An opioid overdose is a medical emergency that requires immediate attention. Opioids directly affect the central nervous system, and using too much can lead to a sudden decrease in breathing and heart rate. This is true of prescription opioid medications as well as illegal opioids like heroin. Learn the signs and symptoms of a drug overdose and what to do if you think someone needs help.
What Are the Physical and Behavioral Signs That Someone May Be Overdosing?
An opioid overdose happens quickly and causes serious signs and symptoms in a person’s body and behavior. Opioid and depressant overdoses slow down vital body functions, most notably breathing. The three classic signs of an opioid overdose (the “opioid overdose triad”) are slow or stopped breathing, pinpoint pupils, and unconsciousness.1 Here are some other signs of overdose to look for:
- Slowed or irregular heartbeat
- Vomiting or choking
- Blue, gray, or purple fingertips or lips, or bluish skin
- Cold, clammy, or pale skin
- Confusion or acting much differently than normal
- Unable to talk or respond normally
- Not waking up when trying to get their attention
- Extreme sleepiness or passing out
- Inability to respond or wake up when you speak to them or touch them
If you think someone is suffering from an opioid overdose, it’s important to act quickly. If you’re unsure, it’s best to treat the situation as though it were an overdose.2 It could save someone’s life.
Related: Fentanyl Overdose: How to Recognize it, Respond, and Get Support
Why “Acting Fast” Matters
Every second matters during a medical emergency like an overdose. During an opioid overdose, a person’s breathing slows down drastically and eventually stops. This cuts off oxygen to their brain and heart. Brain tissue begins to suffer irreversible damage within 4 to 6 minutes of oxygen deprivation.3 Calling 911 immediately, giving Narcan, and providing rescue breathing while you wait for first responders can restore oxygen flow and save a life.
Step-By-Step Instructions for How To Use Narcan
Narcan (naloxone) can reverse the effects of an overdose from opioid medications and illicit drugs, including opioids like:5
Step 1: Call 911 immediately or tell a bystander to call.
Step 2: Administer Narcan Nasal Spray
Narcan is available as a prefilled nasal spray or an injectable.5 Never test the device out before using it.
To use Narcan spray:7
- Place the person in the supine position (on their back with their face and torso facing upwards). Tilt the head back slightly to support the neck.
- Before administering, be sure the nozzle is inserted into either nostril of the person.
- To administer the dose, press firmly on the device plunger.
- Remove the nozzle from the nostril after use.
Step 3: Evaluate and Repeat if Needed
Wait 2 to 3 minutes. If the person does not wake up or resume normal breathing, administer a second dose. Be sure to use a new Narcan nasal spray and administer it in the alternate nostril. If there is still no response and you have additional doses, administer them (alternating nostrils each time) every 2 to 3 minutes while waiting for emergency medical assistance.
Administering Injectable Naloxone (Vial & Syringe)
Narcan (naloxone) is also available as an injectable. To administer naloxone this way, follow these instructions:5
- First, call 911.
- Then, take the cap off the vial. Stick the needle through the rubber stopper.
- Draw all the fluid into the needle by pulling back on the plunger. Be sure that you fill the syringe with liquid and not air.
- Inject the needle straight at a 90-degree angle into a large muscle (shoulder or outer thigh). Naloxone can be injected directly through clothing. Push down on the plunger to empty the syringe.
- Wait 2 to 3 minutes for the person to respond. If they don’t respond, then give additional doses if available until help arrives.
If you or someone that you know is at an increased risk for opioid overdose, you should carry naloxone and also keep it at home. Naloxone can temporarily reverse an overdose, but it doesn’t treat opioids that are mixed with other drugs, so calling for emergency assistance is still essential even after a dose is given.
What To Do While Waiting for Help to Arrive
- Turn the person on their side with their top leg bent at a 90-degree angle. This is called the “Recovery Position.”5,6 This helps keep them stable and prevents them from choking if they vomit.
- Perform CPR. If they are not breathing, follow the 911 dispatcher’s instructions to begin rescue breathing or CPR.
- Stay With Them. Waking up after Narcan can cause sudden agitation or confusion. Stay calm, reassure them, and explain that they experienced an overdose and emergency personnel are on the way.
