How to Respond to an Opioid Overdose

An opioid overdose can happen fast, and the person it’s happening to usually can’t help themselves - they may be too sedated to wake up, and their breathing can slow to a stop. That’s where you come in. You do not need to be a doctor to save a life here. The core of overdose response is simple enough to learn in a few minutes: call for help, give naloxone if you have it, and keep the person breathing until paramedics arrive. In nearly half of overdose deaths, a potential bystander is present, according to the CDC. Knowing what to do - and doing it without hesitation - is what closes that gap.

This guide walks through how to recognize an opioid overdose, the steps to take, and how naloxone fits in. It is educational, not a substitute for emergency medical care. If you are with someone right now who may be overdosing, call 911 first.

Why this matters

Drug overdose is one of the leading preventable causes of death in the United States, and the CDC reports that overdose remains the leading cause of death for adults aged 18 to 44. In 2023, roughly 105,000 people died of a drug overdose, and about 76% of those deaths involved opioids, according to the CDC. Most of those opioid deaths involved illegally made fentanyl - a synthetic opioid so potent that it now turns up in counterfeit pills and other drugs, often without the person knowing.

That last point is the reason overdose response is everyone’s business, not just something for people who use opioids regularly. Someone can overdose on a single pill bought online, believing it was something else entirely. The response is the same regardless of how it happened.

How to recognize an opioid overdose

An overdose is different from being very high. A person who is just intoxicated will usually respond if you shout their name or rub your knuckles hard against their breastbone. A person who is overdosing will not.

The signs to watch for, drawn from SAMHSA and the CDC, include:

• Breathing that is very slow, shallow, or stopped. This is the dangerous part. Opioids suppress the brain’s drive to breathe, and that is what kills.
• Unconsciousness, or being unable to wake up even when shaken or shouted at.
• A limp body and pale, clammy skin.
• Very small, “pinpoint” pupils.
• Blue or grayish lips, fingernails, or skin, especially around the mouth - a sign the body is starving for oxygen.
• Choking, gurgling, or a snoring-like rattle, sometimes called the “death rattle.”

You will rarely see every sign at once. If you are not sure whether it’s an overdose, treat it like one. Giving naloxone to someone who turns out not to have opioids in their system will not harm them - naloxone only acts on opioids, and has no effect when none are present, per NIDA. The far greater risk is doing nothing.

What to do, step by step

These steps follow guidance from SAMHSA and the CDC. The order matters less than the speed: a few minutes without oxygen causes lasting brain damage, so don’t wait.

1. Try to wake them. Shout their name. Rub your knuckles firmly up and down their breastbone (a “sternal rub”). If they don’t respond, assume an overdose and keep going.

2. Call 911. Do this even if you have naloxone. Naloxone wears off, and the person needs medical follow-up. Tell the dispatcher that someone is unresponsive and not breathing normally, and give your location. If you’re afraid of legal trouble, see the section below on Good Samaritan laws.

3. Give naloxone if you have it. Don’t wait for paramedics. With the nasal spray, lay the person on their back, insert the nozzle into one nostril, and press the plunger. With an injectable form, follow the directions on the device. Naloxone usually restores breathing within two to three minutes, according to SAMHSA.

4. Support their breathing. If the person isn’t breathing or is barely breathing, rescue breaths can buy time. Tilt the head back, lift the chin, pinch the nose, and give one breath every five seconds, watching for the chest to rise. If you’re trained in CPR and there’s no pulse, begin chest compressions.

5. Give a second dose if there’s no response. If the person hasn’t improved after two to three minutes, give another dose of naloxone in the other nostril. With fentanyl, more than one dose is often needed, because it is so strong - NIDA notes that stronger opioids “might require multiple doses.”

6. Put them in the recovery position. Once they’re breathing on their own, roll them onto their side - bottom arm stretched out, top knee bent to keep them stable - so they won’t choke if they vomit. Naloxone can trigger sudden withdrawal, and nausea is common.

