or the period of close watching that follows.
Withdrawal, side effects, and emotional preparation
Prepare caregivers for what reversal can look like. Because naloxone blocks opioids, a person who is opioid-dependent may wake into acute withdrawal. MedlinePlus lists possible effects including body aches, diarrhea, fast or pounding heartbeat, and fever, alongside more local effects of the nasal spray such as headache and nasal dryness or congestion. The person may be agitated, frightened, or in pain on waking. Coach families that this reaction, while distressing, is expected, and that they should still keep the person calm and wait for EMS rather than letting them refuse care or take more opioids.
Set expectations that naloxone is safe and that giving it in an emergency is the right call even if they are unsure. Reassure caregivers that Good Samaritan protections exist in many places, while deferring specifics to local law and facility guidance.
Documentation and the nursing handoff
Close the loop in the chart. Document that naloxone was offered or dispensed, what product and route the patient received, who was taught (patient plus named household members or caregivers), that overdose recognition and step-by-step administration were reviewed, and that teach-back was completed. Note where the patient plans to store it and how to check the expiration date.
Naloxone education is most effective when it is repeated and normalized rather than delivered once at discharge. Tie it into every opioid-related encounter, keep the language matter-of-fact, involve the people who will actually be in the room during an emergency, and always work within your facility's protocols and the prescriber's plan.