Overdose deaths appear to have accelerated during the COVID-19 pandemic, reaching 81,230 from June 2019 to May 2020, primarily driven by illicitly manufactured synthetic opioids.12 A higher dose of naloxone may be required to revive a patient due to the stronger effect of illicitly manufactured fentanyl.13 34% of overdose reversal attempts with Narcan® Nasal Spray involved ≥2 sprays.4 The frequency of naloxone multi-dosing has been increasing.14