Call 911 immediately. That is the single most important thing you can do during a suspected overdose at home, whether it involves opioids, alcohol, stimulants, or any other substance. While you wait for paramedics, there are specific actions that can keep the person alive. Every minute matters, and what you do in those first few minutes often determines the outcome.
Call 911 and What to Tell Them
As soon as you suspect an overdose, call 911. You do not need to be certain it’s an overdose before calling. The dispatcher will ask you a series of questions to figure out what kind of help to send and how urgently. Be ready to share your exact location, what substance the person may have taken (if you know), how much they took, when they took it, and whether they are conscious and breathing. If you don’t know what they took, say so. That’s fine. Don’t guess or make something up.
Stay on the line. The dispatcher can walk you through life-saving steps while paramedics are on the way. If the person is not breathing and you’re unsure what to do, the dispatcher will coach you through it in real time.
How to Recognize an Overdose
The signs depend on what substance is involved, but some red flags are universal: the person is unresponsive or extremely difficult to wake, their breathing is very slow or irregular, or their skin has turned blue, gray, or unusually pale.
For opioids (heroin, fentanyl, prescription painkillers), the hallmark signs are pinpoint pupils, extremely slow breathing (sometimes just a few breaths per minute), gurgling or gasping sounds, and loss of consciousness. The person may look like they’re in a deep sleep but cannot be woken by shouting or a firm rub on the breastbone.
For stimulants (methamphetamine, cocaine, amphetamines), the picture looks different. The person may have a rapid or pounding heartbeat, chest pain, extreme agitation, confusion, seizures, or a dangerously high body temperature. Stimulant overdoses can cause strokes, heart problems, and kidney damage.
For alcohol poisoning, look for breathing that drops below eight breaths per minute, gaps of more than 10 seconds between breaths, seizures, vomiting while unconscious, low body temperature, and an inability to stay awake. A person who has passed out from alcohol and cannot be woken is in a medical emergency, even if they “just drank too much.”
What to Do While Waiting for Paramedics
If They Are Breathing but Unconscious
Put them in the recovery position. This keeps their airway open and prevents them from choking on vomit. With the person on their back, kneel beside them. Extend the arm closest to you straight out at a right angle with their palm facing up. Take their other arm and fold it across their chest so the back of that hand rests against the cheek nearest you. Hold it there. With your free hand, bend the far knee up to a right angle. Then gently pull that bent knee toward you, rolling the person onto their side. Their head should rest on the hand you placed against their cheek. Tilt the head back slightly and lift the chin to keep the airway clear. Stay with them and keep checking their breathing.
If They Are Not Breathing
Begin CPR if you have any level of training. If you’ve never been trained, do compression-only CPR: push hard and fast in the center of the chest, about 100 to 120 compressions per minute, and don’t stop until paramedics arrive or the person starts breathing again. The 911 dispatcher can guide you through this.
If You Have Naloxone
Naloxone (the nasal spray sold as Narcan) reverses opioid overdoses and is available without a prescription at most pharmacies. If you have it and suspect an opioid overdose, use it. Lay the person on their back, support the back of their neck so the head tilts slightly back, and insert the nozzle into one nostril. Do not prime or test the device. Press the plunger firmly to deliver the full dose.
If the person does not respond after two to three minutes, give a second dose in the other nostril using a new device. Each spray contains a single dose and cannot be reused. You can continue giving doses every two to three minutes, alternating nostrils, until the person responds or paramedics arrive.
Once the person starts breathing again, roll them into the recovery position. Naloxone wears off faster than most opioids do, so the person can slip back into an overdose after 30 to 90 minutes. This is called rebound toxicity. That is why getting them to a hospital is critical even if they seem to recover. Clinical guidelines recommend at least one hour of medical observation after naloxone, with monitoring of vital signs and alertness, before a patient is considered stable.
What Not to Do
Several common “home remedies” for overdose are not just useless but dangerous. Do not put the person in a cold bath or shower. An unconscious person can drown in inches of water, and the shock of cold water can trigger cardiac problems. Do not try to make them vomit. For many substances, vomiting increases the risk of choking or causes further chemical damage to the throat and airway. Do not give them milk, coffee, salt water, or any other liquid. None of these are antidotes, and forcing fluids into someone with reduced consciousness is a choking hazard.
Do not slap them, shake them violently, or try to “walk it off.” If they are unresponsive, no amount of physical stimulation will safely reverse what’s happening in their body. Do not inject them with anything other than prescribed emergency medication. Focus on the basics: call 911, keep the airway open, give naloxone if it’s an opioid situation, and start CPR if they stop breathing.
You Won’t Get in Trouble for Calling 911
Fear of arrest is one of the most common reasons people hesitate to call for help during an overdose. Forty states and the District of Columbia have passed Good Samaritan laws specifically designed to address this. These laws provide a degree of legal immunity for both the person experiencing the overdose and the person who calls 911. Depending on the state, this immunity can protect you from drug possession charges or lead to reduced sentencing. Washington state’s law, passed in 2010, explicitly directed emergency responders and police to prioritize patient care over drug confiscation and arrests.
The specifics vary by state, so the protections are not identical everywhere. But the principle is consistent: lawmakers want you to make the call. A living person with a legal complication is in a far better position than the alternative.
After the Overdose
Even if the person seems fully recovered after naloxone or after paramedics treat them, the danger is not necessarily over. Opioids like fentanyl and methadone last much longer in the body than naloxone does, which means respiratory depression can return. Research on over 5,400 overdose patients treated with naloxone found that rebound opioid toxicity, while uncommon, did cause deaths in a small number of cases. Hospital observation catches these relapses before they become fatal.
For stimulant overdoses, complications like muscle breakdown, kidney injury, and heart rhythm problems can develop hours after the initial crisis. Alcohol poisoning can continue to worsen as alcohol already in the stomach keeps absorbing into the bloodstream. In both cases, medical monitoring matters even when the person initially looks better.
If you keep naloxone at home, replace any used devices promptly. Check expiration dates periodically. Consider taking a brief training on overdose response through the Red Cross or a local harm reduction organization, so the steps feel familiar if you ever need them under pressure.