If you think someone is having an opioid overdose, act now.Call 911 now. Do not wait to see every sign. Use naloxone if you have it. Follow the dispatcher's orders. Stay with the person until help gets there. Only do rescue breathing or CPR if you are trained or told to.
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What to Do During an Opioid Overdose
Act before all the signs show up. If you suspect an opioid overdose, act now. Keep the person breathing while help is coming.
- Call 911. Tell the dispatcher you suspect an opioid overdose. NIDA says to call 911 and give naloxone if you have it.[1]
- Follow the dispatcher’s directions. They will guide you while help is on the way.
- Check responsiveness and breathing. See if the person wakes up. Check if their breathing is normal.
- Give naloxone if you have it. Follow the instructions on the package. It does not replace emergency care.[1]
- Support breathing. Supporting respiration is the single most important intervention for opioid overdose and may be life-saving on its own.[2] Provide rescue breathing or CPR only if you are trained or told to by the dispatcher.
- Stay with the person. Watch their breathing until emergency services arrive. Naloxone may wear off, so medical care is needed.[3]
Never delay calling 911 to find naloxone. Contact emergency services first. Naloxone alone cannot give the ongoing care that medical staff can.[3]
Opioid Overdose Signs and Treatment: Recognize the Warning Signs
Do not wait until every sign appears.If you think someone is overdosing, call 911 now.
| Observable Sign | What a Bystander Should Do |
|---|---|
| Cannot wake up or respond | Call 911 immediately |
| Slow, shallow, or stopped breathing | Call 911 and give rescue breathing if trained |
| Limp body | Call 911 and keep the person safe |
| Very small pupils | Call 911 and watch their breathing |
| Blue or gray lips or nails | Call 911. If the person is unconscious but breathing normally, follow the dispatcher’s instructions about placing them on their side. |
| Choking, gurgling, or loud snoring sounds | Call 911 and clear the airway if you see blockage |
Someone might show just one or two signs.[1] NIDA points to not waking up, slow or shallow breathing, and tiny pupils as possible signs.[1] MedlinePlus adds a limp body and blue or purple lips or nails as warning signs.[4]
You do not need the full list of symptoms. Treat one sign as an emergency. Fast moves can save a life until help arrives.
Naloxone, Breathing Support, and Emergency Care
Naloxone is a medicine that can quickly reverse the life-threatening effects of an opioid overdose.[5] It is a key part of naloxone and overdose response. But it does not replace calling 911 or helping with breathing.
| Response Step | Role | Who Provides It | Why It Doesn't Replace Others |
|---|---|---|---|
| Naloxone | Reverses opioid effects to restore breathing | Bystander or responder | Does not work on non-opioid drugs[3] and may wear off before the opioid does[3] |
| Breathing Support | Keeps airway open and oxygen flowing | Bystander | Most important immediate step[2]; naloxone alone may not last long enough for help to arrive |
| EMS / Clinician Care | Checks vital signs and manages ongoing medical needs | Paramedics, doctors, nurses | Needed for constant monitoring; naloxone has no effect if opioids aren't present[3] and cannot fix other injuries or drug issues |
Supporting breathing is the single most important step for an opioid overdose.[2] Naloxone works fast. But many opioids stay in the body longer than the medicine does. This means overdose signs can come back after the naloxone wears off.[3] Also, naloxone only works on opioids. It will not reverse an overdose from other drugs like cocaine or methamphetamine.[3]
It is safe to give naloxone if you are unsure if someone used opioids. The medicine has no effect on someone who does not have opioids in their system.[3] Always call 911 first. A bystander cannot match the steady care that emergency crews provide. Our guide on obtaining naloxone kits explains how to get supplies.
BLS Signs and Protocols: Where This Guide Ends
Basic Life Support (BLS) training shows you how to find a person who does not respond. It also covers breathing that is odd or missing. If you hold BLS training, your actions must match that course.
What you see and what a protocol says are not the same. You might see a person who is blue, gray, or limp. You might hear loud snoring. Bystanders can spot these signs. A formal BLS algorithm has specific steps to follow.
Do not let this guide stand in for your BLS training. It is not a replacement for your certification materials or local rules. Listen to your dispatcher’s instructions. Rely on the methods from your most recent training class.
Actions to Take Before Help Arrives
Do not leave the person alone until responders arrive.[6] Listen to the dispatcher’s directions. Keep an eye on their breathing and level of alertness.
While You Wait for Help
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Once the Emergency Passes: Withdrawal and Safe Medical Detox
Overdose and withdrawal are different. If you think someone is overdosing, emergency care comes first. Hold off on planning detox. Focus on keeping the person safe until help gets there. Once the immediate danger passes, our guide to drug withdrawal emergency explains when symptoms need medical attention.
