Opioid Overdose: How to Recognize the Signs, Respond in an Emergency, and Use Naloxone

Every day in the U.S., 187 people die from drug overdoses. Most of them involve opioids - whether it’s prescription painkillers, heroin, or, more often now, fentanyl hidden in pills that look like Xanax or oxycodone. The scary part? You don’t need to be a drug user to be near someone who overdoses. It could be a friend, a family member, or even a stranger on the street. The good news? You can learn to recognize the signs, act fast, and save a life - even if you’ve never held a syringe or a nasal spray before.

What Happens During an Opioid Overdose

Opioids, including oxycodone, hydrocodone, fentanyl, and heroin, work by binding to receptors in your brain that control pain and pleasure. But they also shut down the part of your brain that tells you to breathe. When too much of the drug is in your system, your breathing slows down, then stops. Your body isn’t getting oxygen. Your lips turn blue. Your skin gets cold and clammy. Your brain starts to die - within minutes.

This isn’t just a risk for people with addiction. Someone taking prescribed pain meds might accidentally take too much. Someone might not know their pill contains fentanyl. Someone might mix opioids with alcohol or benzodiazepines. All of it can turn deadly in seconds.

How to Spot an Opioid Overdose

You don’t need medical training to recognize an overdose. Look for these three key signs, often called the “opioid overdose triad”:

• Unresponsive or unconscious - Shake the person’s shoulder. Shout their name. Try to wake them up. If they don’t respond at all, it’s a red flag.
• Slow, shallow, or stopped breathing - Watch their chest. Listen for breaths. You might hear gurgling, snoring, or choking sounds. That’s not sleep - that’s drowning on your own saliva because your airway is blocked and you’re not breathing.
• Pinpoint pupils - Shine a light in their eyes. If their pupils are tiny, like pinpricks, it’s a classic sign. But don’t wait for this - some overdoses don’t show it.

Other signs include:

• Blue, purple, or gray lips and fingernails
• Cold, clammy skin
• Limp body - they’ll feel like a ragdoll
• Slow heartbeat or no pulse

Don’t assume they’re just passed out. Don’t wait to see if they wake up. Don’t think it’s “not that serious.” If someone is unresponsive and breathing poorly, it’s an overdose until proven otherwise.

What to Do Immediately: The 3-Step Emergency Response

Time is everything. Brain damage starts after just 4 to 6 minutes without oxygen. Here’s what to do - in order:

1. Call 911 right away. Even if you’re not sure, call. Say: “I think someone is overdosing on opioids.” Give your location. Stay on the line. The dispatcher can guide you while you act.
2. Give naloxone if you have it. Naloxone (brand name Narcan) reverses opioid overdoses. It’s safe, easy to use, and won’t hurt someone who hasn’t taken opioids. Most naloxone today comes as a nasal spray. Tilt the person’s head back. Spray half the dose into one nostril, half into the other. You don’t need to insert it deep - just spray and let gravity do the work.
3. Stay with them until help arrives. Naloxone wears off in 30 to 90 minutes. Opioids stay in the body longer. The person could stop breathing again. Keep checking their breathing. If they stop, start CPR. Push hard and fast on the center of the chest - at least 100 pushes per minute. Don’t stop unless they start breathing on their own or paramedics take over.

If you don’t have naloxone, skip to step three: call 911 and start CPR. Every second counts.

How Naloxone Works - And Why It’s Safe

Naloxone is a drug that kicks opioids off the brain’s receptors. It doesn’t feel good. It doesn’t get you high. It doesn’t work on alcohol, cocaine, or meth. It only reverses opioids. And it’s safe - even if you give it to someone who didn’t take opioids, it won’t hurt them.

It’s not a cure. It’s a bridge. It buys you time until emergency help arrives. That’s why you must still call 911 - even after giving naloxone.

Naloxone is now available without a prescription in 49 states. You can get it at most pharmacies for $25 to $50 for a two-dose kit. Many community centers, health clinics, and harm reduction programs give it out for free. If you know someone who uses opioids - or even if you just want to be prepared - get a kit. Keep one in your car, your purse, your backpack.

What Comes After the Overdose

Once the person is breathing and the paramedics arrive, they’re not out of danger. Opioid overdose can cause lung injury, heart problems, or brain damage from lack of oxygen. They need to go to the hospital, even if they feel fine.

After the emergency, they need more than medical care - they need support. Many people who survive an overdose don’t want to use drugs again. But without treatment, the risk of another overdose is high. Medication-assisted treatment (MAT) with drugs like buprenorphine or methadone can cut overdose risk by half. Counseling, peer support, and mental health care are just as important.

Don’t assume they’re “just a junkie.” Addiction is a medical condition. Relapse is common. Compassion saves lives - not judgment.

Fentanyl Is Changing Everything

In 2023, fentanyl was involved in over 73,000 overdose deaths in the U.S. - more than any other drug. Fentanyl is 50 to 100 times stronger than morphine. A dose the size of a few grains of salt can kill. And it’s not just in heroin anymore. Fake pills, cocaine, meth, and even marijuana are being laced with it - often without the user’s knowledge.

That’s why fentanyl test strips matter. They cost less than a dollar each. You rub a tiny bit of the drug on the strip. It changes color if fentanyl is present. It won’t make the drug safe, but it lets someone decide whether to use it - or not.

Many harm reduction groups hand out test strips along with naloxone. If you’re helping someone who uses drugs, give them both.

You Don’t Need to Be a Hero - Just Ready

You don’t need to be a doctor, a nurse, or a first responder to save a life. You just need to know what to look for and what to do.

Get a naloxone kit. Keep it where you can find it. Teach the people around you how to use it. Practice with a trainer spray (many pharmacies give them out for free). Talk about it - not in hushed tones, but openly.

Opioid overdoses aren’t rare. They’re happening in living rooms, in parking lots, in college dorms. And they’re preventable - if we act.