Narcan Forms: Nasal Spray, Injection, and Dispensers

Key Takeaways

• Naloxone is available in three primary forms: nasal spray, intramuscular injection, and auto-injector
• The nasal spray (Narcan, RiVive) is the most widely used form for community distribution because it requires no medical training
• Injectable naloxone is still used by some EMS agencies and harm reduction programs, particularly when higher doses are needed
• Naloxone vending machines and public dispensers are expanding across New Jersey and other states
• All forms work by the same mechanism — blocking opioid receptors — and differ primarily in delivery route and ease of use

Naloxone Nasal Spray: A pre-measured, single-use device that delivers naloxone through the nasal membrane to reverse opioid overdoses. It requires no assembly, no needles, and no medical training to administer.

Naloxone comes in several formulations, each designed for different settings and users. The choice between nasal spray, injection, and auto-injector depends on the situation, the training level of the person administering it, and what is available. All forms contain the same active ingredient — naloxone hydrochloride — and all work by the same pharmacological mechanism of displacing opioids from brain receptors. Understanding the differences helps individuals, families, and organizations select the right form for their needs.

Narcan Nasal Spray

How It Works

The Narcan nasal spray delivers a pre-measured 4 mg dose of naloxone through the nasal membrane. The device is a single-use, pre-assembled unit that requires no preparation. The user inserts the nozzle into one nostril and presses the plunger, delivering the full dose in one spray.

Intranasal Delivery: A method of administering medication through the lining of the nasal passages, where it is absorbed into the bloodstream. This route bypasses the need for injection and allows rapid drug absorption through the mucous membrane.

Absorption through the nasal membrane typically produces effects within two to five minutes. The FDA approved Narcan nasal spray in 2015, and in 2023 approved it for over-the-counter sale. A generic version, RiVive (also 3 mg naloxone nasal spray), received OTC approval as well, providing a lower-cost alternative.

Advantages and Limitations

The nasal spray’s primary advantage is accessibility. No training is required beyond reading the simple instructions printed on the packaging. There are no needles, no risk of needlestick injury, and no assembly required.

Limitations include the fact that nasal absorption can be affected by nasal congestion, blood in the nasal passages, or damage to the nasal membrane. In these situations, absorption may be slower or incomplete. With highly potent opioids like fentanyl, multiple doses may be necessary — the person can administer a second spray in the opposite nostril after two to three minutes if breathing has not improved.

Injectable Naloxone

Intramuscular Injection

Intramuscular (IM) Injection: A method of delivering medication directly into muscle tissue, typically the outer thigh or upper arm, using a syringe and needle. IM injection provides rapid absorption into the bloodstream.

Before the nasal spray became widely available, the standard community distribution model was a naloxone vial paired with a syringe. The person draws the naloxone from the vial and injects it into the outer thigh or upper arm muscle. This form is still distributed by some harm reduction programs and is the form many first responders carried for decades.

The injectable form allows flexible dosing. A standard vial contains 0.4 mg/mL, though higher-concentration formulations exist. First responders can administer repeated doses based on the patient’s response, which provides more control in severe overdose situations — particularly those involving fentanyl.

When Injectable Forms Are Used

Injectable naloxone remains common in several settings:

• Emergency medical services (EMS) — paramedics and EMTs may use IM or intravenous (IV) naloxone for precise dosing control
• Hospital emergency departments — IV naloxone allows the most rapid onset and careful titration
• Harm reduction programs — some programs continue to distribute vial-and-syringe kits alongside nasal spray, as the per-unit cost is lower
• Correctional facilities — some jails and prisons stock injectable naloxone for medical staff use

The main barrier for community use is that IM injection requires basic training to draw medication from a vial and administer an injection safely.

Auto-Injectors and Dispensers

EVZIO Auto-Injector

Auto-Injector: A pre-filled, spring-loaded device that delivers a fixed dose of medication through a retractable needle when pressed against the skin. Auto-injectors are designed for use by people without medical training, similar to an EpiPen.

