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If you think someone is overdosing, always call 911 right away and ask around the area to see if anyone has Narcan (naloxone) to immediately give them. Roll the person on their side in recovery position with their top knee bent and wait for medical help to arrive.
There won’t be time to read a whole article before helping someone who is overdosing, but you can still save this information for future situations. This guide will walk you through the key signs to watch for and the steps to follow so you can offer the help someone needs.
This is potentially life-saving knowledge and worth remembering — even if you don’t personally know anyone who uses opioids.
Here’s how to tell if someone is overdosing, according to Dr. Stephen A. Martin, MD, medical director for research, education, and quality at Boulder Care and the SAMHSA Overdose Prevention and Response Toolkit:
If more than one of these opioid overdose signs is present, treat it as a medical emergency, especially if breathing is slowed and they are unresponsive.
The most important thing to do when someone is overdosing is to call 911 immediately, give them naloxone (Narcan) if you have it, and keep them breathing until help arrives.
Staying calm is also key, says Wesley Brewington, a certified peer recovery support specialist at Boulder Care. "Panic can delay getting someone the help they need," he says.
Call 911 immediately and tell them the person is not responding and is possibly overdosing. Make the call, even if you're not 100% sure it's an overdose. Remain on the line so you can follow their instructions for what to do next.
Tilt their head back, lift their chin, and give 1 breath every 5 to 6 seconds. Watch their chest to ensure it is rising with each breath you give. Continue until they start breathing on their own or help arrives.
If the person is unconscious but breathing, roll them onto their side with their top knee bent and head tilted slightly back. This helps keep the airway clear and reduces the risk of choking.
Do not leave them alone. "An overdose can worsen. Some people may quickly need additional doses of Narcan," Brewington says.
If they stop breathing or become unresponsive again, give them another dose of naloxone and continue rescue breathing.
"If the person doesn’t respond to a first naloxone dose, naloxone should be given every 2-3 minutes until the person responds," says Dr. Martin. "You can’t give someone too much Naloxone if they are in this situation."
Tell emergency responders what they took (if you know), how much naloxone was given, and when. Stay until they take over care.
In some cases, administering naloxone can lead to sudden opioid withdrawal symptoms, so informing responders can help them determine what steps may be needed to address symptoms of precipitated withdrawal.
The best way to tell the difference between someone who is very high and someone who is overdosing is to look at whether they can still breathe and respond normally.
When in doubt, treat it as an overdose. Administering Narcan and acting early is much safer than waiting to see if it gets worse. "It's better to be wrong than to wait too long," Brewington says.
During an opioid overdose, breathing slows down so much that oxygen levels drop. As oxygen falls, the brain and body begin to shut down, leading to opioid overdose symptoms like small pupils, lack of responsiveness, and blue or gray lips and fingertips.
While breathing is an automatic reflex, it becomes very slow or may stop completely during an overdose. "Opioids can turn down or even turn off this breathing reflex," says Dr. Martin. "During an opioid overdose, though a person may appear to be just asleep, their brain is actually starving for oxygen."
Gurgling and loud snoring are key warning signs. While often mistaken for sleep, they mean that the airway is partially blocked. “Don't assume a person will sleep it off,” Brewington says. “Slowed or stopped breathing is a medical emergency.”
During an overdose, a person becomes difficult or impossible to wake up. Assess responsiveness by shaking them, shouting their name, or physically stimulating them. You can perform a sternum rub by pressing your knuckles vigorously up and down the center of the chest for several seconds. Dr. Martin also says you can rub your knuckles on their upper lip or pinch the back of their arm to assess responsiveness.
Breathing changes cause blood oxygen levels to drop, leading to visible changes in color. Skin may turn pale, gray, or bluish. On darker skin, these changes are often easier to see on the lips, gums, inside the mouth, or nail beds than in overall skin color. This is one of the most visible signs that oxygen levels are dangerously low.
Opioids affect pupil size because they act on the part of the brain that controls the muscles of the pupils. Pupils become very small, like a pinpoint, and respond less to changes in light.
Fentanyl is powerful and fast-acting, which means it can cause an overdose even at very small doses. Signs of fentanyl overdose are the same as those of other opioids, but a person can lose consciousness within seconds to minutes.
"Fentanyl causes more overdoses because it is much stronger at stopping the breathing reflex, with a potency 100 times that of morphine and 30-50 times that of heroin," Dr. Martin explains. "Fentanyl also crosses into the brain much more quickly than other opioids. A person using fentanyl can have their breathing reflex turned down or off far more quickly and powerfully, creating an overdose."
