Opioid Overdose: How to Recognize Signs, Respond in Emergencies, and Use Naloxone

When someone overdoses on opioids, they don’t always look like they’re in trouble. They might be slumped over, quiet, or even snoring. But that snore could be the last sound they make before their breathing stops. Opioid overdoses kill quickly - often within minutes - because the drugs shut down the brain’s ability to tell the body to breathe. The good news? You don’t need to be a doctor to save a life. Recognizing the signs and acting fast with naloxone can bring someone back from the edge.

What Happens During an Opioid Overdose?

Opioids - including prescription painkillers like oxycodone, illegal heroin, and deadly synthetic drugs like fentanyl - work by binding to receptors in the brain. These receptors control pain, but they also control breathing. When too many opioids flood the system, they silence the signals that keep you alive. Your breathing slows, then stops. Your blood oxygen drops. Brain cells start dying after just 4 to 6 minutes without air. That’s why every second counts.

Fentanyl is the biggest killer today. It’s 50 to 100 times stronger than morphine, and it’s often mixed into other drugs without the user’s knowledge. A pill sold as Xanax might contain fentanyl. A powder thought to be cocaine could be laced with it. The CDC reports that in 2023, 81% of all drug overdose deaths in the U.S. involved opioids, and nearly 74,000 of those were tied to synthetic opioids like fentanyl. That’s more than 200 people a day.

Signs of an Opioid Overdose

You don’t need a medical degree to spot an overdose. Look for these three classic signs, often called the opioid overdose triad:

• Unresponsive or unconscious - Shake their shoulders, shout their name. If they don’t wake up, it’s an emergency.
• Slow, shallow, or stopped breathing - Watch their chest. Are they taking fewer than 10 breaths a minute? Or are they silent?
• Pinpoint pupils - Their pupils will look like tiny dots, even in dim light.

Other warning signs include:

• Blue, purple, or gray lips and fingernails (a sign of low oxygen)
• Cold, clammy, or pale skin
• Gurgling, choking, or snoring sounds - like they’re drowning in their own saliva
• Limp body - Like a ragdoll, no muscle tone
• Extreme drowsiness - They can’t stay awake, even when you try to talk to them

Don’t wait for all these signs to appear. If someone is unresponsive and breathing oddly, act now. Pupils aren’t always pinpoint in every case, especially with mixed drug use. Don’t let doubt stop you.

What to Do: The 3-Step Emergency Response

If you suspect an opioid overdose, follow this simple, life-saving sequence:

1. Call 911 immediately - Even if you’re not sure, call. Tell the dispatcher you think someone is overdosing on opioids. They’ll guide you while help is on the way.
2. Give naloxone if you have it - Naloxone (brand name Narcan) is a nasal spray that reverses opioid effects in minutes. It’s safe, easy to use, and won’t hurt someone who hasn’t taken opioids. Spray one dose into one nostril. You don’t need to remove the person’s clothing or check for a pulse first.
3. Stay with them until help arrives - Naloxone wears off in 30 to 90 minutes. Opioids can stay in the body much longer. The person might wake up, then slip back into overdose. Keep monitoring their breathing. If they stop breathing again, give a second dose of naloxone in the other nostril. If they’re not breathing, start CPR.

Don’t leave them alone. Don’t put them in the shower. Don’t try to make them walk it off. Those are myths. Only naloxone and emergency care can reverse an overdose.

How to Use Naloxone (Narcan)

Naloxone nasal spray is the most common form for non-medical use. Here’s how to use it:

1. Remove the device from its package.
2. Hold it with your thumb on the bottom and two fingers on the top.
3. Tilt the person’s head back slightly.
4. Insert the nozzle into one nostril.
5. Press the plunger firmly to release the full dose.
6. Remove the device and call 911 if you haven’t already.

That’s it. No needles. No training required. Many pharmacies now sell naloxone over the counter without a prescription. In 49 states, you can walk in and ask for it. The price has dropped from over $130 a few years ago to $25-$50 for a two-dose kit. Some community centers, clinics, and even libraries give it away for free.

Keep naloxone in your car, bag, or home if you or someone you know uses opioids - even if it’s just for pain. It’s not a license to use drugs. It’s a safety net.

What Happens After Naloxone?

Naloxone brings someone back to life - but it doesn’t fix the problem. After reversal, the person needs medical care. Why? Because:

• They might overdose again once naloxone wears off.
• They could have organ damage from lack of oxygen.
• They may need treatment for opioid use disorder.

Many people who survive an overdose never get help because they’re afraid of legal trouble, stigma, or being judged. But the truth is: surviving an overdose is a wake-up call. Studies show that people who receive naloxone and are connected to counseling or medication-assisted treatment (like methadone or buprenorphine) are far less likely to die in the future.

After the emergency, encourage them to see a doctor. Offer to help them find a treatment program. Don’t lecture. Don’t shame. Just say: “I’m here. You’re not alone.”

Prevention: Test Strips, Education, and Community Action

Fentanyl is everywhere. That’s why harm reduction tools like fentanyl test strips (FTS) are critical. These small paper strips can detect fentanyl in drugs. You mix a tiny bit of the substance with water, dip the strip, and wait a few minutes. If it turns positive, don’t use it. Or use it with someone else present, and have naloxone ready.

Communities that train people - friends, family, police, baristas - to recognize overdoses and use naloxone have seen death rates drop by up to 14%. Programs like Virginia’s REVIVE! have trained tens of thousands of bystanders. They didn’t wait for the system to fix itself. They acted.

You don’t have to be a hero. You just have to be willing to act. If you see someone who looks like they’re not breathing, don’t assume they’re just passed out. Don’t wait for someone else to do something. You might be the only person who can save their life.

Why This Matters More Than Ever

Opioid overdoses aren’t a distant problem. They’re happening in your neighborhood, your workplace, your family. In Pennsylvania, they’re the top cause of accidental death. In Ohio, Michigan, West Virginia - the same. The crisis didn’t start with drugs. It started with silence. With stigma. With the belief that someone else would handle it.

It’s not about judgment. It’s about survival. One spray. One call. One moment of courage can mean the difference between life and death. And if you’ve ever wondered if you’re qualified to help - you are. You don’t need permission. You don’t need a badge. You just need to know what to do.

Next Steps: Be Ready, Not Afraid

If you’re reading this, you’re already ahead of most people. Now take the next step. Get a naloxone kit. Keep one in your car. Give one to a friend who uses drugs. Learn how to do CPR. Talk to your kids about fentanyl. Don’t wait for someone to die before you act. The tools are there. The knowledge is here. All you need to do is use it.