- Don’t leave them alone. Narcan works temporarily, so it’s important to note that the person may become unresponsive again even if they do wake up initially.
- Be prepared to administer another dose. They may need another dose if they do not respond to the first dose or their breathing does not improve after 2 to 3 minutes. Closely follow the directions on your specific product.
What Are Some Common Misconceptions About Narcan?
Several myths about Narcan may keep someone from using it when it is needed. Here are a few of the most common ones.
“Narcan encourages drug use.”
Fact: Giving someone Narcan does not make them more likely to use opioids.4 Narcan is an emergency medication that is designed to reverse an opioid overdose.
“Narcan is hard to find.”
Fact: Depending on where you live, you may be able to access Narcan through a pharmacist without a prescription, or through certain community programs.
“One dose is enough.”
Fact: One dose may not always be enough to reverse an opioid overdose, especially if the person combined opioids with alcohol or other substances. A person may need additional doses, which is why it’s important to call 911 and follow the medication’s instructions while administering it.
Another common myth is that Narcan can be abused or misused. The truth is, Narcan is safe and effective with no potential for abuse. It only works if someone has opioids in their system. There is no harmful effect if opioids are not present.
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Frequently asked questions
Read through our FAQ for any questions you may have or give us a call today. We are here to answer your questions and support you or your loved one through their healing journey.
What are the signs of an overdose?
Signs of an opioid overdose include shallow or stopped breathing, difficulty breathing, inability to wake up or respond, pinpoint pupils, blue or purple lips, choking sounds, and a limp body. Without prompt action, an overdose can lead to death, which is why recognizing these signs early matters.
How can you tell if someone is overdosing?
If you suspect someone is overdosing, you may notice they can’t wake up or respond, are breathing very slowly (or not at all), have blue or purple lips or fingernails, and their body is very weak.
How do you use Narcan?
To use Narcan nasal spray, lay the unresponsive person on their back, insert the nozzle into one nostril, and press the plunger firmly. To use injectable Narcan, follow the instructions provided.
How quickly does Narcan work?
Narcan can work very quickly, often within 2 to 3 minutes after administering it.
What happens after you give someone Narcan?
After administering Narcan, the person may wake up, gasp, and become responsive. Waking up abruptly from an overdose can cause fear, confusion, or hostility.
Can you give someone more than one dose of Narcan?
Yes, you can administer more than one dose if they don’t respond or if their breathing doesn’t improve.
How can you help prevent an opioid overdose?
Staying informed about overdose prevention strategies, such as safely storing and disposing of prescription medications and avoiding illicit drugs, can reduce the risk. Building a response toolkit with naloxone on hand and knowing how to contact emergency help can also make a difference if an overdose happens.
References
- World Health Organization. (2023, August 29). Opioid overdose fact sheet. https://www.who.int/news-room/fact-sheets/detail/opioid-overdose
- Centers for Disease Control and Prevention. (2024, May 8). Preventing opioid overdose. U.S. Department of Health and Human Services https://www.cdc.gov/overdose-prevention/prevention/index.html
- American Heart Association. (2020). Part 10: Special circumstances of resuscitation – Opioid-associated emergency for lay responders. 2020 American Heart Association Guidelines for CPR and ECC. https://eccguidelines.heart.org/
- Centers for Disease Control and Prevention. (2024, May 8). Reverse opioid overdose to prevent death. U.S. Department of Health and Human Services. https://www.cdc.gov/overdose-prevention/reversing-overdose/index.html
- Centers for Disease Control and Prevention. (2024, May 8). Lifesaving naloxone. U.S. Department of Health and Human Services. https://www.cdc.gov/overdose-prevention/reversing-overdose/about-naloxone.html
- Substance Abuse and Mental Health Services Administration. (2023). SAMHSA opioid overdose prevention toolkit (HHS Publication No. SMA 18-4742). U.S. Department of Health and Human Services. https://store.samhsa.gov/product/opioid-overdose-prevention-toolkit/sma18-4742
- National Library of Medicine. (October 2023). NARCAN- naloxone hydrochloride spray [Drug label]. U.S. Department of Health and Human Services, National Institutes of Health. https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=784a0e98-c2d6-f845-e053-2991aa0ac4b4&type=display