If someone near you is overdosing, your response in the first few minutes can be the difference between life and death. The core steps are: call 911, administer naloxone if available, support their breathing, and place them in the recovery position. Each of these steps has details that matter, and the right approach depends partly on what substance is involved.
Recognize What’s Happening
The two most common types of overdose, opioid and stimulant, look very different from each other. Knowing which one you’re dealing with helps you respond effectively.
An opioid overdose (from heroin, fentanyl, or prescription painkillers) typically makes a person unconscious and unresponsive. Their breathing slows dramatically or stops entirely. Their pupils shrink to tiny pinpoints. Their skin may turn bluish, especially around the lips and fingertips. They are difficult or impossible to wake up.
A stimulant overdose (from cocaine, methamphetamine, or similar drugs) often looks like the opposite. The person is usually still conscious. Their pupils are dilated, their breathing is rapid, their heart may be racing or beating irregularly, and they may be overheating or sweating heavily. A stimulant overdose becomes life-threatening when body temperature rises dangerously high.
If you’re not sure what substance is involved, or if the person isn’t breathing, treat it as an opioid overdose. Naloxone won’t harm someone who hasn’t taken opioids.
Call 911 First
Call 911 immediately, even if you plan to give naloxone. You don’t need to know what drug was taken or provide a detailed medical history. Tell the dispatcher: “Someone is unresponsive and not breathing.” Give a specific street address or describe your location clearly. Then follow whatever instructions the dispatcher gives you.
Professional medical care is essential because naloxone wears off faster than most opioids do. A person who wakes up after naloxone can slip back into overdose 30 to 90 minutes later once the medication fades. Paramedics need to evaluate and monitor them.
Good Samaritan Laws and Calling for Help
Fear of police involvement is the most common reason bystanders hesitate to call 911 during an overdose. Most U.S. states now have Good Samaritan laws that provide some legal protection when you call for help. These protections typically cover low-level drug offenses like possession of drugs or paraphernalia. The specifics vary by state: some protect you from arrest, others only protect you from prosecution, and a few offer only a reduced sentence as a defense. These laws generally do not cover outstanding warrants, drug distribution charges, or other serious offenses. Despite their limitations, calling 911 remains the single most important thing you can do. Someone’s life depends on it.
How to Give Naloxone Nasal Spray
Naloxone (sold under the brand name Narcan) is available over the counter at most pharmacies without a prescription. A two-pack of nasal spray costs roughly $45. If you or anyone in your life uses opioids, or if you simply want to be prepared, keeping a box at home or in your bag is worth considering.
To administer it:
- Lay the person on their back.
- Open the package. Peel back the tab to remove the nasal spray device.
- Hold it correctly. Place your thumb on the bottom of the plunger and your first and middle fingers on either side of the nozzle.
- Position the person’s head. Tilt their head back slightly and support the back of their neck with your free hand.
- Insert and spray. Gently insert the nozzle into one nostril until your fingers rest against the bottom of their nose. Press the plunger firmly. Each device delivers one full 4 mg dose.
- Remove the device from their nostril.
If the person doesn’t wake up or start breathing normally within 2 to 3 minutes, give a second dose using a new device in the other nostril. You can repeat this every 2 to 3 minutes with additional sprays if you have them.
Fentanyl May Require More Naloxone
Fentanyl is now the leading cause of overdose deaths in the U.S., and it presents a specific challenge. Because fentanyl is far more potent than heroin and reaches very high levels in the body very quickly, a single dose of naloxone sometimes isn’t enough. Research published in the journal Substance Abuse Treatment, Prevention, and Policy found that multiple sequential doses of naloxone are frequently required in fentanyl overdoses. Before the rise of synthetic opioids, community naloxone programs reported nearly 100% survival rates with standard doses. That’s no longer guaranteed with fentanyl. If you have multiple naloxone devices available, be prepared to use them.
Support Their Breathing
Opioid overdoses kill by shutting down breathing. If someone’s breathing is extremely slow (one breath every 5 to 10 seconds or less) or has stopped completely, rescue breathing is one of the most critical things you can do while waiting for naloxone to take effect or for paramedics to arrive.
To perform rescue breathing: tilt the person’s head back to straighten their airway, pinch their nose closed, seal your mouth over theirs, and give one breath every 5 seconds. Watch for the chest to rise with each breath.
You may have heard that current guidelines recommend “hands-only CPR” with chest compressions and no mouth-to-mouth. That guidance applies to cardiac arrest, not overdose. In an opioid overdose, the primary problem is that the person has stopped breathing, not that their heart has stopped. Rescue breathing gets oxygen into their body and is the fastest way to address that. If the person has no pulse and isn’t responding to naloxone or rescue breathing, then full CPR with chest compressions is needed.
Place Them in the Recovery Position
Once the person is breathing on their own, or after you’ve given naloxone, turn them onto their side into the recovery position. This prevents them from choking on vomit, blood, or mucus, which is a real and common danger during overdose.
The position works like this: the person lies on their side with their face angled slightly toward the ground so fluids drain out of the mouth rather than back into the throat. Their bottom leg stays straight, aligned with their spine. Their top leg bends at the knee into an L-shape, with the knee touching the ground to keep them from rolling onto their stomach. Tuck their top hand under their cheek as a cushion. Their bottom arm rests on the ground in front of them for stability.
Stay with them and keep watching. If they stop breathing again, roll them onto their back and resume rescue breathing or give another dose of naloxone.
Responding to a Stimulant Overdose
Stimulant overdoses require a different approach because naloxone has no effect on stimulants. There is no equivalent reversal medication for cocaine or methamphetamine. Call 911 and focus on keeping the person as safe and calm as possible while you wait.
The most dangerous aspect of a stimulant overdose is overheating. If the person is conscious, move them to a cool environment, remove excess clothing, and apply cool water or ice packs to their neck, armpits, and groin to bring their temperature down. Keep them from exerting themselves. Reduce noise and stimulation around them. If they lose consciousness, place them in the recovery position and monitor their breathing.
What to Do if You’re Not Sure What They Took
Street drugs are increasingly unpredictable. Pills sold as one substance frequently contain fentanyl. If someone is unconscious, unresponsive, or breathing very slowly and you don’t know what they took, give naloxone. It only works on opioids, so it won’t make a stimulant overdose worse. It also won’t harm someone who isn’t on opioids at all. The risk of not giving it when fentanyl is involved far outweighs any concern about giving it unnecessarily.
If the person wakes up after naloxone, they may be confused, agitated, or even combative. This is normal. Opioid withdrawal symptoms can kick in rapidly when naloxone reverses the drug’s effects. Calmly explain what happened and that help is coming. Do not let them leave before paramedics arrive, because the naloxone will wear off and they can overdose again.