Overdose Prevention and Response: What Everyone in Recovery Should Know

The Most Preventable Tragedy

Drug overdose is the leading cause of accidental death in the United States, claiming more than 100,000 lives per year. The vast majority of these deaths are preventable — with the right knowledge, the right tools, and the right response. Every person in recovery, every family member of someone in recovery, and every community member should know how to recognize and respond to an overdose.

This article covers the essentials: how to recognize different types of overdose, how to respond, how to use naloxone, and how to reduce overdose risk for yourself and those you love.

Recognizing an Opioid Overdose

Opioid overdose is the most common and most immediately life-threatening type of drug overdose. Opioids suppress the central nervous system, including the drive to breathe. Death from opioid overdose occurs when breathing stops.

Signs of opioid overdose include: unresponsive or unconscious (cannot be woken up), slow, shallow, or stopped breathing (fewer than one breath every 5 seconds), choking or gurgling sounds (the "death rattle"), blue or grayish lips, fingernails, or skin (cyanosis), pinpoint (very small) pupils, limp body, pale or clammy skin.

The most important sign is breathing. If the person is not breathing normally, treat it as an overdose and respond immediately.

Responding to an Opioid Overdose

Step 1: Try to wake the person. Rub your knuckles firmly on their sternum (breastbone). Call their name loudly. If they do not respond, proceed immediately.

Step 2: Call 911. Do not wait to see if the person recovers on their own. Call 911 immediately. Most states have Good Samaritan laws that provide legal protection to people who call 911 for an overdose — do not let fear of legal consequences prevent you from calling for help.

Step 3: Administer naloxone. If naloxone is available, administer it immediately. Naloxone nasal spray (Narcan): insert the tip into one nostril and press the plunger firmly. Naloxone auto-injector (Evzio): follow the device's voice instructions. If the person does not respond within 2-3 minutes, administer a second dose if available.

Step 4: Rescue breathing. If the person is not breathing, begin rescue breathing: tilt their head back, lift their chin, and give one breath every 5 seconds. Continue until they begin breathing on their own or emergency services arrive.

Step 5: Recovery position. If the person is breathing but unconscious, place them on their side (recovery position) to prevent choking if they vomit. Stay with them until emergency services arrive.

Important: Naloxone wears off in 30-90 minutes, which may be shorter than the duration of the opioid. The person may go back into overdose after naloxone wears off. Do not leave them alone, and ensure they receive medical evaluation.

Recognizing and Responding to Other Types of Overdose

Stimulant overdose (cocaine, methamphetamine) presents differently from opioid overdose. Signs include: chest pain, rapid or irregular heartbeat, difficulty breathing, extremely high body temperature, seizures, stroke symptoms (sudden weakness, confusion, difficulty speaking), and severe agitation or paranoia. Call 911 immediately. Keep the person calm and cool. Do not give them anything to eat or drink. Naloxone will not help with stimulant overdose.

Alcohol overdose (alcohol poisoning) signs include: confusion, vomiting, seizures, slow or irregular breathing, blue-tinged or pale skin, low body temperature, unconsciousness. Call 911. Place the person on their side to prevent choking on vomit. Do not give them coffee or food. Do not leave them alone.

Benzodiazepine overdose alone is rarely fatal but is dangerous in combination with opioids or alcohol. Signs include: extreme drowsiness, confusion, slurred speech, loss of coordination, slow breathing. Call 911. There is no reversal agent for benzodiazepine overdose available outside of hospital settings (flumazenil is used in hospitals but is not appropriate for community use).

Naloxone: Getting It and Using It

Naloxone is a life-saving medication that reverses opioid overdose. It is safe, effective, and available without a prescription in most states. Everyone who uses opioids, everyone in opioid recovery, and everyone who knows someone in opioid recovery should have naloxone and know how to use it.

Naloxone is available at most pharmacies without a prescription. It is also distributed free of charge by many harm reduction organizations, health departments, and community organizations. NEXT Distro (nextdistro.org) can help you find naloxone in your area.

Naloxone has no effect on people who have not taken opioids — it is completely safe to administer to someone you suspect has overdosed on opioids, even if you are not certain. The only risk is that it will not work if opioids are not involved.

Reducing Overdose Risk

Never use alone. Overdose deaths are more likely when the person is alone and no one can respond. If you are going to use, do so with someone present who knows how to respond to an overdose. The Never Use Alone hotline (1-800-484-3731) provides a live person to stay on the phone with you while you use and call 911 if you become unresponsive.

Test your drugs for fentanyl. Fentanyl is now present in a wide range of illicit drugs. Fentanyl test strips can detect its presence and allow you to make more informed decisions about your use.

Start low, go slow. Tolerance drops rapidly during periods of abstinence — even a few days. A dose that was tolerated before a period of not using can be fatal after abstinence. This is why the period immediately after leaving treatment, jail, or hospital is one of the highest-risk periods for overdose.

Avoid mixing substances. Combining opioids with alcohol, benzodiazepines, or other depressants dramatically increases overdose risk. Combining stimulants with opioids can mask the signs of opioid overdose.

Stay on MAT. Medication-assisted treatment with buprenorphine or methadone dramatically reduces overdose risk. If you are on MAT, staying on it — even through difficult periods — is one of the most important things you can do to protect your life.

If You Have Experienced an Overdose

Surviving an overdose is a profound experience. It can be a turning point — the moment when the reality of the danger becomes undeniable and the motivation for change becomes urgent. If you have survived an overdose, please reach out for help. SAMHSA's National Helpline (1-800-662-4357) is available 24/7. You deserve support, and your life is worth protecting.