Opioid Overdose & Naloxone
In 12 minutes you'll know how to recognize an opioid overdose, how to use naloxone, and why you should give it and call 911 whenever you're in doubt.
Print this course — or save it as a PDF from the print dialog. Good for a fridge, a glovebox, or a waiting room.
Why this matters
An opioid overdose slows a person's breathing until it stops, and it can happen to anyone who takes an opioid their body isn't ready for — including a pill bought online that turns out to contain illicit fentanyl. It is not only a risk for people with addiction. Naloxone reverses an overdose within minutes, and you do not need training or a prescription to carry it.
Know the signs
How to recognize an opioid overdose
An opioid overdose slows breathing until it stops. The signs are usually clear once you know what to look for.
- They won't wake up to a loud voice or a firm rub on the breastbone.
- Breathing is slow, irregular, or has stopped altogether.
- You hear gurgling or snoring sounds, which mean the airway is partly blocked.
- Lips or fingertips look blue-grey, a sign the body isn't getting enough oxygen.
- Pupils are pinpoint — tiny, even in a dim room.
Any one of these means act now. You do not need all five, and you do not need to be certain.
Give naloxone right away
Naloxone (brand name Narcan) reverses an opioid overdose within minutes by restoring normal breathing. It is sold over the counter at pharmacies nationwide, and many local health departments give it out free, no prescription and no ID required. Anyone can carry it — no medical training needed.
Use it exactly as packaged: spray it into one nostril, call 911, put them in the recovery position, and give a second dose after 2–3 minutes if there is no response. The recovery position means rolling them onto their side with the top leg bent, so if they vomit it drains out instead of going into the lungs.
When in doubt, give it
You do not need to be sure this is an opioid overdose before you act. Naloxone only affects opioids in the body. If you give it to someone whose trouble has a different cause, it does essentially nothing and will not hurt them.
That makes the decision simple. If someone is unresponsive and breathing badly, and there is any chance opioids are involved, give the naloxone. Hesitating to be certain costs the exact minutes that matter most.
Stay, even after they wake up
Naloxone wears off before many opioids do — often within half an hour to an hour — while the opioid can still be active in the body much longer. That means someone can wake up, look fine, and then slide back into an overdose once the naloxone fades.
Always call 911, even if naloxone works right away and the person seems okay afterward. Stay with them until paramedics arrive. Someone who just overdosed should never be left alone, and should never simply go back to sleep unsupervised.
This can happen to anyone
Illicit fentanyl, a powerful opioid, is now mixed into many counterfeit pills, so a person can overdose without ever meaning to take an opioid at all. A teenager who buys what they believe is a Percocet or a Xanax online has no real way to know what's in it. This is not only something that happens to people with addiction. It can be anyone.
Most states also have Good Samaritan overdose laws that generally protect the person who calls 911, and often the person who overdosed, from certain legal consequences. Protections vary by state, so treat this as a reason to act, not a guarantee. Either way, getting help there fast is what matters most.
How it really looks
The sound through the wall
Simone hears a strange gurgling sound through the wall and finds her roommate slumped against his bed, lips a dusky grey. He won't wake to her voice or a firm rub on his breastbone. She remembers the naloxone kit from the health department sitting in her kitchen drawer, sprays a dose into one nostril, and calls 911 while rolling him onto his side. Two minutes pass with no change, so she gives the second dose, just like the instructions said. He starts breathing better and opens his eyes right before paramedics arrive. Simone stays beside him in the ambulance. She was scared the whole time, and she is glad she didn't wait to be sure.
Everyone was scared of getting in trouble
At a party, Bao's friend collapses and stops responding after taking a pill he bought online, thinking it was Percocet. A few people want to just let him sleep it off in a bedroom so nobody finds out. Bao has heard about fentanyl turning up in fake pills and knows better. He calls 911, tells the dispatcher exactly what happened, and rolls his friend into the recovery position while he waits. The dispatcher reminds him that Good Samaritan laws in most states generally protect people who call for help. Paramedics arrive within minutes and give more naloxone on scene. His friend recovers fully. Nobody at that party got in trouble for calling. They just got their friend back.
What to do until help arrives
- Try to wake them. Shout their name and rub your knuckles firmly on their breastbone.
- Call 911 right away, even if you're not fully sure it's an overdose.
- If you have naloxone, spray it into one nostril, then give a second dose after 2–3 minutes if there is no response.
- Roll them into the recovery position, on their side with the top leg bent, so they don't choke if they vomit.
- Start hands-only CPR if they stop breathing normally and don't respond to the naloxone.
- Stay with them until paramedics arrive, even after they wake up. Naloxone wears off before many opioids do.
- Tell paramedics what was taken if you know, and hand over any pill bottles or packaging.
Myths & mistakes
People often think naloxone is only for people who are addicted to opioids.Actually anyone can end up overdosing on an opioid they never meant to take, including a counterfeit pill bought online. Naloxone is for the emergency, not for judging how someone got there.
People often think giving naloxone to someone who turns out not to be overdosing on opioids could hurt them.Actually naloxone only acts on opioids in the body. If opioids aren't involved, it does essentially nothing, so there is little downside to giving it when you're unsure.
People often think that once naloxone works and the person wakes up, the danger has passed.Actually naloxone wears off before many opioids do. The person can slide back into an overdose, so calling 911 and staying with them still matter.
What you learned
- The signs of an opioid overdose: won't wake up, slow or stopped breathing, gurgling, blue-grey lips, pinpoint pupils.
- Naloxone is sold over the counter nationwide and is often free from health departments. Anyone can carry it.
- When you're not sure, give it anyway. Naloxone only affects opioids and won't harm someone who doesn't need it.
- Call 911 and stay, even if the person wakes up, because naloxone wears off before many opioids do.
- Fentanyl means any street or counterfeit pill can contain an opioid, so this can happen to anyone.
Sources
- Substance Abuse and Mental Health Services Administration (SAMHSA) — Naloxone and opioid overdose prevention
- Centers for Disease Control and Prevention — Opioid overdose: recognizing the signs and responding
Spot an error? Tell us — accuracy matters more to us than being fast.
Common questions
Is it legal for me to carry and give naloxone?
Yes. Naloxone is sold over the counter at pharmacies nationwide, and no prescription is required in any state. Most states also have Good Samaritan laws that generally protect people who give naloxone or call 911 during an overdose, though protections vary by state. The bigger risk is always doing nothing.
What if I give naloxone and the person wasn't actually overdosing on opioids?
Naloxone only affects opioids, so if opioids aren't involved, it won't help, but it also won't hurt them. That's why the guidance is simple: when you're not sure, give it anyway. Waiting to be certain costs time you may not get back, and there is very little downside to being wrong.
The person woke up after naloxone. Do we still need an ambulance?
Yes, still call 911 and stay with them. Naloxone wears off before many opioids do, often within half an hour to an hour, so someone can wake up, seem fine, and then slide back into an overdose once it fades. Never leave them alone or let them sleep it off.
Check what you know
Five questions. Four correct to pass. Retake as many times as you like — this is practice, not a test.
Keep going
This course belongs to Mental Health & Crisis. Courses that pair well with it:
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