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In short, yes, Narcan® (naloxone) works on heroin overdoses. It rapidly reverses the effects by displacing heroin from the opioid receptors in the brain that control breathing, often restoring normal breathing within 2 to 3 minutes.
Today, however, with most heroin mixed with fentanyl and sometimes xylazine, the picture is a little more complicated. With that said, the bottom line stays the same; if you suspect an overdose, give Narcan®. It can’t hurt, and it can absolutely save a life.
What is Narcan®? How Does It Work?
Narcan® is the brand name for naloxone, a medication specifically designed to reverse opioid overdoses.
Heroin is an opioid, so Narcan® reverses heroin overdoses. It also works on fentanyl, oxycodone (OxyContin), hydrocodone (Vicodin), morphine, methadone, and other opioids.
Just as importantly, Narcan® has no effect on someone who has no opioids in their system, and it can’t hurt them. This is why doctors and the CDC recommend giving it any time an overdose is suspected, even if you aren’t sure what someone took.
How Narcan® Reverses a Heroin Overdose
Heroin works by binding to opioid receptors in the brain, particularly the ones that control breathing. When too much heroin floods those receptors, breathing slows or stops entirely. And this respiratory failure is what kills people in an overdose.
Naloxone is an opioid antagonist, meaning it binds to the same receptors, but it doesn’t activate them. Instead, it knocks the heroin loose and blocks any new heroin from attaching for the next 30 to 90 minutes. As a result, breathing typically restarts within 2 to 3 minutes of a single dose.
However, naloxone wears off in 30 to 90 minutes. Heroin, and especially fentanyl-laced heroin, often lasts much longer. Once the Narcan® wears off, the person can stop breathing again. This is why you should always call 911, even after a successful Narcan® reversal. It’s also why it may be recommended to give multiple doses of naloxone.
When Narcan® May Not Be Enough
Fentanyl is far stronger than heroin and binds tightly to opioid receptors. Research from a CDC study in Massachusetts found that 83% of suspected fentanyl overdoses required two or more doses of naloxone before the person responded. This is why carrying multiple Narcan kits is now considered best practice.
Xylazine, also known as tranq, is a veterinary sedative that has spread through the U.S. drug supply since 2022. It’s not an opioid, which means Narcan® can’t reverse it. But most xylazine in the drug supply is mixed with fentanyl, so you should still give Narcan® immediately. It will reverse the opioid component of the overdose. The person may still be sedated from the xylazine and need rescue breathing or hospital care, but Narcan® can save their life from the opioid part.
Overall, it’s recommended to always give Narcan® if you suspect an overdose.
How to Use Narcan® in an Overdose Emergency
Recognize the signs of an overdose, including:
- Slow, shallow, or stopped breathing
- Blue or grey lips and fingertips
- Pinpoint pupils
- A limp body or an unresponsive person
- Gurgling, choking, or snoring sounds from someone who cannot be woken up
Use these steps to administer Narcan® nasal spray:
- Call 911 immediately. Even if Narcan® works, follow-up medical care is critical.
- Lay the person on their back and tilt their head back to open the airway.
- Insert the nozzle of the Narcan® nasal spray into one nostril until your fingers touch the bottom of their nose.
- Press the plunger firmly to release the full dose.
- Wait 2 to 3 minutes. If there is no response, give a second dose in the other nostril.
- Place the person in the recovery position (on their side) and stay with them until paramedics arrive.
When they wake up, they may be confused, agitated, or in immediate withdrawal. This is completely normal. Make sure not to leave them alone.
Where to Get Narcan® in Richmond and Virginia
You have several options, and most of them are free. These include:
- Over the counter: They’re available at most pharmacies (CVS, Walgreens, Rite Aid) for around $45 to $50 per two-dose kit.
- Virginia’s REVIVE! program: Run by the Virginia Department of Behavioral Health and Developmental Services, headquartered right here in Richmond, REVIVE! offers free training and free naloxone.
- Community Services Boards: These provide free naloxone after a brief training. Henrico Area Mental Health and Developmental Services even offers free Narcan® by mail.
- Chesterfield County Public Libraries:Free Narcan® is available at every Chesterfield County library location — no appointment, no questions asked.
- The Chris Atwood Foundation: This organization mails free naloxone to Virginia residents anywhere in the state.
Additionally, Virginia’s Good Samaritan Law protects anyone who calls 911 during an overdose from being arrested for drug possession or paraphernalia, in most circumstances.
Treatment With Freedom Recovery Centers
Narcan® essentially buys time, but the underlying addiction is still there. This means getting proper help is paramount to ensuring your or your loved one’s safety and health.
The 48 to 72 hours after an overdose are some of the most dangerous; the person is shaken, disoriented, often in withdrawal, and at very high risk of using again just to feel normal. This is exactly when structured treatment can change the trajectory of someone's life.
Freedom Recovery Centers (FRC) in Richmond is here to listen, understand, and walk beside you throughout your recovery journey. With us, there’s no shame. We’re here to help you in the best way we know how, including evidence-based therapies and compassionate care. When you’re ready, call us at 804-635-3746. We can even help arrange transportation to our center.
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