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Does Narcan Work on Fentanyl? Does It Reverse an Overdose?

Peter Manza, PhD profile image
Reviewed By Peter Manza, PhD • Updated Oct 15, 2023 • 7 cited sources

Yes, Narcan (naloxone) works on fentanyl.[1] It can reverse a fentanyl overdose, but due to fentanyl’s potency, more than one dose of naloxone is sometimes needed. 

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The opioid epidemic, marked by a rise in overdose deaths caused by the use of prescription painkillers and heroin, is a critical public health concern. In response, the medical community created medications like Narcan (naloxone) in order to address the issue. These medications now play a pivotal role in saving lives when opioid overdose strikes. 

Narcan works to reverse the effects of fentanyl by kicking fentanyl off opioid receptors and binding to those receptors in their place, immediately stopping the effects of the drug.[1] When this happens, the person is immediately kicked into withdrawal if they have a physical dependence on the drug, but they are no longer at risk of succumbing to respiratory depression, at least temporarily. 

What Is the Opioid Epidemic?

The opioid epidemic refers to the steadily increasing rates of overdose, often fatal, caused by misuse of opioid drugs. This includes the use of street drugs like heroin as well as prescription drugs like oxycodone, hydrocodone and fentanyl.  

These substances are highly addictive, and their misuse often results in opioid use disorder (OUD). Compulsive use of any opioid can mean that people accidentally take more of the substances than their bodies can handle. Respiratory depression occurs, and this can be fatal.[1] 

How Can Medications Like Narcan Save Lives? 

The drug Narcan, the brand name for naloxone, is a drug that essentially kicks all opioids in the system off the opioid receptors, neutralizing their effect on organ systems.[6] 

In most cases, a single dose of Narcan has the desired effect, causing someone who is unconscious or unresponsive due to opioid use to “come back” and no longer be in imminent medical danger. However, as use of fentanyl has increasingly become more common, a single dose of Narcan may not be enough. Multiple doses may be required to have the desired effect due to the strength of fentanyl. 

In cases where opioids are mixed with other drugs, including sedatives like alcohol or benzodiazepines, Narcan may not be effective in stopping the overdose no matter how many doses are given. This is why it is so important to always call 911 even if you are able to administer naloxone. 

Research indicates that when communities have access to naloxone and education on how to use the medication, the number of overdose deaths tends to decrease.[2] For example, a program in Massachusetts that provided naloxone and education about overdoses led to an significantly fewer opioid overdose deaths in the 19 communities where the program was implemented.[3]

Can Narcan Reverse the Effects of Fentanyl?

Narcan has the potential to counteract the effects of fentanyl and other opioids.[4] 

As an incredibly strong synthetic opioid, fentanyl can induce severe respiratory depression and escalate the risk of overdose in users. Since Narcan is an opioid receptor antagonist, it has the ability to rapidly attach to opioid receptors in the brain, displacing fentanyl (or other opioids) and nullifying its effects.

When administered in a timely manner, Narcan can be a hugely effective resource, stopping respiratory depression abruptly and helping people to avoid all the risks that come with overdose, including brain damage and death.[6] 

Why Timing Matters With Naloxone 

While Narcan is a lifesaving medication, the dose must be given in time. Respiratory depression can slow oxygen flow to the brain and potentially stop breathing completely. If Narcan is not given before that happens, it won’t be able to work. 

For this reason, friends and family members should always keep multiple doses of Narcan on hand at all times in the event of an emergency. One dose may not be enough to do the job, so it is always better to have multiple doses on standby if you know someone who misuses opioids. 

Even if you have a valid prescription for opioids and only use them as prescribed, have naloxone available in case of emergency.[6] While emergency medical providers carry Narcan with them, they may not arrive in time. 

How Does Narcan Work to Treat Fentanyl Overdose?

Narcan functions by binding to the opioid receptors even more strongly than fentanyl or other opioids in the system that are causing the overdose.[1] 

When Narcan is given, it takes the place of the opioids on the receptors and blocks their effects.[4] This action quickly restores normal breathing and can help the person to wake up from the sedated, unconscious or depressed state caused by opioids.

