Think someone is overdosing on opioids? Call 911 now. Do not wait to see all the signs. Give naloxone if you have it. Follow the dispatcher's directions. Stay with the person until help arrives. Only give rescue breathing or CPR if you are trained or told to do so.
We are an editorial team that runs a treatment directory. We do not provide treatment or claim medical review.
What to Do During an Opioid Overdose
Do not wait for every sign to appear. If you suspect an opioid overdose, act now. Your goal is to keep the person breathing until help arrives.
- 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. Get emergency help first. Medical staff can provide ongoing care that naloxone alone cannot.[3]
Opioid Overdose Signs and Treatment: Recognize the Warning Signs
If you think someone is overdosing, call 911 now. Do not wait for all signs to show up.
| 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 may show only one or two signs.[1] NIDA lists inability to wake, slow or shallow breathing, and pinpoint pupils as possible signs.[1] MedlinePlus notes that a limp body and blue or purple lips or fingernails are also warning signs.[4]
Do not wait for a full list of symptoms. If you see even one sign, treat it as an emergency. Quick action can save a life while help is on the way.
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. But many opioids stay in the body longer 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]
If you are not sure if someone took opioids, giving naloxone is safe. The medicine has no effect on someone who does not have opioids in their system.[3] Always call 911 first. Emergency crews can provide constant care that a bystander cannot. For more info on getting supplies, see our guide on obtaining naloxone kits.
BLS Signs and Protocols: What This Guide Can’t Replace
Basic Life Support (BLS) training teaches you to spot an unresponsive person. It also covers abnormal or missing breathing. If you have BLS training, your actions must match that course.
There is a difference between what you see and what a protocol says. You might notice someone is blue, gray, or limp. You might hear loud snoring. These are signs a bystander can spot. A formal BLS algorithm has specific steps to follow.
This guide does not replace your BLS training. It is not a substitute for your certification materials or local rules. Always follow your dispatcher’s instructions. Use the methods from your latest training class.
What to Do While Waiting for Emergency Responders
Stay with the person and keep monitoring them until emergency help arrives.[6] Follow the dispatcher's instructions closely. Watch for changes in their responsiveness and breathing.
While You Wait for Help
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After the Emergency: Withdrawal and Safe Medical Detox
Overdose and withdrawal are different. If you think someone is overdosing, emergency care comes first. Do not worry about detox plans yet. Keep the person safe until help arrives. Once the immediate danger has passed, our guide to opioid withdrawal explains what to expect and how to stay safe.
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 feel very bad. It may cause nausea, body aches, or anxiety. A qualified clinician can check these symptoms and make a safe plan. Do not try to handle severe withdrawal alone at home.
Detox is not the same as full treatment for opioid use disorder. It is a first step, but it does not fix the whole issue. Ongoing care often uses FDA-approved medicines like methadone, buprenorphine, or naltrexone.[9] These drugs help stop cravings and prevent relapse when paired with support. For a closer look at how naltrexone works alongside opioid pain medicine, see our guide to naltrexone and opioid use.
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.
Read our guide on how to tell withdrawal from overdose to learn more about the differences between these conditions.
Calling 911 and State Good Samaritan Protections
Concern about legal consequences should never delay calling 911 for a suspected overdose. Your first priority is getting medical help.
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. For example, some laws do not protect the person overdosing from arrest, and one state only protects witnesses who deliver naloxone.[12]
Because these rules change depending on where you live, do not assume you have full immunity. Consult current state law or a qualified legal resource for information specific to your area.
Plan for Ongoing Opioid Care
Once the danger is over, you need lasting support. NIDA says addiction, like opioid use disorder, is a treatable disorder. Treatment is more than just taking medicine.
Talk to your care team about next steps. Ask about an evaluation and long-term care options. You can also call the free, confidential SAMHSA National Helpline at 1-800-662-4357. They help people find services.[13] If you need to keep working, our guide to outpatient opioid treatment options shows how to schedule care around your shifts.
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.
A score cannot tell you if you are safe if you saw danger signs. See a doctor only when there are no danger signs.
You can view our list of medically supervised detox programs. You can also read our guide on opioid use disorder treatment. Use find emergency support nearby in our directory. This tool is not 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.
