Opioid Overdose

Signs of Overdose

Small, constricted pupils

Loss of consciousness and/or unresponsiveness

Soft and shallow, erratic, or stopped breathing

Choking or gurgling sounds

Limp body, droopy muscles

Pale, blue, gray, and/or cold skin

Test for Overdose


If you're not sure whether they are overdosing, check if they respond to stimulus. Do not use too much force.


  • Call their name.
  • Say something they may not like to hear to grab their attention (such as "I'm going to call the police").


  • Rub your knuckles on the middle of their chest where the ribs meet (on the sternum).
  • Rub your knuckles on their upper lip.
  • Pinch the back of their arm.

If they don't respond and show signs listed above, assume they are overdosing.

How to Respond

Administer naloxone if available.

  • Nasal Spray: Pick one nostril, stick the device all the way up, and activate the plunger.
  • Injectable: Inject into thigh muscle.

Apply a second time if they do not respond in 3-5 minutes.

Contact emergency medical services or instruct someone else to do so.

Tell the dispatcher:

  • Their breathing has slowed or stopped.
  • They are unresponsive.
  • Your exact location.

The dispatcher only needs to know that someone's life is in immediate danger. Mentioning drugs could draw unwanted and unnecessary attention.

Tell the paramedics:

  • Whether or not you administered naloxone and if it helped.
  • As much information about the ingested substances as possible.

Try to keep them awake, alert, and breathing.

Use the stimulation techniques described above if they are losing consciousness. If they are struggling to breathe or have chest tightness, contact emergency medical services immediately.

Rescue breathing

If they are unresponsive and not breathing much or have stopped breathing, you need to get oxygen into their body.

  • Place them on their back.
  • Tilt up their chin to open the airway.
  • Ensure their airway is clear (remove anything from inside their mouth).
  • Pinch the nose closed with one hand and give 2 breaths. If their chest does not rise, tilt their head back more and ensure their nose is completely plugged.
  • Repeat: give one breath every 5 seconds.

Recovery position

If they are unconscious, or if you must leave them alone (even for a minute), place them in the recovery position so they cannot choke on their own vomit.

Recovery position illustration
  • Ensure their airway is clear (remove anything inside their mouth).
  • Lay them on their side.
  • Bend the knee that is higher up in the air over their body to prevent them from rolling over.
  • Turn their face to the side, optionally resting it on their arm.
  • Position their chin up so their throat is open.

Photograph by Rama, Wikimedia Commons, Cc-by-sa-2.0-fr