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

8 Dec

by April Morone 13 Comments

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.

Diverse people exchange overdose prevention tools in a vibrant community center, animated by fantastical creature helpers.

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.

A person calls for help at night as a protective spirit guardian hovers above, turning overdose signs into stars.

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:

Call 911 immediately.
Give naloxone if you have it.
Start rescue breathing if they’re not breathing-tilt head back, pinch nose, give one breath every 5 seconds.
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.

Can naloxone harm someone who didn’t overdose on opioids?

No. Naloxone only works on opioid receptors. If someone hasn’t taken opioids, it has no effect. It won’t make them sick or cause side effects. It’s safe to use even if you’re unsure. Giving naloxone to someone who overdosed on fentanyl, heroin, or prescription painkillers could save their life.

Are fentanyl test strips legal?

Yes. Fentanyl test strips are legal in all 50 U.S. states and are classified as harm reduction tools, not drug paraphernalia. Many public health departments and nonprofits distribute them for free. They’re not intended to encourage drug use-they’re meant to reduce harm and save lives.

Can I get naloxone without insurance or a prescription?

Yes. Since March 2023, Narcan nasal spray is available over the counter at pharmacies like CVS, Walgreens, and Walmart without a prescription. Many community health centers, needle exchanges, and local health departments also give it out for free. You don’t need to prove you’re at risk. Just ask.

Is MAT just trading one addiction for another?

No. Medication-assisted treatment helps restore normal brain function. People on methadone or buprenorphine can work, parent, go to school, and live stable lives. Unlike street drugs, these medications are dosed safely and monitored. Studies show people on MAT are far more likely to stay in treatment, avoid overdose, and reduce illegal drug use. It’s not substitution-it’s recovery.

What if I’m afraid to call 911 during an overdose?

Most states have Good Samaritan laws that protect people who call for help during an overdose. You won’t be arrested for possession if you’re calling for yourself or someone else. Emergency responders are there to save lives, not punish. Calling 911 is the most important step you can take. Delaying it can be fatal.

Tags: overdose prevention naloxone fentanyl test strips MAT substance use disorder

13 Comments

Larry Lieberman
December 10, 2025 AT 07:24

This is so important 🙏 I keep Narcan in my car and my backpack. If you’re reading this and haven’t gotten some yet, go to CVS right now. It’s literally just sitting on the shelf. No judgment. Just life-saving.
Lisa Whitesel
December 10, 2025 AT 12:08

People still think addiction is a choice. It’s not. It’s a chronic disease like diabetes. Stop blaming victims and start funding treatment.
Sabrina Thurn
December 10, 2025 AT 22:39

The data on MAT is unequivocal: buprenorphine reduces mortality by 50-70% compared to abstinence-only models. Yet structural barriers-provider shortages, Medicaid restrictions, stigma in primary care-continue to prevent access. We need decentralized, community-based prescribing networks, not clinic-dependent models that alienate marginalized populations.
iswarya bala
December 12, 2025 AT 07:18

this really help me my bro used to do drugs and now he on buprenorphine and its changd his life <3
Simran Chettiar
December 12, 2025 AT 13:24

The ontological dilemma of harm reduction lies not in its efficacy, but in its epistemological positioning within a moral framework that still equates substance use with deviance. One cannot merely distribute naloxone while the sociopolitical architecture of criminalization persists; true liberation demands the dismantling of the carceral logic that pathologizes suffering.
Anna Roh
December 13, 2025 AT 12:16

I read this whole thing and honestly? I’m just tired. Why does everything have to be so complicated? Just give people naloxone and move on.
om guru
December 15, 2025 AT 11:30

Kindly be informed that the implementation of harm reduction protocols represents a humanitarian imperative grounded in ethical duty and public health jurisprudence. Your cooperation in disseminating this knowledge is both prudent and morally obligatory.
Richard Eite
December 17, 2025 AT 06:07

America is falling apart because we coddle addicts instead of locking them up. This whole post is woke nonsense. If you can’t control your drug use, you shouldn’t be allowed to live. End of story.
Philippa Barraclough
December 18, 2025 AT 01:04

I appreciate the thoroughness of this piece, particularly the emphasis on polysubstance risks and the limitations of naloxone in the context of xylazine. However, I wonder whether the public health messaging around fentanyl test strips might inadvertently normalize usage by implying that testing makes use safer, rather than framing abstinence as the only truly safe option.
Olivia Portier
December 18, 2025 AT 03:31

i got my first naloxone kit last week from the library!! they had it next to the books and no one asked me anything. my cousin uses and i told him to keep one too. we’re all gonna be okay <3
Tiffany Sowby
December 19, 2025 AT 16:33

I don’t know why we keep pretending this is a health crisis. It’s a moral failure. People choose to do drugs. If they die, it’s their fault. Why should taxpayers pay for their bad decisions?
Asset Finance Komrade
December 20, 2025 AT 21:47

While the Western model of harm reduction is well-intentioned, it fails to address the deeper existential void that drives substance dependence. Eastern traditions offer mindfulness, detachment, and community-based healing-concepts alien to a system obsessed with pharmacological quick fixes. Perhaps the real solution lies not in naloxone, but in reawakening the soul.
Jennifer Blandford
December 21, 2025 AT 00:20

I just got back from a trip to rural Kentucky. The community center there gives out free test strips and naloxone next to the free coffee and sandwiches. People are hugging each other. Someone told me, 'We don’t call them addicts here. We call them family.' I cried. This is what hope looks like.