Reviewed by Dr. Philip Moore, Chief Medical Officer at Gaudenzia
The opioid epidemic has led to unprecedented numbers of overdose deaths across the U.S. in recent years. Understanding how to recognize the signs of an opioid overdose and knowing what to do in an emergency can mean the difference between life and death. While attending an in-person or virtual overdose reversal training is the best way to prepare yourself to help someone in crisis, today’s post will cover common signs of an opioid overdose and provide resources on naloxone (Narcan®), as well as how to administer this life-saving medication.
This post may be helpful if:
- You are a person who uses drugs
- You are a person in recovery
- Someone you love is at risk of experiencing an overdose
- You want to be prepared to help anyone experiencing an overdose
- You interact with individuals at risk of experiencing an overdose through your line of work
Common Signs of Opioid Overdose
Learning how to recognize the signs of an opioid overdose can save a life. A person experiencing an opioid overdose requires immediate medical attention. Every effort should be made to get a medical professional on the scene as quickly as possible. If emergency medical services (EMS) personnel are not on site, call 911 immediately and alert the operator that someone is “unresponsive and not breathing.”
Here are a few common signs of an opioid overdose to look out for:
- Small pupils
- Drowsiness, inappropriately falling asleep, or losing consciousness
- Slow, shallow, or weak breathing
- Apparent difficulty or no signs of breathing
- Choking or gurgling sounds*
- Limpness
- For lighter-skinned people, a blueish-purple skin tone (late stages of overdose)
- For darker-skinned people, a greyish or ashen skin tone (late stages of overdose)
*If you notice choking or gurgling sounds, immediately lay the individual in a recovery position (pictured below) on their side to prevent choking. Find more in-depth resources on how to place an individual in a recovery position later in this post.
What to Do if Someone is Overdosing
If no medical professionals are on the scene and you suspect someone is experiencing an overdose, try stimulating them by calling their name. If they do not respond, perform a sternal rub by vigorously rubbing your knuckles on their sternum (breastbone/chest plate) or press their nail bed between your fingers and apply as much pressure as possible. If the individual responds, monitor to see if they can maintain consciousness and breathing. In the event of an opioid overdose, the individual will likely lose consciousness again when pressure is not applied.
If a person does not respond after attempts to wake or rouse them, call 911 immediately. Provide rescue breathing (see below) if the individual does not appear to be breathing on their own and administer naloxone (discussed in-depth later in this post) if on hand.
The following video illustrates how to perform rescue breathing:
Depending on the individual and the substances involved, it can be difficult to tell whether someone is experiencing an overdose. If you’re unsure, treat the situation like an overdose and seek professional medical care right away. Most states have laws in place that protect the individual who is experiencing an overdose, as well as the person who called for help and aided, from legal trouble.
What to Do After an Overdose
Even if you can provide rescue breathing and administer naloxone, it is imperative to seek professional medical care as soon as possible. Alert EMS or call 911 as soon as you suspect an overdose and continue to monitor the individual in crisis.
Here are a few steps to take while you wait for assistance:
- Attempt to keep the individual conscious and breathing.
- Once breathing regularly and independently, lay the individual in a recovery position on their side to prevent choking (see below).
- Stay with the individual until emergency assistance arrives.
The following video illustrates how to properly place an individual in a recovery position:
Where Can I Find Naloxone?
Naloxone (often also referred to by the brand name Narcan®, though many brands are available) is a life-saving medication that can reverse the effects of an opioid overdose involving opioids like heroin, fentanyl, and prescription opioid medications. It is available to the public in all 50 states. In most states, naloxone can be purchased from a local pharmacy without a prescription and may be covered under private insurance plans or Medicaid. Naloxone can also often be obtained for free through community-based harm reduction organizations or initiatives.
Naloxone is available as a nasal spray or as an injectable solution and can be used by anyone without medical training or authorization. Individuals should, however, familiarize themselves with how to administer naloxone, and some sources require viewing training materials before ordering naloxone by mail.
Below, see information on how to obtain naloxone in Pennsylvania, Delaware, Maryland, and Washington, D.C. (all within Gaudenzia’s footprint):
- Pennsylvania — A statewide standing order allows residents in PA to obtain naloxone from pharmacies without a prescription from their doctor.
- Delaware — Residents can obtain naloxone without a prescription at participating pharmacies and find naloxone information and training resources here.
- Maryland — Residents of Maryland can obtain naloxone through pharmacies without a prescription or training, or can obtain harm reduction supplies like naloxone and drug testing strips from MD Overdose Response Programs (ORPs) like these.
- Washington, D.C. — Naloxone is available in every ward in the District at no cost without requiring ID or a prescription.
If cost is a barrier, residents of all three states listed above (and 32 others) can request free naloxone by mail from NEXT Distro here. Local community-based harm reduction initiatives also often distribute free naloxone and provide training or can assist with information on where to find naloxone in your state.
How to Administer Naloxone
Naloxone can restore regular breathing within 2-3 minutes if an individual’s breathing has slowed or stopped due to an opioid overdose. Naloxone won’t cause harm to an individual if they are experiencing an overdose due to drugs other than opioids. It is important to note, however, that other drugs or adulterants taken with opioids, like the animal tranquilizer xylazine — which is a sedative and not an opioid — can make opioid overdoses harder to reverse with naloxone. In cases that involve an opioid with another agent such as a sedative, naloxone combined with CPR or Basic Life Support is paramount for survival until emergency responders can arrive.
The following training videos from the CDC illustrate how to administer naloxone in its nasal spray and injectable forms:
Addiction Treatment at Gaudenzia
Gaudenzia provides evidence-based, person-centered treatment for substance use and co-occurring disorders. Our treatment model incorporates care that is trauma-informed, gender-responsive, and culturally responsive.
If you or a loved needs help with addiction treatment, please contact our Treatment and Referral HelpLine at 833.976.HELP (4357) or email [email protected] today.
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