In the case of a fentanyl overdose, Narcan competes with fentanyl for space on the opioid receptors, effectively reversing the overdose’s effects when there is enough Narcan to unseat the fentanyl. This means a more rapid return to regular breathing and a revival of the individual who might have previously been unresponsive. 

How to Get Narcan

Acquiring Narcan depends on your location and local rules. In most cases, you can get Narcan when you follow these steps: 

Know Local Rules

Understand the laws about naloxone distribution where you live. Some places let you buy it without a prescription, while others require one.

Check With Pharmacies

In many areas, you can get Narcan from pharmacies. Call ahead to ensure they have it and ask about any special requirements.

Get a Prescription

If your area requires all purchasers of the drug to have a prescription, consult a healthcare provider like a doctor or nurse practitioner. Explain why you need Narcan and talk about your situation.

Find a Community Outreach Program

Some community groups, harm reduction centers and health agencies give out Narcan for free or at a lower cost.[3] They might also teach you how to use it and follow up to make sure you get new doses when needed.

Consider Buying It Online

In some places, you can buy Narcan kits online. But be sure the source is trustworthy and the product is safe and effective.

Find Out if Insurance Covers It

If Narcan is at a pharmacy and requires a prescription, check to see if your insurance provider covers it. Some plans might help with the cost of lifesaving meds like Narcan.

Learn How to Use Narcan Properly

No matter how you get Narcan, learn how to use it correctly. Many groups that provide Narcan also offer training sessions on how to administer the medication and how to respond to opioid overdoses in general.

How to Administer Narcan if You Witness Someone Overdosing on Fentanyl

If you see someone struggling after taking fentanyl, especially if they are unresponsive, have bluish nails and lips, or appear to be breathy shallowly or not at all, you can use Narcan to help them. Here’s how:[5]

  • If the person is not responding or breathing at a normal and healthy rhythm, it’s a serious situation. You need to act fast.
  • Call 911 right away. Even though they will likely keep you on the phone and bring Narcan with them, every minute counts. Administer naloxone while you wait for them to arrive. 
  • If you have Narcan, follow the instructions to get it ready. You don’t need medical training to administer it.[7] Lay the person down and gently lift their head.
    • If it’s a spray, put it in their nose and administer it.
    • If it’s a shot, inject it into their leg (even through clothes) and hold.
  • If they don’t seem to respond to the medication, use another Narcan dose if you have one.
  • If you administer multiple doses of Narcan and the person’s situation appears to be unchanged, begin CPR if they are not breathing or there is no heartbeat. 
  • Stay with the person and watch their breathing, assisting them to the best of your ability.[5] Be ready to give more Narcan if needed.

Reviewed By Peter Manza, PhD

Peter Manza, PhD received his BA in Psychology and Biology from the University of Rochester and his PhD in Integrative Neuroscience at Stony Brook University. He is currently working as a research scientist in Washington, DC. His research focuses on the role ... Read More

  1. Fentanyl: One pill kills. Texas Health and Human Services. Accessed September 2023.
  2. McClellan C, Lambdin BH, Ali MM, et al. Opioid overdose laws association with opioid use and overdose mortality. Addictive Behaviors. 2018;86:90-95. doi:10.1016/j.addbeh.2018.03.014
  3. Walley AY, Xuan Z, Hackman HH, et al. Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: Interrupted time series analysis. BMJ. 2013;346:f174. doi:10.1136/bmj.f174
  4. Naloxone DrugFacts. National Institute on Drug Abuse. Published January 11, 2022. Accessed August 20, 2023.
  5. Narcan/naloxone — What is it and how does it work? University of Wisconsin – Madison. Published October 13, 2022. Accessed August 20, 2023.
  6. Lifesaving naloxone. Centers for Disease Control and Prevention. Published April 21, 2023. Accessed August 20, 2023.
  7. Hanson, B.L., Porter, R.R., Zöld, A.L. et al. Preventing opioid overdose with peer-administered naloxone: findings from a rural state. Harm Reduct J 17, 4 (2020).

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