This potency means a single dose of naloxone may not be enough. If the person doesn't start breathing or wake up within 2 to 3 minutes, you should give them another dose and continue rescue breathing.
It's also common for fentanyl to be mixed into other drugs without people knowing. Having fentanyl test strips on hand can help detect the drug in other substances before use, reducing the risk of harm. They are inexpensive and available through many local health departments and harm reduction programs.
People are at the highest risk for opioid overdose after a break from opioid use, when mixing opioids with other substances, or when using drugs that may contain fentanyl. Overdose risk can increase as opioid use becomes more frequent or severe. Recognizing the signs of opioid use disorder may help people seek support before an overdose occurs.
Losing tolerance after a break from opioids increases the risk of overdose. After days or weeks without opioids, the body becomes less used to them, so a previously familiar dose becomes dangerous. This risk can be high after detox or rehab, release from jail or prison, hospitalization, or any other period of reduced use.
Mixing opioids with alcohol, benzodiazepines (like Xanax or Valium), or other central nervous depressants that slow breathing also greatly increases the risk of overdose. Dr. Martin notes that using alone presents the highest risk for fatal overdose.
Fear of legal consequences is a common reason why people hesitate to call 911 during an overdose. "People hesitate because they're afraid of legal consequences from saying the wrong thing or making a mistake. The biggest mistake is usually doing nothing," Brewington explains. "Calling for help or staying with the person can make all the difference."
He suggests knowing the Good Samaritan laws in your state, which provide legal protection for certain drug possession charges for people seeking emergency help.
Protections vary by state, but most U.S. states have some form of overdose-related immunity law.
There are also additional protections for the use of naloxone. People who administer naloxone in good faith are protected from liability in most states.
However, laws can change, and the details vary by state. You can check your state's current protections in the DopaGE Good Samaritan law database.
Naloxone nasal spray is widely available throughout the U.S., often free or low-cost through harm reduction and public health programs, most commonly under the brand name Narcan. Nightclubs and bars frequently have a stock of Narcan available to use when overdose emergencies occur.
Brewington suggests keeping some on hand and learning how to use it before you ever need it. This can help save lives by reversing overdoses before emergency help can get there.
You can find naloxone at:
Naloxone is just one part of overdose prevention. Additional overdose awareness resources from Boulder Care can help you learn how to recognize and respond to an overdose effectively.
The most common signs of an opioid overdose are slowed or stopped breathing and an inability to wake the person. It's a medical emergency that can happen quickly, especially with fentanyl or after a break in use. If you suspect an overdose, call 911, give naloxone if you have it, perform rescue breathing, and stay with the person until help arrives.
"The most important thing is keeping someone alive long enough to have another chance. Recovery is possible, but only if they survive the moment in front of them," Brewington says.
For people struggling with opioid use disorder, treatment can also reduce the risk of future overdoses. Call 888-422-6530 to speak with a care team member and learn more about available options, including buprenorphine, the Sublocade shot, and naltrexone.
Substance Abuse and Mental Health Services Administration (SAMHSA). Overdose Prevention and Response Toolkit.
During an overdose, opioids cause sedation that slows breathing and heart rate to dangerously low levels. Oxygen levels drop, causing them to lose consciousness, stop responding, and eventually stop breathing altogether. This can quickly lead to brain damage or death without quick opioid overdose treatments, such as naloxone. Naloxone works quickly by stopping opioids from attaching to brain receptors, which can restore normal breathing patterns.
Yes, a person can overdose on opioids even if it is their first time taking them. This is especially true with fentanyl, since it is such a powerful drug. The risk of overdose is also higher when taking opioids for the first time if they are combined with alcohol or other sedatives, which also affect breathing.
People often respond to one dose. However, Dr. Martin says that a person may not respond to a single dose of naloxone because the opioid causing the overdose is too strong or because something else has caused them to stop breathing. In this situation, call 911, give rescue breathing, and continue administering naloxone every 2 to 3 minutes until they wake and help arrives. It is safe to keep giving doses, and you may need to use all of the doses in the pack.
At Boulder Care, we’re committed to providing clear, evidence-based information about opioid and alcohol use disorder recovery. Learn more about our editorial standards and medical review process.
Our mission is to improve the lives of people with substance use disorders. We provide medication, resources, and support to help our patients succeed on their own terms, wherever they are.
