An overdose is a medical emergency that can happen with opioids, stimulants, alcohol, benzodiazepines, or a combination of substances, and knowing how to respond in those first few minutes can mean the difference between life and death. Whether you’re a parent, friend, coworker, or bystander, you don’t need medical training to take action that matters. You need to recognize the warning signs and know the right steps to take while help is on the way.
This article walks through how to spot the signs of an overdose and exactly what to do when one is happening. The goal is simple: keep the person alive until emergency responders arrive.
Step 1: Recognize the Signs of an Overdose
The first step is knowing what an overdose looks like. The most common warning signs of an opioid overdose include:
- Unconsciousness or the inability to wake the person up
- Slow or shallow breathing, sometimes with choking, gurgling, or snoring sounds
- Fingernails or lips turning blue or purple. In lighter skinned people the skin may take on a bluish purple tone, while in darker skinned people it may look pale, grayish, or ashen
- Pinpoint pupils, or pupils that don’t respond to light
If you suspect someone has overdosed, try to wake them. Start by calling the person’s name. If that doesn’t work, you can shake their shoulders will continuing to talk to them. The sternal rub (knuckles of a fist rubbed against the center of the breastbone) can be used, but caution should be taken to not cause damage to the skin from excessive pressure. If the person responds, check whether they can stay awake and keep breathing, and continue to monitor their breathing and alertness while keeping them as awake as possible. If they don’t respond, it’s time to act immediately.
Step 2: Call 911 for Help
An opioid overdose needs immediate medical attention, so getting someone with medical expertise to the person as fast as possible is essential. If there are no emergency medical services (EMS) or other trained personnel already on the scene, call 911 right away. You don’t need to explain everything. Telling the dispatcher something like “Someone is unresponsive and not breathing, and I think it’s an overdose” is enough to get help moving. Be sure to give a specific address or a clear description of your location.
Once you’ve called, follow the dispatcher’s instructions. If appropriate, the 911 operator may walk you through starting CPR, based on your level of training.
If you’re worried about getting in trouble for calling, don’t let that stop you. Most US states have Good Samaritan laws that protect people who seek emergency help during an overdose from certain drug-related charges. These protections vary from state to state, but the priority in that moment is saving a life, and making the call is always the right thing to do.
Step 3: Administer Naloxone
Naloxone is a medication that can reverse an opioid overdose, and it should be given to anyone showing signs of an overdose or whenever one is suspected. It comes as a nasal spray or as an injection into a muscle or under the skin, and it has been used safely for decades to reverse opioid overdoses, including those involving fentanyl.
One important thing to understand: naloxone only works on opioids, but you don’t need to be certain that opioids are involved before using it. If you aren’t sure what the person took, give naloxone anyway. It will not harm someone if they are not overdosing on an opioid, and it can save their life if they are. Naloxone can also be given safely to people of all ages, from infants to older adults, including a teen or young adult who may have taken an opioid without realizing it.
Give one dose first, then wait 2 to 3 minutes to see if the person starts breathing or responds. If there is no change, give a second dose. Overdoses involving stronger opioids like fentanyl, or large amounts, may take several doses. Keep in mind that naloxone’s effects wear off faster than many opioids, so a person can slip back into an overdose even after they seem to recover. The goal is to get them breathing again, not necessarily fully awake.
Finally, be ready to comfort the person as they come around. Naloxone can trigger sudden withdrawal, which feels unpleasant and may leave them agitated or confused. Give them space: being surrounded by unfamiliar faces after waking from an overdose can be frightening and disorienting. Keep the area calm, speak softly, and reassure them about what happened and that help is on the way.
Step 4: Support Breathing and Position the Person
Once naloxone has been given, the next priority is making sure the person can keep breathing. What you do here depends on whether they are breathing on their own. If they are not breathing, or their breathing is dangerously slow, start with rescue breathing. If they are breathing on their own, you can skip ahead to the recovery position below.
Rescue Breathing
Helping the person breathe is one of the most important things you can do, and it can be lifesaving on its own. During an overdose, breathing can slow or stop, so rescue breathing and chest compressions both help keep oxygen moving until help arrives or naloxone takes effect. If you have a barrier device available, such as a face shield or pocket mask, use it when giving rescue breaths. These small protective tools sit between your mouth and the person’s face and are the safest way to give rescue breathing. If you do not have one, rescue breathing without it is still far better than doing nothing.
To perform rescue breathing on an adult:
- Make sure the airway is clear by checking that nothing inside the mouth or throat is blocking it
- Place one hand on the person’s chin and tilt the head back
- Pinch the nose closed, place your mouth over theirs to form a seal and give two slow breaths
- Watch for the chest, not the stomach, to rise
- Continue with one breath every 6 seconds
If the person has no pulse (cardiac arrest), chest compressions should be performed to keep the blood flowing. To perform chest compressions on an adult:
- Lay the person on their back
- Press hard and fast on the center of the chest
- Keep your arms straight and extended
If at any point you’re unsure how fast, how often, or how to do any of this, stay on the line and follow the instructions the 911 dispatcher gives you. They are trained to walk you through it step by step.
The Recovery Position
Once the person is breathing on their own again, or if they were breathing the whole time, roll them onto their side into what is known as the recovery position. The reason this matters comes down to the airway. An unconscious person loses the natural reflexes that normally protect their lungs, so anything in the mouth, whether saliva, vomit, or blood, can easily be inhaled and cause choking. Turning them onto their side uses gravity to let those fluids drain away from the airway rather than pool in it. It also keeps their body weight off the chest, making it easier for them to keep breathing while they are out.
To place an adult in the recovery position from lying flat on their back:
- Move the arm closest to you so it is raised in an L-shape, with the hand about even with their head, as if they were waving
- Using your hand nearest their head, take the hand on the far side of their body and bring it across to rest flat against their cheek on the side closest to you
- With your other hand, lift the outside of the far knee so the leg forms an upside-down V
- Pull that raised knee toward you to roll their whole lower body over, then rest the knee against the ground so they end up in a position that looks like a running pose
- Make sure the face is angled down toward the ground, with the neck extended slightly and the chin away from the chest so the airway stays open
Once the person is settled on their side, drape a blanket or jacket over them if cold or shock is a concern. Stay with them and watch their breathing closely the whole time. Should it stop at any point, turn them onto their back right away and start CPR.
Step 5: Stay With the Person and Keep Monitoring
Once the person starts responding, the job is not over. Most people begin breathing again on their own within 2 to 3 minutes of getting naloxone, but because naloxone wears off faster than many opioids, the overdose can come back even after they seem to be doing better. For that reason, it is important to stay with them and keep a close watch on their breathing and alertness. Keep providing rescue breathing or compressions as needed while waiting for the naloxone to take effect.
Most importantly, the person needs to get to an emergency department or other medical care as quickly as possible, even if they wake up after the first dose and say they feel fine. The risk has not fully passed just because they have come around, and only medical professionals can make sure they are truly in the clear.
Preparation Saves Lives
An overdose is frightening, but you do not need to be a medical professional to save a life. Recognizing the signs, calling 911, giving naloxone, supporting breathing, and staying with the person until help arrives are simple actions that make a real difference in those critical minutes. Keeping naloxone on hand and knowing these steps ahead of time means you will be ready to act if you ever need to.
If you or someone you love is struggling with substance use, an overdose is often a sign that it is time to reach out for help. Treatment and support are available, and recovery is possible.