EVZIO was the first naloxone auto-injector approved by the FDA, designed to be used by family members and caregivers without medical training. The device included electronic voice instructions that guided the user through each step of administration. The injection was delivered into the outer thigh, through clothing if necessary.

However, EVZIO was discontinued by its manufacturer, Kaleo, in 2020 after significant controversy over its pricing — the device’s list price had risen to over $4,000 for a two-pack, drawing scrutiny from lawmakers and public health advocates. While no auto-injector is currently on the U.S. market as of early 2026, the FDA has indicated interest in approving future devices in this category.

Vending Machines and Public Dispensers

One of the most significant developments in naloxone access has been the deployment of public naloxone dispensers and vending machines. These machines make naloxone available 24 hours a day in locations where overdoses are likely to occur or where people at risk may gather.

Naloxone Dispenser: A free-standing machine, often resembling a vending machine, that distributes naloxone kits — typically nasal spray along with printed instructions — at no cost to the user. Dispensers may require a button press or brief interaction but no identification or payment.

Several New Jersey counties have installed naloxone vending machines in public locations, including:

• College campuses
• Public libraries
• Community centers
• Transit hubs
• Near homeless service agencies

These programs are typically funded by state or federal opioid response grants through SAMHSA or the NJ Division of Mental Health and Addiction Services (DMHAS). The dispensers are restocked by local health departments or harm reduction organizations.

Choosing the Right Form

For Families and Bystanders

For most families, friends, and community members, the nasal spray is the recommended form. The reasons are practical:

• No training beyond reading the package instructions
• No needles or sharps disposal concerns
• Pre-measured dose eliminates dosing errors
• Available over the counter at pharmacies
• Shelf life of approximately 24 months when stored at room temperature

The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends that any household where opioids are present — whether prescribed or illicitly used — keep at least two doses of naloxone nasal spray accessible. NIDA echoes this guidance, noting that having naloxone on hand is comparable to keeping a fire extinguisher in the home.

For First Responders

Law enforcement officers, firefighters, and EMS personnel may carry either nasal spray or injectable naloxone depending on their agency’s protocol and training level:

• Police and fire departments — most NJ departments carry nasal spray due to ease of use and no needle disposal requirements
• Basic EMTs — typically authorized for nasal spray or IM injection
• Paramedics — may use IV naloxone for more precise titration, particularly in fentanyl overdoses where repeated doses are needed

The New Jersey Department of Health has supported equipping all first responders with naloxone through training programs and funded distribution.

Accessing Narcan in New Jersey

Over-the-Counter Availability

Since the FDA’s 2023 approval of OTC Narcan, any person in New Jersey can purchase naloxone nasal spray at a pharmacy without a prescription. Major chains including CVS, Walgreens, and Rite Aid stock it alongside other over-the-counter medications. Prices vary but typically range from $35 to $50 for a two-pack of Narcan brand nasal spray. The generic RiVive is available at a lower price point.

NJ Distribution Programs

For those who cannot afford to purchase naloxone or who want free access:

• County-level distribution — all 21 New Jersey counties have naloxone distribution programs funded through state opioid response grants
• NJ Harm Reduction Centers — organizations in cities including Newark, Camden, Paterson, and Trenton distribute free naloxone along with training
• DMHAS-funded programs — the state funds naloxone distribution as part of its comprehensive opioid response strategy
• Pharmacy standing orders — New Jersey’s standing order from the Commissioner of Health allows pharmacies to dispense naloxone without an individual prescription, and some pharmacies can bill insurance to reduce or eliminate cost

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This glossary entry is part of our Addiction Treatment Glossary. For foundational information on how naloxone works, see What Is Narcan (Naloxone)?. To understand how naloxone differs from medications used for ongoing addiction treatment, read Naloxone vs. Naltrexone vs. Narcan. For context on the opioid crisis driving naloxone distribution, see our guide to fentanyl addiction in New Jersey.