What to Do in an Opioid Overdose
Key takeaways:
Opioid overdoses are serious medical emergencies that kill tens of thousands of people every year.
Learning the signs and symptoms of an opioid overdose can help keep your loved ones safe.
Reacting in quick and decisive ways to an overdose is essential. You can call for help, keep the person awake, and use anti-overdose medications to prevent injury and death.
Table of contents
Opioid overdoses are a leading cause of death in the U.S. Over 100,000 people died from drug overdoses in 2022. And in 3 out of 4 of those deaths, opioids were involved.
Opioid overdoses are preventable and treatable with quick action.
Let’s take a closer look at how to recognize opioid overdose symptoms and what you can do to limit the risks.
What are the symptoms of an opioid overdose?
Opioid overdoses occur when you consume more opioids than your body can handle. The drugs overwhelm parts of your brain that control breathing and can lead to death.
Some common signs and symptoms of opioid overdoses are:
Slow or irregular breathing
Falling unconscious
Pinpoint pupils
Bluish skin, especially in the lips and fingertips
Limp body
Pale face
Tiny pupils
Vomiting or gurgling noises
Being unable to speak or respond to questions
Slow or irregular heart rate
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Telling the difference between being high and having an overdose may be difficult. When the person’s breathing, pulse, and alertness are greatly affected, it could be an overdose.
When should you call for help?
If you believe someone is at risk of an overdose, take action immediately. Call for help by phoning 9-1-1 as soon as possible. Quick decisions can save a life.
What should you do in an opioid overdose?
If you use opioids, chances are high you’ll see or experience an overdose. About 2 in 3 opioid users have witnessed an overdose. But just because you see an overdose doesn’t mean you need to see a death. Many opioid overdoses are well-treated.
If you believe someone is overdosing on opioids, you should take these steps:
Stop what you’re doing and call 9-1-1. Requesting emergency medical services is key. If you’re driving, get them to the nearest emergency department.
Communicate the situation. The treatment may change depending on what they took, how they took it, and if they mixed it with anything. A victim of an overdose most likely won’t be aware enough to say what substances they’ve taken. However, if you do know, be honest and clear about what drugs they’ve consumed. Tell this information to the 9-1-1 dispatcher or to any medical personnel who may have arrived at the scene.
Try to keep the person awake. Talk to them, ask them questions, and take other steps to get their attention. These actions can help support their breathing
Lay them on their side. While lying flat, they can choke on drinks or vomit. Always keep their breathing clear and roll them on their side.
Don’t leave the person. They may need your support and assistance to survive this ordeal. Stay by their side, even if you feel the urge to flee.
How is an opioid overdose treated?
The best that you can do is connect the other person with professional treatments as quickly as possible. Healthcare professionals will take actions to help manage the overdose. They may:
Stimulate the person: Called a sternal rub, they rub their knuckles up and down the person’s breast bone.
Attempt rescue breathing: Rescue breathing may be enough to help support airflow until other help is available.
Administer naloxone: This is a medication that can be used in opioid overdoses. See below for more information on naloxone.
What is naloxone?
Perhaps the most important tool used with opioid overdoses is naloxone (Narcan). Naloxone is a medication labeled as an opioid antagonist. It blocks opioids from connecting to receptors in the brain.
Using naloxone greatly reduces the risk of death and serious injury from opioids. If the heroin, fentanyl, or other opioid can’t connect to these receptors in the brain, the substances can’t disrupt the opioid user’s breathing.
Naloxone is a very helpful medication because it:
Works very quickly
Can be administered many different ways
Can’t be misused
Can’t get people high
Only creates an influence if opioids are present
When and how do you administer naloxone?
If you have naloxone on hand, you should plan to administer it very quickly after recognizing the signs of overdose. In most situations, you should call 9-1-1 first and then give naloxone second.
The way you administer naloxone depends on the type you have. Naloxone is available in two forms, intranasal and injectable:
Intranasal: This nasal spray (Narcan, Kloxxado) is applied to one nostril while the person is lying on their back.
Injectable: This form is a liquid that’s injected into the muscle or under the skin. Prefilled syringes (Zimhi) are currently approved by the FDA.
When preparing to give someone naloxone, do your best to stay calm, understand the directions, and administer the medication correctly. The injectable forms require more steps and safety measures to use. But they can still be done effectively.
Do you have to be trained to administer Narcan?
You usually don’t need special training to give Narcan or another naloxone variety to someone in need. However, some amount of training might help you feel more calm and confident that you’re correctly offering the medication.
How do you get naloxone?
States in the U.S. vary in the way they distribute naloxone. In some places, you can receive it from a pharmacy without a prescription or from community distribution programs. In certain states and cities, you can get naloxone for free.
To see what options are available where you live, check out this naloxone finder tool.
Does naloxone resolve every overdose?
Naloxone is a powerful way to reverse an overdose. But one dose can’t stop every overdose all of the time. A person who doesn’t respond to the first dose may need more naloxone. Very potent opioids, like fentanyl, often require multiple doses of naloxone to counteract the effects.
In other cases, the naloxone may begin to wear off before the overdose risk is over. The medication lasts between 30 and 90 minutes. The effect of opioids may last for several hours. So, the person should always be monitored by professionals in case more naloxone is required later.
Who’s most at risk of experiencing an opioid overdose?
Not everyone who uses opioids experiences the same level of danger. Synthetic opioids, like fentanyl, can be much more powerful than others — and the overdose risk is high.
Some of the risk factors for an opioid overdose are:
Having an opioid addiction, often called an opioid use disorder
Injecting opioids, because it creates a more powerful effect
Using prescription drugs that aren’t meant for you
Taking high daily doses of opioids
Mixing opioids with other substances like alcohol or benzodiazepines
Having chronic medical problems
Using opioids without knowledge of what substance could be mixed into the drug
Another significant risk factor for overdose is restarting opioid use after a period of recovery. During abstinence, your body loses its tolerance for opioids. Resuming use can shock the system and cause an overdose.
Frequently asked questions
By definition, when you overdose, you’ve used more of the drug than is safe for your body. In the case of an opioid overdose, you become unconscious, your pupils become tiny, and you have difficulty breathing.
Brain damage is the most dangerous long-term effect of an opioid overdose. Severe opioid overdoses cause you to have slow and shallow breathing. This can prevent your body from getting enough oxygen. If your brain is deprived of oxygen for a prolonged period of time, you can get brain damage known as hypoxic brain injury.
It depends on the opioid. For example, morphine will stay in your body for a few hours, while methadone can stay in your body for up to 24 hours. Each opioid has specific properties that affect how long it lasts in your body. In general, though, opioids taken in pill form stay in your system longer than opioids that are injected.
The bottom line
Opioid overdoses are life-threatening, but they’re treatable. When you know the overdose symptoms and how to react, you help keep others safe. Having access to and experience with naloxone could be the best way to save a life.
Why trust our experts?
If you or someone you know struggles with substance use, help is available. Call SAMHSA’s National Helpline at 1-800-662-HELP (4357) to learn about resources in your area.
References
Centers for Disease Control and Prevention. (2024). About overdose prevention.
Lacerte, M., et al. (2023). Hypoxic brain injury. StatPearls.
MedlinePlus. (2014). Opioid overdose.
National Institute on Drug Abuse. (2022). Naloxone DrugFacts.
University of Iowa Health Care. (2012). Adult opioid reference guide.
World Health Organization. (2023). Opioid overdose.
