If someone is overdosing, call 911 immediately, administer naloxone if you have it, and try to keep the person awake and breathing until help arrives. Those three actions, done quickly, are the difference between life and death in most overdose emergencies. The steps below cover exactly what to do, what to look for, and what to avoid.
How to Recognize an Overdose
The signs vary depending on the substance, but an opioid overdose is the most time-sensitive and the most common cause of fatal drug overdose. Look for:
- Unconsciousness or inability to wake up, even when you shout or shake the person
- Slow, shallow, or stopped breathing, sometimes with choking sounds, gurgling, or a snoring noise
- Blue or purple fingernails or lips, a sign the body isn’t getting enough oxygen
- Tiny “pinpoint” pupils that don’t react to light
If you aren’t sure whether it’s an overdose, treat it like one anyway. Acting on a false alarm does no harm. Waiting on a real overdose can be fatal.
Sedative overdoses from alcohol or anti-anxiety medications look similar: extreme drowsiness, slurred speech, loss of coordination, and in serious cases, coma and dangerously slow breathing. Most fatal sedative overdoses involve a combination of substances, particularly alcohol mixed with opioids or anti-anxiety pills. The emergency response is the same: call 911, support breathing, and stay with the person.
Step-by-Step Emergency Response
1. Try to Wake the Person
Call their name loudly. If they don’t respond, grind your knuckles firmly into the center of their chest (the breastbone) or rub your knuckles across their upper lip. These are standard techniques for checking responsiveness. If the person wakes up, keep them alert and monitor their breathing closely. If they don’t wake up, move to the next step immediately.
2. Call 911
You don’t need to diagnose what happened. All you need to say is: “Someone is unresponsive and not breathing.” Give your exact address or describe your location as specifically as you can. Stay on the line and follow the dispatcher’s instructions.
Nearly every U.S. state (47 states plus Washington, D.C.) has a Good Samaritan law that protects people who call 911 during an overdose from prosecution for drug-related offenses. The specifics vary by state, but the intent is the same: you should never hesitate to make the call because you’re worried about legal consequences.
3. Give Naloxone if You Have It
Naloxone (commonly sold as Narcan) is a nasal spray that reverses opioid overdoses. It’s available over the counter at most pharmacies without a prescription. If you have it, use it right away.
To administer the nasal spray: lay the person on their back, support the back of their neck so their head tilts slightly backward, insert the nozzle into one nostril, and press the plunger firmly. Don’t test or prime the device first. After giving the dose, turn them on their side.
If the person doesn’t respond within 2 to 3 minutes, give a second dose in the other nostril using a new spray device. You can continue giving a dose every 2 to 3 minutes, alternating nostrils, until help arrives. Naloxone only works on opioids, so if the overdose involves alcohol or sedatives alone, it won’t reverse it, but it also won’t cause harm.
4. Support Their Breathing
Opioids kill by shutting down the drive to breathe. If the person is breathing very weakly or has stopped breathing entirely, rescue breaths can keep oxygen flowing to their brain until paramedics arrive.
To give rescue breaths: check that nothing is blocking the airway (look inside the mouth), tilt the head back with one hand on the chin, pinch the nose shut, seal your mouth over theirs, and give two slow breaths. Watch for the chest to rise. Then give one breath every 5 seconds. Continue until their breathing returns to normal or emergency services take over.
If you aren’t trained or comfortable giving rescue breaths, the 911 dispatcher can walk you through it. If the person has no pulse, hands-only chest compressions are the priority: place them on their back, push hard and fast in the center of the chest with straight arms.
5. Put Them in the Recovery Position
Once the person is breathing but still unconscious, turn them on their side. This prevents vomit from blocking the airway, which is one of the most common ways overdose victims die. Position them so their face angles slightly downward and their head is a bit lower than their stomach. You can bend their top knee forward to keep them from rolling. Hold the back of your wet hand near their mouth so you can feel each breath.
What Not to Do
Some common “home remedies” for overdoses are dangerous. Do not put the person in a cold bath or shower. The shock can cause drowning, hypothermia, or cardiac arrest. Do not try to make them vomit, as an unconscious person can choke. Do not inject anything other than naloxone. Do not slap, kick, or inflict pain to try to wake them. And do not assume they can “sleep it off.” Snoring or gurgling sounds from someone you can’t wake up are signs of a life-threatening breathing problem, not deep sleep.
The single most dangerous thing you can do is leave. Stay with the person until paramedics arrive, even if they seem to improve after naloxone.
Why Hospital Monitoring Matters
Naloxone wears off in 30 to 90 minutes. Many opioids, especially fentanyl and its analogs, last much longer in the body. This means a person can wake up, seem fine, and then stop breathing again once the naloxone fades. This is called renarcotization, and it’s the reason paramedics will transport someone to the hospital even after a successful reversal.
In the emergency department, patients are typically monitored for at least 4 hours after the last dose of naloxone. Doctors check that the person can walk normally, breathe on their own with adequate oxygen levels, and maintain a normal heart rate and temperature before clearing them to leave. If the person who overdosed refuses to go to the hospital, watch them closely for several hours. Do not let them be alone during that window.
Preparing Before an Emergency Happens
If someone in your life uses opioids, whether prescribed or not, having naloxone on hand is the single most effective thing you can do. The nasal spray form requires no medical training. Keep it at room temperature and check the expiration date periodically.
Learning basic rescue breathing takes about 10 minutes. Many local health departments, harm reduction organizations, and fire departments offer free overdose response training that includes a naloxone kit. Knowing these steps before an emergency means you won’t be learning them for the first time while someone’s life depends on it.