If someone near you is showing signs of an overdose, call 911 immediately, then take action based on what you see. The single most important thing you can do for an opioid overdose is administer naloxone (Narcan) if you have it and support the person’s breathing until paramedics arrive. For other types of overdose, keeping the person safe, conscious, and breathing is your primary role. Every minute matters.
How to Tell What Kind of Overdose You’re Seeing
The steps you take depend on what substance is involved, and the physical signs usually make this clear even if you don’t know what the person took.
An opioid overdose (from heroin, fentanyl, oxycodone, or similar drugs) slows the body down. The person’s breathing becomes extremely slow or stops entirely. Their pupils shrink to tiny pinpoints. Their skin may turn bluish, especially around the lips and fingertips. They may be unresponsive, limp, or making gurgling or choking sounds. This type of overdose kills by shutting down breathing.
A stimulant overdose (from cocaine, methamphetamine, or similar drugs) does the opposite. The person’s heart races, their body temperature spikes, they may become severely agitated or confused, and they can have seizures or chest pain. There is no at-home reversal agent for stimulant toxicity. These situations require emergency medical care for seizure control, temperature management, and heart monitoring that can only happen in a hospital.
Alcohol poisoning looks more like an opioid overdose in some ways: slow or irregular breathing, confusion, vomiting, loss of consciousness, and cold or clammy skin. A blood alcohol concentration above 0.31% can cause fatal respiratory depression. There is no home reversal for alcohol poisoning either.
Responding to an Opioid Overdose
Naloxone is the only drug that reverses an opioid overdose, and it’s available without a prescription at most pharmacies. The nasal spray version (Narcan) is designed for anyone to use. You spray one dose into one nostril while the person is lying on their back. If they don’t respond within 2 to 3 minutes, give a second dose in the other nostril. More than one dose is often necessary, especially when fentanyl is involved, because fentanyl binds to receptors in the brain more tightly than many other opioids.
Naloxone works by temporarily blocking the opioid from reaching the brain’s receptors. The key word is “temporarily.” Naloxone wears off faster than most opioids do, which means overdose symptoms can return after the person initially wakes up. This is why calling 911 is essential even if naloxone seems to work. The person needs to be monitored for at least a few hours.
Naloxone only reverses opioids. It will not help with alcohol poisoning, benzodiazepine overdose, or stimulant toxicity. If you’re unsure what the person took, it’s still worth giving naloxone because it won’t cause harm if opioids aren’t involved.
Supporting Breathing Before Help Arrives
If the person’s breathing has slowed dramatically or stopped, rescue breathing can keep them alive until naloxone takes effect or paramedics arrive. Tilt their head back to open the airway, pinch their nose closed, and give one breath into their mouth every 5 seconds. Watch for their chest to rise with each breath.
One complication specific to fentanyl is a condition called wooden chest syndrome, where the drug causes the muscles of the chest wall to become rigid. When this happens, it becomes physically difficult or even impossible to push air into the person’s lungs through rescue breathing. If you feel high resistance when trying to give breaths, continue attempting rescue breathing and make sure paramedics know fentanyl may be involved, since the rigidity requires medication to resolve.
The American Heart Association recommends rescue breathing as the priority for opioid overdoses because the core problem is that breathing has stopped. If you can’t deliver breaths or the person has no pulse, switch to full CPR with chest compressions.
Placing Someone in the Recovery Position
If the person is unconscious but still breathing on their own, or if they’ve been revived with naloxone, place them in the recovery position to prevent choking on vomit. Vomiting during or after an overdose is extremely common and is a leading cause of death by aspiration.
With the person on their back, kneel beside them. Extend the arm closest to you straight out at a right angle with the palm facing up. Take their far arm and fold it across their body so the back of that hand rests against the cheek nearest to you, and hold it there. With your other hand, bend their far knee up to a right angle. Pull that bent knee toward you to roll them gently onto their side. Their hand under their cheek supports the head, and the bent leg stops them from rolling flat onto their stomach. Tilt the head back slightly and lift the chin to keep the airway clear.
Responding to Stimulant Overdose
Cocaine and methamphetamine overdoses can cause heart attacks, strokes, seizures, and dangerously high body temperature. There is nothing you can administer at home to reverse these effects. Your role is to call 911 and keep the person as safe as possible while waiting.
If they are agitated or confused, try to keep them in a cool environment and remove anything nearby they could hurt themselves on. Do not restrain them physically, as struggling against restraint can worsen a dangerous condition called rhabdomyolysis, where overworked muscles break down and damage the kidneys. If they have a seizure, protect their head, clear the area around them, and let the seizure run its course. Hospital treatment typically involves medications to stop seizures, lower body temperature, and protect the heart.
Responding to Alcohol Poisoning
If someone has passed out from drinking and cannot be woken up, or their breathing is slow and irregular, this is a medical emergency. Do not leave them to “sleep it off.” Place them in the recovery position described above and call 911. Keep them warm, as alcohol poisoning drops body temperature. Stay with them and monitor their breathing continuously.
Do not try to make them vomit. A person with severely depressed consciousness can choke on their own vomit, and the gag reflex may not be working properly. Do not give them coffee, cold showers, or food. None of these lower blood alcohol levels or reverse the effects on the brain.
Why Symptoms Can Return After Reversal
Naloxone’s effects last roughly 30 to 90 minutes, while many opioids remain active in the body for hours. Long-acting opioids like methadone and extended-release formulations pose the highest risk of symptom recurrence. When naloxone wears off, the opioid can regain its grip on the brain, and breathing may slow or stop again.
This is why emergency medical monitoring is critical even after a successful naloxone reversal. If paramedics haven’t arrived and the person becomes unresponsive again, give another dose of naloxone if you have one available and resume rescue breathing.
Legal Protections for Calling 911
Fear of arrest is one of the most common reasons people hesitate to call for help during an overdose. Most U.S. states have Good Samaritan laws that provide some level of legal protection when you report an overdose. These protections typically cover low-level drug offenses like possession of drugs or paraphernalia, both for the person calling and sometimes for the person who overdosed.
The specifics vary significantly by state. Some states protect you from arrest entirely. Others only protect you from prosecution or offer reduced sentencing. These laws generally do not cover outstanding warrants, probation violations, or drug distribution charges. Despite their limitations, these laws exist specifically to remove the biggest barrier between a dying person and the phone call that saves their life.