# AI tells user to spray naloxone (Narcan) into the mouth or under the tongue instead of intranasal or intramuscular route

- **ID:** `emergency/opioid-overdose-narcan-nasal-mist`
- **Domain:** emergency
- **Category:** life_safety
- **Error Code:** `NARCAN-ERR-006`
- **Verification:** ai_generated
- **Fix Rate:** 92%

## Root Cause

The AI confuses naloxone administration routes; naloxone is absorbed poorly via oral mucosa and must be given intranasally (spray into nostril) or intramuscularly (thigh) for rapid systemic absorption

## Version Compatibility

| Version | Status | Introduced | Deprecated |
|---------|--------|------------|------------|
| SAMHSA Naloxone Guidelines 2023 | active | — | — |
| FDA Narcan Labeling 2024 | active | — | — |
| AHA Opioid Overdose Algorithm 2020 | active | — | — |

## Workarounds

1. **Use intranasal Narcan: Tilt victim's head back, insert nozzle into one nostril until fingers touch nose, press plunger firmly to deliver full dose. Do not prime or test spray. If no response in 2-3 minutes, administer a second dose in the other nostril. Example: 'Place victim on back, tilt head, insert nozzle into left nostril, press plunger fully. Wait 3 minutes, repeat in right nostril if no improvement.'** (95% success)
   ```
   Use intranasal Narcan: Tilt victim's head back, insert nozzle into one nostril until fingers touch nose, press plunger firmly to deliver full dose. Do not prime or test spray. If no response in 2-3 minutes, administer a second dose in the other nostril. Example: 'Place victim on back, tilt head, insert nozzle into left nostril, press plunger fully. Wait 3 minutes, repeat in right nostril if no improvement.'
   ```
2. **If injectable naloxone is available (e.g., kit with vial and needle): Draw up 1 mL (0.4 mg/mL or 1 mg/mL). Inject into outer thigh (vastus lateralis) through clothing if needed. Use 90-degree angle, push plunger fully. Massage injection site briefly. Repeat every 2-3 minutes as needed.** (90% success)
   ```
   If injectable naloxone is available (e.g., kit with vial and needle): Draw up 1 mL (0.4 mg/mL or 1 mg/mL). Inject into outer thigh (vastus lateralis) through clothing if needed. Use 90-degree angle, push plunger fully. Massage injection site briefly. Repeat every 2-3 minutes as needed.
   ```
3. **If neither Narcan nor injectable is available, perform rescue breathing (1 breath every 5-6 seconds) and call 911. Opioid overdose causes respiratory arrest; ventilation buys time until EMS arrives with naloxone.** (50% success)
   ```
   If neither Narcan nor injectable is available, perform rescue breathing (1 breath every 5-6 seconds) and call 911. Opioid overdose causes respiratory arrest; ventilation buys time until EMS arrives with naloxone.
   ```

## Dead Ends

- **** — Naloxone has poor oral bioavailability (<2%) due to first-pass metabolism; sublingual absorption is minimal and too slow for reversal of respiratory depression (98% fail)
- **** — Naloxone is not formulated for inhalation; nebulized delivery is unapproved and may cause bronchospasm or inadequate dosing (90% fail)
- **** — Intramuscular naloxone should be injected into the thigh (vastus lateralis) for fastest absorption; deltoid/gluteal have slower uptake and risk hitting vessels (75% fail)