Do not wait to spot every sign if you think someone is overdosing on opioids.Call 911 now. Give naloxone if you have it. Listen to the dispatcher. Stay by their side until help gets there. Do rescue breathing or CPR only if you are trained or instructed to.
Our team writes for a treatment directory. We do not give treatment. We also do not claim medical review.
What to Do During an Opioid Overdose
You do not need to see every sign to act. If you suspect an opioid overdose, act now. Focus on keeping the person breathing while help is on the way.
- 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. Call for emergency help right away. Medical staff can give ongoing care that naloxone alone cannot.[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 |
A person might show just one or two signs.[1] NIDA lists trouble waking up, slow or shallow breathing, and small pupils as possible signs.[1] MedlinePlus says a limp body and blue or purple lips or fingernails are also warning signs.[4]
Never wait to see the whole list of symptoms. If you spot even one sign, act like it is an emergency. Fast action can save a life while help is coming.
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. Yet, many opioids remain in the body for a longer time 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]
Giving naloxone is safe even if you are not sure someone took opioids. The medicine has no effect on someone who does not have opioids in their system.[3] Always call 911 first. Emergency crews can give steady care that a bystander cannot. For more on getting supplies, read our guide on obtaining naloxone kits.
BLS Signs and Protocols: What This Guide Cannot Replace
Basic Life Support (BLS) training helps you find people who do not wake up. It also covers missing or odd breathing. If you have BLS training, your actions must match that course.
What you see is not the same as a protocol. You may notice someone is blue, gray, or limp. Loud snoring is another sign. Bystanders can spot these clues. A formal BLS algorithm has specific steps to follow.
This guide is not a swap for your BLS training. It does not take the place of your certification materials or local rules. Follow your dispatcher’s instructions every time. Use the methods from your latest training class.
Steps to Take Until Emergency Help Arrives
Keep watching the person until emergency help gets there.[6] Listen carefully to the dispatcher's directions. Note any shifts in their breathing or ability to respond.
While You Wait for Help
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What Comes After the Emergency: Withdrawal and Medical Detox
Overdose and withdrawal are different. If you think someone is overdosing, emergency care comes first. Put detox plans aside for now. Keep the person safe while you wait for help.
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.
Withdrawal can be very hard. It may bring on anxiety, body aches, or nausea. A qualified clinician can check these symptoms and build a safe plan. Do not try to manage severe withdrawal on your own at home. Our guide to the opioid withdrawal timeline explains what to expect as you move through that phase of recovery. If cost is a concern, our guide to opioid detox insurance coverage helps you estimate what you might pay out of pocket.
Detox is a first step, not full treatment for opioid use disorder. It does not solve the whole problem. Ongoing care often relies on FDA-approved medicines such as methadone, buprenorphine, or naltrexone.[9] Used with support, these drugs help curb cravings and stop relapse.
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.
Check out our guide on how to tell withdrawal from overdose to see how these conditions differ.
Calling 911 and State Good Samaritan Protections
Concern about legal consequences should never delay calling 911 for a suspected overdose. Getting medical help is the top thing to do.
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. One state only shields witnesses who give naloxone. Also, some laws leave the person overdosing open to arrest.[12]
Rules vary by location, so do not assume you have full immunity. Check current state law or a qualified legal resource for details on your area.
Setting Up Long-Term Opioid Care
After the danger is gone, you need ongoing help. NIDA says addiction, like opioid use disorder, can be treated. Getting care is more than just taking medicine.
Ask your care team about long-term care options and an evaluation. You can also dial the free, private SAMHSA National Helpline at 1-800-662-4357. They assist people in locating 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.
Do not rely on a score if you notice danger signs. Only see a doctor when no danger signs are present.
You can view our list of medically supervised detox programs. Our guide on opioid use disorder treatment is also available to read. Try find emergency support nearby within 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.
