How to Prevent Overdose in People with Substance Use Disorders: Practical Steps That Save Lives

Every day, more than 175 people in the U.S. die from drug overdoses. Most of them aren’t strangers-they’re neighbors, family members, coworkers. And the majority of these deaths are preventable. The problem isn’t just drugs-it’s how we respond to them. For people with substance use disorders, overdose isn’t a failure of willpower. It’s a medical emergency that can be stopped with the right tools, knowledge, and support.

Know the Real Danger: Fentanyl and Polysubstance Use

The biggest threat today isn’t heroin or prescription pills alone. It’s fentanyl-a synthetic opioid 50 to 100 times stronger than morphine. It’s not always labeled. It’s mixed into cocaine, meth, counterfeit pills that look like oxycodone or Xanax, and even MDMA. In 2022, fentanyl was involved in about 80% of opioid-related overdose deaths. And it doesn’t take much: just two milligrams can kill someone who hasn’t built up a tolerance.

Even worse, 78% of overdose deaths in 2022 involved more than one drug. People aren’t just using opioids-they’re using opioids with alcohol, benzodiazepines, or xylazine (a veterinary sedative now showing up in street drugs). Xylazine isn’t reversed by naloxone, and it can cause severe tissue damage and long-term coma. This means even if you give naloxone, you still need emergency help.

Carry Naloxone-It’s Simple, Safe, and Life-Saving

Naloxone (brand names Narcan, Kloxxado) is the only medication that can reverse an opioid overdose. It works by kicking opioids off brain receptors and restoring breathing. It doesn’t work on cocaine, meth, or alcohol overdoses-but since most overdoses now involve opioids, it’s the single most important tool you can have.

You don’t need a prescription. Since March 2023, Narcan has been available over the counter at pharmacies across the U.S. It comes in two forms: a nasal spray (easy to use) and an auto-injector. The nasal spray requires no training-just tilt the head back, insert the nozzle, and press the plunger. Studies show 96% of people who get a 20-minute training can successfully use it.

Keep naloxone where you keep your keys or wallet. If someone you care about uses drugs, give them naloxone too. Don’t wait for an emergency. Keep two doses on hand-sometimes one isn’t enough, especially with fentanyl. And always call 911 after giving naloxone. Its effects wear off in 30 to 90 minutes, but fentanyl can stay in the body much longer. The person could overdose again.

Use Fentanyl Test Strips Before Using

Fentanyl test strips (FTS) cost less than a dollar each. You dip them in water mixed with a tiny bit of the substance-powder, dissolved pill, or liquid-and wait 1-5 minutes. A single line means fentanyl is present. Two lines mean it’s not detected.

They’re not perfect. They can miss fentanyl if it’s not evenly mixed, or if the dose is below 0.25 nanograms. But they give you information. If you know fentanyl is in the mix, you can:

• Use less
• Use with someone else present
• Start with a tiny amount to test tolerance
• Choose not to use at all

Many harm reduction centers give out test strips for free. Some apps, like MyNarcan, even show nearby locations where you can pick them up. Test strips don’t eliminate risk-but they turn guesswork into choice.

Medication-Assisted Treatment (MAT) Is the Most Effective Long-Term Strategy

If someone has opioid use disorder, medication-assisted treatment (MAT) is the gold standard. It’s not replacing one drug with another. It’s stabilizing the brain so people can rebuild their lives.

Three FDA-approved medications are used:

• Methadone: Taken daily at a clinic. Reduces cravings and withdrawal.
• Buprenorphine: Can be prescribed by doctors in offices. Less risk of overdose than methadone.
• Naltrexone: Blocks opioids entirely. Comes as a daily pill or monthly injection.

Studies show MAT reduces overdose death risk by 50%. Yet only 18.4% of people with opioid use disorder in the U.S. received any medication in 2022. Why? Stigma. Lack of providers. Insurance barriers. Rural areas are hit hardest-60% of rural counties have no MAT provider at all.

If you or someone you know is ready to seek help, start here: call SAMHSA’s helpline at 1-800-662-HELP (4357). They connect you to treatment, even if you have no insurance. MAT isn’t a quick fix. But it’s the only treatment proven to save lives long-term.

Never Use Alone-Use the ‘Never Use Alone’ Hotline

Most overdoses happen alone. People are scared to use with others. They fear judgment, arrest, or being reported. That’s why the Never Use Alone hotline exists. You call, talk to a live operator, and use while they’re on the line. If you stop responding, they call 911 and send help to your location.

In 2023, the service received about 12,000 overdose-related calls per month. They’ve saved hundreds of lives. It’s anonymous. No questions asked. You don’t need to give your real name. You just need to be willing to call before you use.

If you can’t call, use a buddy system. Text someone you trust. Set a timer. Agree that if you don’t check in within 15 minutes, they call for help. Simple. Effective. Human.

Build a Safety Plan-It’s Not Just for Addiction Professionals

A safety plan isn’t a treatment plan. It’s a practical list of actions you take before, during, and after using. It’s something you write down and keep on your phone or in your wallet.

Here’s what a basic safety plan includes:

• Who to call if something goes wrong
• Where your naloxone is kept
• Whether you’ll use alone or with someone
• What dose you plan to use (and how you’ll test it)
• What to do if you feel dizzy, slow to breathe, or unresponsive

A 2022 study found that people who used structured safety plans had 28% fewer overdose events. It doesn’t stop addiction. But it stops death.

Know the Signs of an Overdose-and Act Fast

You don’t need to be a medic to recognize an overdose. Look for:

• Unresponsiveness (can’t wake them up)
• Slow, shallow, or stopped breathing
• Blue or gray lips and fingernails
• Pinpoint pupils
• Gurgling or snoring sounds

If you see these signs:

1. Call 911 immediately.
2. Give naloxone if you have it.
3. Start rescue breathing if they’re not breathing-tilt head back, pinch nose, give one breath every 5 seconds.
4. Stay with them until help arrives.

Don’t wait for symptoms to get worse. Don’t assume they’re just passed out. Don’t leave them alone. Time is everything.

Break the Stigma-It’s Killing People

Stigma is why people hide their use. Why they avoid treatment. Why they use alone. Why they don’t carry naloxone.

The truth? Addiction is a brain disease. It’s not moral failure. It’s not weakness. It’s biology. People with substance use disorders are not “junkies” or “users.” They’re people trying to cope with trauma, pain, or mental illness.

When you talk about overdose prevention, you’re not just talking about drugs. You’re talking about dignity. About access. About compassion. If you know someone struggling, say this: “I care about you. I want you to be safe.” Then hand them naloxone. Or a test strip. Or a number to call.

What’s Next? Policy, Funding, and Hope

The federal government is spending $1.5 billion a year on overdose prevention. That’s up from $100 million in 2016. New tools like nalmefene (a longer-acting overdose reversal drug) are coming. Apps are helping people find help faster.

But gaps remain. Rural areas still lack treatment. Incarcerated people are released without any support-and face 120 times higher overdose risk in the first two weeks. Xylazine is spreading. Fentanyl is getting stronger.

The solution isn’t one thing. It’s many things working together: naloxone in every home, MAT in every clinic, test strips in every community center, safe spaces for use, and zero judgment for those who need help.

You don’t have to fix the system to save a life. You just have to be willing to act.