During a suspected overdose
Call 911 right away. Follow the dispatcher's steps. Your goal is to keep the person alive.
After emergency stabilization
Once the person is safe, ask the care team about withdrawal. ASAM guidance recommends using a Level of Care Assessment to check clinical needs.[8]
For ongoing recovery
Talk with a clinician about long-term care. This links withdrawal help to lasting treatment for opioid use disorder.
Dealing with withdrawal can be tough. You may face anxiety, body aches, or nausea. A qualified clinician can check for these symptoms and create a safe plan. Do not try to manage severe withdrawal at home alone. To understand what your plan might cover, see our guide to opioid detox insurance coverage and how to verify benefits. When you are ready to start, our guide to the first day of opioid detox walks through intake and what to expect. If you are balancing treatment with a job, our guide to working during drug detox covers how to manage that transition. If you need urgent help for drug withdrawal, our guide to finding medical detox care explains how to choose a safe program.
Full treatment for opioid use disorder is not the same as detox. Detox is just a first step. It does not fix the entire issue. Ongoing care often involves FDA-approved medicines like methadone, buprenorphine, or naltrexone.[9] With support, these drugs help stop cravings and prevent relapse. If you are considering naltrexone, our guide to naltrexone and opioid use explains when it is safe to start.
Your body's tolerance drops after staying off opioids.[10] If you start using again after a break, even at old doses, you are at high risk for overdose.[10] This makes steady professional support key to staying safe.
Read our guide on how to tell withdrawal from overdose to learn more about the differences between these conditions.
Calling 911 and State Good Samaritan Protections
Get medical help first. That is your top goal.Concern about legal consequences should never delay calling 911 for a suspected overdose.
Good Samaritan laws related to overdose response differ by state in their conditions and scope, specifically varying in the level of protections from prosecution.[11] Some state protections are limited. In some cases, laws do not shield the overdosing person from arrest. One state only shields witnesses giving naloxone.[12]
These rules shift based on your location. Do not assume you are fully protected. Look up current state law or ask a qualified legal resource for details about your area.
Opioid Overdose Signs and Treatment: Long-Term Care
Lasting support is needed once the danger passes. NIDA notes that opioid use disorder is a treatable form of addiction. Care involves more than just using medicine.
Speak with your care team to plan what comes next. You can ask about an evaluation and long-term care options. SAMHSA National Helpline is free and private. Call 1-800-662-4357 for help finding services.[13]
Next Steps After an Emergency
Use this check only after immediate safety is addressed. It is for information only and isn't a diagnosis. It cannot determine if someone is safe.
A score cannot show you are safe if you spot danger signs. Go to a doctor only when no danger signs appear.
You can view our list of medically supervised detox programs. You can also read our guide on opioid use disorder treatment. Find find emergency support nearby in our directory. This tool does not serve as an emergency service. It does not replace calling 911.
Frequently Asked Questions
What are six signs of an opioid overdose?
Watch for these signs. The person cannot wake up. Breathing is slow or shallow. They may stop breathing. Their body feels limp. Pupils are very small, or pinpoint.[14] Lips or nails turn blue or gray. You may hear choking or gurgling sounds. Other issues can cause small pupils.[14] You do not need to see all signs to call 911.
Can I get naloxone without a prescription?
Yes, some naloxone is sold over the counter. The FDA approved Narcan nasal spray for this use in 2023.[15] Availability varies by product and place. Check with your local pharmacy. See our guide on getting naloxone kits for more help.
Which signs of an opioid overdose are covered in BLS?
Basic Life Support (BLS) covers key signs. These are unresponsiveness and abnormal or absent breathing. These signs mean the person needs urgent action. Follow your current BLS course materials. Also follow local protocols. Do not use this article as BLS training.
What should I do while waiting for 911?
Stay with the person. Follow the dispatcher’s instructions closely. Watch their breathing and condition until help arrives. Tell responders what you saw when they get there. Do not put yourself in danger while helping.
What should happen after a nonfatal opioid overdose?
See a clinician after the emergency ends. Talk about checking for opioid use disorder and next steps in care. Emergency care is not the same as ongoing treatment. A study found that getting meds for opioid use disorder after a nonfatal overdose was linked to lower death rates.[16] This follow-up supports long-term safety and recovery.
Can naloxone cause withdrawal symptoms?
Yes, naloxone can cause withdrawal symptoms in people dependent on opioids.[17] This is not a reason to hold back naloxone during an overdose. Call 911 right away if you suspect an overdose. Follow product labels and dispatcher instructions to save a life.
