- Using Again?
- You are welcome back at any meeting, with any amount of time. Nobody there will ask why you left.
- find a meeting
Everyone who has been around the rooms for a while can name somebody who did not make it back. The most dangerous use tends to be the first one after time away, whether that time was treatment, jail or six good months. Tolerance drops in the meantime, and the supply does not get any kinder. Overdose deaths are falling: the CDC’s provisional count for the twelve months ending May 2026 is about 66,500, down from about 75,000 a year earlier. That is still more than 180 people a day, and naloxone is part of why the number is not higher.
Call 911.
People often wake up sick, scared and angry, because naloxone pushes them into withdrawal. It is miserable and generally not life threatening. The danger is that they use again to make it stop while the naloxone is wearing off. Stay with them, and do not argue.
The FDA made Narcan 4 mg nasal spray an over-the-counter product in March 2023, and RiVive 3 mg followed in July. Generic 4 mg sprays are now sold under several manufacturers’ names and as pharmacy store brands, and a third brand, Rextovy, was approved for over-the-counter sale in June 2026. Narcan launched at about $45 for a two-pack and RiVive at $36. Compare prices: they are the same drug.
You will find them in pharmacies, and in Pennsylvania also in some grocery stores, gas stations and online. You do not need ID or a prescription, and nobody at the register will ask what it is for.
More is not obviously better. Higher-dose products such as the 8 mg spray and the 5 mg injection remain prescription only, and Pennsylvania’s standing order lists them as less preferred because they cause harsher withdrawal. The answer to a stubborn overdose is a second standard dose.
Narcan’s label says to keep it between about 36°F and 77°F, away from light, and not to let it freeze. RiVive’s range is narrower and it should not go in the fridge. Either way, a glove box in a Pennsylvania August or January is the wrong place. Narcan made after January 2024 carries a four-year shelf life.
If the only naloxone in reach is expired, use it. SAMHSA says it may be less effective but will do no harm, and the American College of Medical Toxicology supports using expired naloxone when nothing else is available.
Naloxone only helps if someone can find it in the first minute. Tell the people you live with where it is, and keep one where visitors could find it too. If someone in the house has just come home from treatment or jail, that is the week to buy it.
Naloxone only works on opioids. It does nothing for alcohol, benzodiazepines, or the animal sedatives that now turn up in Pennsylvania’s supply: xylazine, called tranq, and more recently medetomidine. Give it anyway. Fentanyl is in most of those overdoses, and the CDC’s April 2026 health alert on medetomidine says naloxone may restore breathing even when the person stays sedated.
So watch the breathing, and do not wait for them to wake up. Someone who is breathing steadily but still out may be under the sedative, which naloxone cannot touch. Put them in the recovery position, give rescue breaths if the breathing slows, and let the paramedics take it from there.
Fear of the police is one of the main reasons people do not call. Pennsylvania’s Good Samaritan law, Act 139 of 2014, protects both the person who calls and the person overdosing from charges for drug possession, small amounts of marijuana and paraphernalia, and from probation or parole violations based on those, as long as you give your name and location, cooperate, and stay with the person.
It does not cover selling or delivering drugs, and it will not clear an outstanding warrant. Every state now has some version of the law, but the details differ. Call anyway. Paramedics carry oxygen and can breathe for someone with a bag, which matters most in the overdoses naloxone cannot fully reverse.
Some readers will wonder why a site run by people in recovery explains how to test drugs. If somebody you love is going to use tonight whatever you say, you want them testing first. Most of us who have buried a friend feel the same way.
The strips use the same technology as a urine drug test, applied to the drug itself. Pennsylvania removed them from its paraphernalia law in Act 111 of 2022, so they are legal to own and carry here. In April 2026 federal health agencies barred their grant money from paying for strips handed to people who use drugs, and the state now funds its free strips from opioid settlement money instead. The same DDAP partners above give them out.
The CDC’s method:
Know the limits. A strip tells you whether fentanyl is there, not how much. It misses some fentanyl-like drugs, including carfentanil, and it does not detect xylazine, medetomidine or nitazenes at all. Large amounts of meth, MDMA, diphenhydramine or lidocaine can trigger a false positive, and results vary between production batches. A negative only means fentanyl was not found in the part you tested. In 2024 the DEA found that five in ten counterfeit pills it tested held a potentially deadly dose. Any pill that did not come from a pharmacy should be treated as one of them.
Xylazine test strips are used in a similar way and are given out free through the same programs.
If you are reading this because you are using again, you are not the first, and the door has not closed. Nobody in NA keeps score of the time you lost. Walk into a meeting this week, or call the free SAMHSA helpline at 1-800-662-4357, any hour, or one of our local helplines. Anyone who ever injected should also get a hepatitis C test, which is covered in our guide to at-home STI tests.