7. Stay with them until help arrives. Naloxone works for only 30 to 90 minutes, but many opioids - including fentanyl - last longer than that, NIDA explains. When it wears off, the overdose can return. Keep watching their breathing, and be ready to give another dose.

If you or someone you love is struggling, call or text 988 (US) anytime, or contact SAMHSA’s National Helpline at 1-800-662-HELP (4357) for free, confidential treatment referrals.

About naloxone

Naloxone (you may know it by the brand name Narcan) is a medicine that reverses an opioid overdose. It attaches to the same receptors in the brain that opioids do, knocks the opioids off, and restores the drive to breathe - often within minutes, NIDA reports.

A few things worth knowing:

• It’s available without a prescription. Naloxone is sold over the counter in all 50 states, and many community programs hand it out free. It comes as a nasal spray and as an injection.
• It’s safe. Naloxone has few side effects and is not a drug someone can misuse. Because it only works on opioids, it won’t hurt a person who doesn’t have any in their system.
• It can cause withdrawal. In someone who is opioid-dependent, naloxone can bring on sudden, uncomfortable withdrawal - sweating, nausea, vomiting, body aches, a racing heart. These symptoms are unpleasant but, per NIDA, usually not life-threatening. The person may wake up confused or agitated; stay calm and keep them safe.
• It is not the finish line. Naloxone is a temporary measure. MedlinePlus stresses that emergency medical help is still needed after every dose. As NIDA explains, the effects of the opioid can outlast the naloxone, so the overdose can come back.

The Good Samaritan law

A common reason people hesitate to call 911 is fear of being arrested. Most states have addressed this. As of 2025, all 50 states and the District of Columbia have passed “Good Samaritan” overdose laws that give limited legal protection to people who call for help during an overdose - and often to the person who overdosed as well. A U.S. Government Accountability Office review found that most states have such laws and that research indicates they may have positive effects, in part because they make bystanders more willing to call.

Protections vary by state, so they aren’t identical everywhere. But the principle holds across the country: calling 911 to save a life is the right move, and the law is generally on your side for doing it.

Why naloxone won’t help with other overdoses

Naloxone reverses opioid overdoses - heroin, fentanyl, oxycodone, morphine, and similar drugs. It does nothing for an overdose caused by alcohol, benzodiazepines like Xanax on their own, cocaine, or methamphetamine, because those don’t act on opioid receptors.

Here’s the catch: because fentanyl is so often mixed into other drugs, many overdoses that look like they involve a stimulant or a counterfeit pill actually involve opioids too. That’s why the guidance is to give naloxone whenever an opioid overdose is possible, even if you’re not certain. It can’t hurt, and it might be exactly what’s needed. Either way, call 911 - emergency responders can treat what naloxone can’t.

FAQ

Can I hurt someone by giving naloxone if they’re not overdosing on opioids? No. Naloxone only works on opioids and has no effect on a person who has none in their system, according to NIDA. If you’re unsure, giving it is the safer choice.

What if one dose of naloxone doesn’t work? Give another dose after two to three minutes, in the other nostril if you’re using the spray. Fentanyl and other strong opioids often need more than one dose. Keep supporting the person’s breathing and wait for paramedics.

Do I still need to call 911 if the person wakes up? Yes. Naloxone wears off in 30 to 90 minutes, but the opioid can last longer, so the overdose may return. MedlinePlus and SAMHSA both stress getting the person to medical care even if they seem fine after a dose.

Where can I get naloxone? It’s available over the counter at pharmacies in all 50 states without a prescription, and many local health departments and harm-reduction programs provide it for free. Carrying it is reasonable for anyone who might be near an opioid overdose.

Sources

• Centers for Disease Control and Prevention (CDC) - Understanding the Opioid Overdose Epidemic and overdose-prevention resources
• National Institute on Drug Abuse (NIDA) - Naloxone DrugFacts
• Substance Abuse and Mental Health Services Administration (SAMHSA) - Opioid Overdose Reversal Medications and the Overdose Prevention and Response Toolkit
• MedlinePlus (U.S. National Library of Medicine) - Naloxone Nasal Spray