Opioid Overdose: How to Recognize the Signs, Respond in an Emergency, and Use Naloxone

Every 8 minutes, someone in the U.S. dies from an opioid overdose. That’s not a statistic from a decade ago-it’s today. In 2023, over 87,000 of the 107,941 drug overdose deaths in America involved opioids, mostly synthetic ones like fentanyl. Many of these deaths happen because no one around knows what to look for-or what to do. But here’s the truth: opioid overdose is not always a death sentence. With the right knowledge, a bystander can save a life in under five minutes.

What Happens During an Opioid Overdose?

Opioids-whether prescription painkillers like oxycodone, illegal heroin, or deadly fentanyl-work by attaching to receptors in your brain that control pain and pleasure. But they also latch onto the part of your brain that tells your lungs to breathe. When too much of the drug floods your system, those breathing signals get silenced. Your breath slows. Then stops. Your lips turn blue. Your body goes limp. And within minutes, your brain starts dying from lack of oxygen.

This isn’t just about people who use drugs illegally. Many overdoses happen to people taking prescribed medications exactly as directed. Others happen because pills sold as Xanax or oxycodone are actually laced with fentanyl-sometimes in doses 50 to 100 times stronger than heroin. You don’t have to be addicted to overdose. You just have to take something that contains an opioid you didn’t expect.

Recognizing the Signs of an Opioid Overdose

You don’t need medical training to spot an overdose. There are three clear, urgent signs-often called the “opioid overdose triad”:

• Unresponsive to shaking or shouting-they won’t wake up, even when you shout their name or shake their shoulder hard.
• Slow, shallow, or stopped breathing-you might hear gasping, gurgling, or snoring sounds. Their chest isn’t rising and falling like normal.
• Pinpoint pupils-their pupils shrink to tiny dots, even in dim light. (Note: Not everyone has this, so don’t wait for it.)

Other warning signs include:

• Blue, purple, or gray lips and fingernails
• Cold, clammy skin
• Limp body, like a ragdoll
• Choking or gurgling noises
• Extreme drowsiness or inability to stay awake

If you see even one of these signs-especially unresponsiveness and slow breathing-don’t wait. Don’t assume they’re just asleep. Don’t think they’ll wake up on their own. Time is the enemy here. Brain damage starts after just 4 to 6 minutes without oxygen.

What to Do Right Now: The 3-Step Emergency Response

There’s no time for panic. There’s only time to act. Follow these three steps exactly as recommended by the CDC, Health Canada, and emergency medical services worldwide:

1. Call 911 immediately-even if you’re not sure. Say: “I think someone is overdosing on opioids.” Emergency dispatchers are trained to guide you through the next steps while help is on the way.
2. Give naloxone if you have it-it’s safe, easy, and works fast. You don’t need to be a doctor. Naloxone doesn’t work on cocaine, meth, or alcohol. But if opioids are involved, it can reverse the overdose in 2 to 5 minutes.
3. Stay with them until help arrives-even after they wake up. Naloxone wears off in 30 to 90 minutes. Opioids can stay in the body much longer. They could slip back into overdose once the naloxone wears off.

How to Use Naloxone: Simple, Safe, and Effective

Naloxone is available as a nasal spray (like Narcan or Kloxxado) or as an auto-injector. The nasal spray is the most common for non-medical use. Here’s how to use it:

1. Remove the device from its package. Don’t test it. Don’t check if it’s expired-use it anyway if you think it’s needed.
2. Place the tip of the spray into one nostril. Tilt the person’s head back slightly.
3. Press the plunger firmly to deliver the full dose.
4. Remove the device and call 911 if you haven’t already.
5. Start rescue breathing if they’re not breathing: pinch their nose, give one breath every 5 seconds.
6. If they don’t wake up after 3 minutes, give a second dose in the other nostril.

You can’t overdose on naloxone. It won’t hurt someone who hasn’t taken opioids. It’s not addictive. It doesn’t get you high. If you’re unsure, give it anyway. That’s what health experts say.

Where to Get Naloxone-No Prescription Needed

In 49 U.S. states and many countries including Canada and New Zealand, you can get naloxone without a prescription. Pharmacies like CVS, Walgreens, and local community health centers often stock it for free or for under $30. Some cities offer free naloxone kits through public health programs.

In New Zealand, naloxone is available through community overdose prevention programs, needle exchanges, and some pharmacies under a pharmacist’s authority. Ask for it by name. Don’t be shy. You’re not enabling drug use-you’re saving a life.

What Happens After the Overdose?

Once emergency services arrive, they’ll check vital signs, give oxygen, and may give more naloxone. But the work isn’t done when they wake up. Many overdose survivors suffer brain injury, heart problems, or lung damage from lack of oxygen. They need a full medical check-up.

More importantly, they need support. Overdose is often a cry for help. Many people who survive one overdose will try again unless they get treatment. That’s why follow-up care matters: counseling, medication-assisted treatment (like methadone or buprenorphine), and mental health services can break the cycle.

Community programs like Virginia’s REVIVE! program have shown that when people are trained to use naloxone and connected to care, overdose death rates drop by up to 14%. This isn’t just about reversing overdoses-it’s about giving people a second chance.

Preventing Overdose: Harm Reduction Works

Naloxone saves lives, but prevention saves more. Here’s what actually works:

• Fentanyl test strips-these small paper strips can detect if drugs contain fentanyl. They cost less than $1 each and can be bought online or at harm reduction centers.
• Never use alone-if someone uses drugs with you, you can help if they overdose. If you’re alone, call someone before you use. Tell them what you’re taking and where you are.
• Start low, go slow-if you’re using after a break, your tolerance is lower. A dose you used to handle could now be deadly.
• Know what you’re taking-pills bought on the street aren’t what they claim. Fake oxycodone pills are now the #1 cause of overdose deaths in the U.S.

Why This Matters More Than Ever

Fentanyl is now found in nearly 7 out of 10 illicit pills seized by police. It’s mixed into cocaine, meth, and even counterfeit Xanax. You don’t need to use opioids to be at risk. You just need to take something that’s been contaminated.

The good news? We have the tools to stop this. Naloxone is cheap. Training is free. And anyone-parents, teachers, friends, coworkers-can learn how to use it. You don’t need to be a hero. You just need to act.

Every time you learn these signs, carry naloxone, or teach someone else, you’re changing the odds. You’re turning a statistic into a survival story.

Next Steps: What You Can Do Today

- Ask your pharmacist for naloxone. Keep one in your bag, car, or home. - Teach a friend or family member how to use it. - Download a free overdose response guide from your local health department. - Carry fentanyl test strips if you or someone you know uses street drugs. - If you’re worried about a loved one, talk to them-not about their use, but about safety. Say: “I care about you. If something happens, I want you to know I’ve got naloxone.” This isn’t about judgment. It’s about survival. You don’t need to fix someone’s addiction to save their life. You just need to act when they can’t.