Call 911 immediately. If someone near you is unresponsive, breathing slowly or not at all, and you suspect an overdose, getting emergency help on the way is the single most important thing you can do. Everything else you do while waiting for paramedics improves their chances of surviving.
Here is exactly what to do, step by step.
Step 1: Check for Signs of Overdose
An opioid overdose (from heroin, fentanyl, prescription painkillers, or similar drugs) has a distinct set of warning signs. The person may be unconscious or impossible to wake up. Their breathing may be very slow, shallow, or stopped entirely. You might hear choking, gurgling, or snoring sounds. Their lips, fingernails, or skin may turn blue, purple, or grayish. Their pupils may shrink to tiny pinpoints.
If the person is unconscious, try to wake them. Call their name loudly. If that doesn’t work, grind your knuckles hard into the center of their chest (the breastbone) or rub your knuckles firmly across their upper lip. These are painful enough to wake someone who is just sleeping or heavily sedated. If they don’t respond, treat it as an overdose emergency.
Step 2: Call 911
Call 911 right away. You don’t need to diagnose what happened. All you need to say is: “Someone is unresponsive and not breathing.” Give a specific address or describe your location clearly. The dispatcher will walk you through what to do next while help is on the way.
Many people hesitate to call because they’re worried about legal trouble, especially if drugs are present. In 45 states plus Washington, D.C., Good Samaritan laws provide some level of legal protection to people who call for help during an overdose. These protections typically cover low-level drug offenses like possession of drugs or paraphernalia. The specifics vary by state, but the laws exist precisely so that fear of arrest doesn’t stop someone from making the call that saves a life.
Step 3: Give Naloxone If You Have It
Naloxone (often sold under the brand name Narcan) is a nasal spray that reverses opioid overdoses. It’s available without a prescription at most pharmacies. If you have it, use it immediately.
To administer the nasal spray: remove it from the box, insert the nozzle into one nostril, and press the plunger firmly. One spray delivers the full 3 mg dose. After giving it, place the person on their side in the recovery position (more on that below) and watch them closely.
If the person hasn’t responded after 2 to 3 minutes, give a second dose in the other nostril using a new spray device. Most overdoses, including those involving fentanyl, respond to one or two standard doses. Giving more naloxone beyond that does not reverse an overdose faster or more effectively. If the person still isn’t responding after two doses, other sedating substances like alcohol, benzodiazepines, or xylazine may be involved, and the person needs the advanced medical care that paramedics can provide.
One critical thing to know: naloxone wears off before most opioids do. In clinical settings, people have started sliding back into overdose as soon as 15 to 30 minutes after naloxone, and sometimes up to 2 hours later. About a third of people who initially respond to naloxone experience some degree of recurrence. This is why calling 911 is essential even if the person wakes up after you give naloxone. They need to be monitored by medical professionals.
Step 4: Support Their Breathing
Opioid overdoses kill by shutting down breathing. If the person is not breathing on their own, rescue breathing can keep them alive until naloxone works or paramedics arrive.
First, check that nothing is blocking their airway (look inside the mouth for food, vomit, or objects). Then tilt their head back by placing one hand on their chin and lifting. Pinch their nose closed, seal your mouth over theirs, and give two slow breaths. Watch for their chest to rise. After those first two breaths, give one breath every 5 seconds.
If you’re not comfortable with rescue breathing or the person has no pulse, do chest compressions instead. Place the person flat on their back, put the heel of your hand on the center of their chest, lock your arms straight, and press hard and fast.
Step 5: Put Them in the Recovery Position
If the person is breathing but still unconscious, roll them onto their side. This keeps their airway open and prevents them from choking if they vomit, which is common when someone comes out of an overdose.
To do this: kneel beside the person while they’re on their back. Extend the arm closest to you straight out at a right angle, palm facing up. Take their other arm and fold it across their body so the back of their hand rests against the cheek nearest you. With your free hand, bend the knee farthest from you to a right angle. Then pull that bent knee toward you to gently roll them onto their side. Their head should rest on the folded hand, and the bent leg keeps them stable. Tilt their head back slightly and lift their chin to keep the airway open.
Stay with them. Keep watching their breathing and level of alertness until paramedics arrive.
What to Do If You’re Not Sure It’s Opioids
You might not know what the person took. That’s OK. If someone is unconscious, barely breathing, or unresponsive, call 911 regardless of the substance. Naloxone only works on opioids, but it won’t harm someone who overdosed on something else, so it’s safe to give even if you’re unsure.
Stimulant overdoses (from cocaine, methamphetamine, or similar drugs) look different. Instead of slowing everything down, they tend to speed the body up: rapid heart rate, high body temperature, agitation, seizures, or chest pain. Naloxone won’t help with a stimulant overdose, but calling 911 and keeping the person safe while you wait for paramedics still applies.
What Not to Do
Do not put the person in a cold bath or shower. Do not try to make them vomit. Do not inject them with saltwater, milk, or any other home remedy. None of these work, and some can cause additional harm, especially if the person is unconscious and could inhale water or vomit into their lungs. Do not leave them alone “to sleep it off.” An overdose can worsen rapidly, and someone who seems stable can stop breathing minutes later.
After the Emergency
Even if naloxone revives someone and they seem fine, they still need medical attention. Naloxone’s effects can wear off in as little as 30 minutes, while the opioid in their system may last much longer. In cases involving long-acting opioids like methadone, medical teams sometimes need to monitor patients for 24 hours or more. Someone who walks away feeling fine after naloxone can slip back into a life-threatening overdose once it wears off.
If you spend time around people who use opioids, or if you use them yourself, carrying naloxone nasal spray is one of the most practical things you can do. Many community health organizations, harm reduction programs, and pharmacies distribute it for free or at low cost. Having it on hand and knowing these steps can be the difference between a close call and a death.