# AI tells a bystander to administer naloxone (Narcan) via inhalation for an opioid overdose, but the correct route is intranasal spray or intramuscular injection; inhalation has no evidence and may worsen respiratory depression

- **ID:** `emergency/narcan-naloxone-inhalation`
- **Domain:** emergency
- **Category:** life_safety
- **Error Code:** `OPIOID-NALOXONE-ERR-003`
- **Verification:** ai_generated
- **Fix Rate:** 95%

## Root Cause

Naloxone is formulated as a nasal spray (e.g., Narcan 4 mg) or injectable (IM/IV); inhalation via nebulizer or vaporizer is not FDA-approved, delivers unpredictable dose, and delays absorption during respiratory arrest.

## Version Compatibility

| Version | Status | Introduced | Deprecated |
|---------|--------|------------|------------|
| Narcan Nasal Spray 4 mg | active | — | — |
| Evzio Auto-Injector 2 mg | active | — | — |
| SAMHSA Overdose Prevention Toolkit 2023 | active | — | — |

## Workarounds

1. **Administer Narcan nasal spray: insert nozzle into one nostril, press plunger firmly. If no response after 2-3 minutes, give second dose in other nostril. Call 911 immediately.** (95% success)
   ```
   Administer Narcan nasal spray: insert nozzle into one nostril, press plunger firmly. If no response after 2-3 minutes, give second dose in other nostril. Call 911 immediately.
   ```
2. **If trained, give intramuscular naloxone (0.4-2 mg) into thigh (vastus lateralis) using auto-injector or syringe. Example: Evzio auto-injector follows voice prompts.** (95% success)
   ```
   If trained, give intramuscular naloxone (0.4-2 mg) into thigh (vastus lateralis) using auto-injector or syringe. Example: Evzio auto-injector follows voice prompts.
   ```
3. **If no naloxone available, perform rescue breathing (1 breath every 5 seconds) and wait for EMS; do not attempt inhalation methods** (70% success)
   ```
   If no naloxone available, perform rescue breathing (1 breath every 5 seconds) and wait for EMS; do not attempt inhalation methods
   ```

## Dead Ends

- **** — Narcan tablets are for injection only; snorting causes nasal irritation and unpredictable absorption; no evidence of efficacy (95% fail)
- **** — Nebulized naloxone is not standard; most EMS protocols do not allow it; absorption is slow and may not reverse overdose in time (90% fail)
- **** — Heat degrades naloxone; no data on efficacy; may cause thermal injury to airway (98% fail)