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

When someone overdoses on opioids, they don’t always look like they’re in trouble. They might be slumped in a chair, snoring softly, or unresponsive to your voice. But inside, their body is shutting down-breathing is slowing, oxygen is vanishing, and brain cells are dying. Opioid overdose isn’t just a drug problem. It’s a medical emergency that can kill in minutes. And the good news? You can stop it.

What Happens During an Opioid Overdose?

Opioids-whether prescription painkillers like oxycodone, illegal heroin, or deadly synthetic fentanyl-work by binding to receptors in your brain. These receptors control pain, but they also control breathing. When too many opioids flood the system, they silence the brain’s signal to breathe. Within seconds, breathing becomes shallow. Then slow. Then it stops.

Without oxygen, your brain starts to die. After just four to six minutes, permanent damage can happen. After ten minutes, death is likely. And this isn’t rare. In 2023, over 80% of the 107,941 drug overdose deaths in the U.S. involved opioids. Fentanyl, a synthetic opioid 50 to 100 times stronger than morphine, is now the main driver. It’s often mixed into pills sold as Xanax or oxycodone. People don’t even know they’re taking it.

Signs of an Opioid Overdose

You don’t need medical training to spot an overdose. Look for these clear, urgent signs:

• Unresponsive to shaking or shouting-no reaction at all
• Slow, irregular, or stopped breathing (fewer than 8 breaths per minute)
• Lips, fingernails, or skin turning blue, purple, or gray
• Cold, clammy skin
• Pinpoint pupils (tiny dots in the center of the eyes)
• Gurgling, snoring, or choking sounds-like they’re drowning
• Limp body, head hanging, no muscle control

Some people think pinpoint pupils are always present. They’re not. If someone is unconscious and not breathing, don’t wait for the pupils to look normal. Act immediately.

Also, don’t assume it’s just someone passed out from alcohol or drugs. Opioid overdoses often happen alone. Someone might be using in a bathroom, in a car, or in their bedroom. If you find someone like this, treat it as an overdose until proven otherwise.

What to Do: The 3-Step Emergency Response

If you suspect an opioid overdose, time is everything. Follow these steps exactly:

1. Call emergency services right away. In Australia, dial 000. In the U.S., dial 911. Say clearly: “I think someone is overdosing on opioids.” Don’t wait. Don’t try to handle it alone.
2. Give naloxone if you have it. Naloxone (sold as Narcan, Kloxxado, or generic versions) reverses opioid overdose. It’s safe, fast, and works even if you’re unsure what the person took. It won’t harm someone who didn’t use opioids.
3. Stay with them until help arrives. Even after naloxone, they can relapse into overdose. The effects of naloxone wear off in 30 to 90 minutes. Opioids stay in the body longer. They need monitoring.

Don’t try to make them walk, give them coffee, or put them in a cold shower. These don’t work. They waste time. Your job is to get help and reverse the overdose.

How to Use Naloxone

Naloxone comes in two main forms: nasal spray and auto-injector. The nasal spray is easiest for non-medical people to use.

For nasal spray (like Narcan):

1. Remove the device from its package.
2. Hold it with your thumb on the bottom and two fingers on the top.
3. Tilt the person’s head back slightly.
4. Insert the nozzle into one nostril.
5. Press the plunger firmly to spray the full dose.
6. Remove the device and call for help if you haven’t already.

If they don’t respond in 2-5 minutes, give a second dose in the other nostril. Keep giving doses every 2-3 minutes if needed.

For auto-injectors (like Evzio):

1. Remove the cap.
2. Place the device against the outer thigh (through clothing if needed).
3. Press firmly until you hear a click and hold for 5 seconds.
4. Remove and call for help.

Some people worry naloxone is hard to use. It’s not. The devices are designed for anyone-even a teenager or grandparent. Many pharmacies now give naloxone for free or low cost without a prescription. In Australia, it’s available behind the counter at most pharmacies. Ask for it. Keep one at home if someone you know uses opioids.

After Naloxone: What Happens Next?

Naloxone brings someone back-but it doesn’t fix the problem. After revival:

• They may feel sick, anxious, or angry. Naloxone can trigger sudden withdrawal.
• They still need medical care. Opioids can cause heart rhythm issues, lung damage, or brain injury.
• They need follow-up care. Overdose survivors are at high risk for another overdose. Studies show up to 10% die within a year if they don’t get treatment.

Encourage them to see a doctor. Offer support for addiction treatment. Medications like methadone, buprenorphine, or naltrexone can reduce cravings and prevent relapse. Counseling and peer support matter too.

And if you’re the one who gave naloxone-you’re not alone. Many people feel shaken, guilty, or overwhelmed afterward. That’s normal. Reach out. Talk to someone. You saved a life. That’s huge.

How to Prevent Overdose Before It Happens

You can’t always stop someone from using drugs-but you can reduce the risk:

• Use fentanyl test strips. These cheap paper strips (available at harm reduction centers or online) can detect fentanyl in pills or powder. Just mix a tiny bit with water, dip the strip, and wait a minute. If it shows fentanyl, don’t use it.
• Never use alone. If someone uses with another person, someone can call for help if things go wrong.
• Start with a small dose. Especially if the drug’s source is unknown. Fentanyl can be deadly in doses smaller than a grain of salt.
• Don’t mix opioids with alcohol, benzodiazepines, or stimulants. This multiplies the risk of respiratory failure.

Community programs in places like Melbourne, Vancouver, and Baltimore have distributed over a million naloxone kits and trained tens of thousands of people. In areas with these programs, overdose deaths dropped by up to 14%. It’s not magic. It’s preparation.

Where to Get Naloxone

You don’t need a prescription in most places. In Australia, ask your pharmacist for naloxone. In the U.S., most states allow pharmacists to dispense it directly. Many community health centers, needle exchanges, and even some libraries give it out for free.

If you’re unsure where to go:

• Search “naloxone near me” online
• Call your local health department
• Visit a pharmacy and ask: “Can I get naloxone without a prescription?”

Costs have dropped dramatically. A two-dose nasal spray that cost $130 in 2016 now costs $25-$50. Many programs give it away for free.

Why This Matters

Opioid overdose isn’t about “bad people” or “weak willpower.” It’s about a medical condition that can happen to anyone. Someone could be taking painkillers after surgery. Someone could be using heroin because they lost access to treatment. Someone could have taken a pill they thought was Xanax-and it was fentanyl.

You don’t need to be a doctor. You don’t need to be brave. You just need to know the signs. You just need to act.

One dose of naloxone can bring someone back to their family, their job, their life. And you can be the one who does it.

If you’re reading this because you’re worried about someone, you’re already doing the right thing. You don’t need to fix everything. You just need to know the signs, have naloxone ready, and act fast. That’s enough. That’s powerful. That’s life-saving.