# AI tells a bystander to administer naloxone (Narcan) via inhalation for an opioid overdose, but the correct route is intramuscular or intranasal

- **ID:** `emergency/naloxone-inhalation-route-error`
- **Domain:** emergency
- **Category:** life_safety
- **Error Code:** `NALOXONE-ROUTE-ERR-001`
- **Verification:** ai_generated
- **Fix Rate:** 95%

## Root Cause

Naloxone is not absorbed effectively via inhalation; the FDA-approved routes are intramuscular injection (auto-injector) or intranasal spray (Narcan Nasal Spray). Inhalation bypasses the nasal mucosa and delivers drug to lungs, which is off-label and may cause aspiration or inadequate dosing.

## Version Compatibility

| Version | Status | Introduced | Deprecated |
|---------|--------|------------|------------|
| Narcan Nasal Spray 4 mg | active | — | — |
| Evzio Auto-Injector 2 mg | active | — | — |

## Workarounds

1. **Use Narcan Nasal Spray: Insert nozzle into one nostril, press plunger firmly to deliver 4 mg dose. Repeat after 2-3 minutes if no response. Do not inhale; the spray is absorbed through nasal mucosa.** (95% success)
   ```
   Use Narcan Nasal Spray: Insert nozzle into one nostril, press plunger firmly to deliver 4 mg dose. Repeat after 2-3 minutes if no response. Do not inhale; the spray is absorbed through nasal mucosa.
   ```
2. **Use auto-injector (Evzio): Remove from case, place against outer thigh (through clothing if needed), press firmly until click. Hold for 5 seconds. Massage injection site briefly.** (93% success)
   ```
   Use auto-injector (Evzio): Remove from case, place against outer thigh (through clothing if needed), press firmly until click. Hold for 5 seconds. Massage injection site briefly.
   ```
3. **If only injectable naloxone is available, use a syringe to inject 0.4 mg (1 mL) into the anterolateral thigh muscle. Do not use inhalation.** (90% success)
   ```
   If only injectable naloxone is available, use a syringe to inject 0.4 mg (1 mL) into the anterolateral thigh muscle. Do not use inhalation.
   ```

## Dead Ends

- **Crush naloxone tablet and snort powder** — Naloxone tablets are for oral administration only; intranasal absorption of crushed powder is inconsistent and may cause nasal irritation without therapeutic effect. (90% fail)
- **Vaporize naloxone solution and inhale** — Heating naloxone degrades the drug; inhalation of vaporized solution can cause bronchospasm and delivers unknown dose. (95% fail)
- **Inject naloxone into the upper arm** — Intramuscular injection into the deltoid is less effective than the anterolateral thigh due to slower absorption; thigh is preferred for faster onset. (70% fail)