How to Recognize an Overdose and What to Do in the First Five Minutes

This guide explains how to recognize the signs of an opioid overdose and the general steps you can take while help is on the way.

This is general information, not medical or legal advice. In an emergency, call 911 and follow the dispatcher's instructions.

The signs of an opioid overdose

An overdose is not always dramatic. The body slows down. Common signs include:

• The person will not wake up when you call their name or shake them

• Breathing that is slow, shallow, or has stopped

• Gurgling, choking, or snoring-like sounds

• Lips, fingertips, or skin turning blue, gray, or ashen

• Pale, cold, or clammy skin

• A limp body

• Very small, pinpoint pupils

You do not need to see every sign to act. If someone's breathing is slow or stopped and you cannot wake them, treat it as a possible overdose. When you are unsure, it is generally safer to respond than to wait.

What to do in the first few minutes

1. Try to wake them. Call their name and rub your knuckles firmly on the center of their chest. If they do not respond, do not wait.

2. Call 911. Tell the dispatcher the person is unresponsive and not breathing normally. You do not need to name any drug or be certain of what happened. Give your location, stay on the line, and follow the instructions you are given.

3. Give naloxone if it is available. Follow the directions printed on the product. For most nasal sprays, that means one dose in one nostril, and a second dose after two to three minutes if there is no response. Products can differ, so use the instructions that come with the one you have.

4. Help them breathe. If they are not breathing and you are able, follow the dispatcher's guidance on rescue breaths or CPR until help arrives.

5. Once they are breathing on their own, roll them onto their side so they do not choke if they vomit.

6. Stay with them. Naloxone can wear off before the opioids do, and symptoms may return. Try not to leave the person alone until emergency responders arrive.
   

What to know about naloxone

Naloxone, sold as Narcan and as generic nasal sprays, is widely used to reverse opioid overdoses. Public health guidance describes it as safe to give even when you are not certain opioids are involved, because it has no effect on someone who does not have opioids in their system. If you are unsure, giving it is generally considered the safer choice. Always follow the instructions on the specific product.

Two things are worth knowing. Because fentanyl is common in the drug supply, one dose is often not enough, and more than one may be needed before the person responds. Xylazine, a sedative increasingly found in the supply, is not an opioid and naloxone does not reverse it. Even so, giving naloxone can still help, since opioids are often present as well.

In most Appalachian states, naloxone is available at pharmacies without an individual prescription, and many local health departments and harm reduction programs provide it at no cost. Rules can vary by state and by pharmacy, so it is worth checking what is available where you live. Keeping a kit at home is one of the most practical steps a family can take.

Good Samaritan laws

Fear of arrest can keep people from calling for help, and that hesitation costs lives. Many states have some form of Good Samaritan law that may protect the person who calls, and sometimes the person who overdosed, from certain drug-related charges. These protections vary widely from state to state and can be limited, so this should not be read as legal advice or a guarantee. In general, calling 911 is the safest choice you can make.