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

Every day, 187 people in the U.S. die from drug overdoses. Most of those deaths involve opioids - drugs like heroin, oxycodone, fentanyl, and morphine. And here’s the hard truth: opioid overdose doesn’t always look like what you see in movies. It’s not always someone slumped on the floor with a needle in their arm. Sometimes, it’s a person who just won’t wake up after taking what they thought was a pain pill. Or a teenager who took a pill they found in a medicine cabinet. Or a parent who used a drug they thought was safe because it came in a pill form.

If you’re reading this, you might be worried about someone. Or you’re trying to be prepared. Either way, knowing what to look for and what to do could save a life - maybe even your own.

What Happens During an Opioid Overdose?

Opioids work by attaching to receptors in your brain that control pain - but they also mess with the part that tells your body to breathe. When too much of the drug is in your system, those breathing signals shut down. Oxygen stops reaching your brain. Within minutes, brain cells begin to die. You can lose consciousness. Your lips and fingernails turn blue or gray. You might make gurgling or snoring sounds - not because you’re asleep, but because your airway is collapsing.

This isn’t a slow process. It’s fast. And it’s silent. People don’t scream. They don’t thrash. They just stop responding. That’s why bystanders often don’t realize it’s happening until it’s too late.

Signs of an Opioid Overdose

You don’t need to be a doctor to spot an overdose. Look for these three key signs - the classic triad:

• Unresponsive or unconscious - No matter how much you shake or shout, the person won’t wake up. Try rubbing your knuckles hard on their chest bone. If they don’t react, they’re in trouble.
• Slow, shallow, or stopped breathing - Watch their chest. Are they taking fewer than 12 breaths a minute? Or none at all? That’s a red flag.
• Pinpoint pupils - Their pupils will look like tiny dots, even in dim light. But here’s the catch: not everyone has this sign. Don’t wait for it.

Other warning signs include:

• Blue, purple, or gray lips and fingertips
• Cold, clammy, or pale skin
• Limp body - like a ragdoll
• Gurgling, choking, or snoring sounds
• Extreme drowsiness - they can’t stay awake

And here’s something many people don’t know: fentanyl, a synthetic opioid 50 to 100 times stronger than morphine, is now mixed into almost every kind of street drug - cocaine, counterfeit Xanax, even pills sold as “OxyContin.” You don’t have to be using heroin to overdose. You just have to take something that contains fentanyl - and you might not even know it.

What to Do If Someone Is Overdosing

Time is everything. Brain damage starts after just 4 to 6 minutes without oxygen. So don’t wait. Don’t call a friend first. Don’t try to wake them up by slapping them. Don’t put them in a cold shower. Those things don’t work. Here’s what does:

1. Call 911 right away. Say clearly: “I think someone is overdosing on opioids.” Give your location. Stay on the line. Dispatchers can walk you through steps while help is coming.
2. Give naloxone if you have it. Naloxone (brand name Narcan) is a medication that blocks opioids from binding to brain receptors. It reverses the overdose. It’s safe. It won’t hurt someone who hasn’t taken opioids. If you’re unsure - give it anyway.
3. Administer it correctly. Most naloxone today comes as a nasal spray. Tilt the person’s head back. Insert the nozzle into one nostril. Press the plunger all the way in. One spray is usually enough. If you only have the injectable version, give it into the thigh muscle, through clothing if needed.
4. Start rescue breathing if they’re not breathing. Tilt their head back, pinch their nose, and give one breath every 5 seconds. Keep going until they breathe on their own or help arrives.
5. Stay with them. Naloxone wears off in 30 to 90 minutes. Opioids can stay in the body much longer. The person can stop breathing again. Do not leave them alone. Even if they wake up, they need medical care.

Don’t worry about getting in trouble. In 49 states, Good Samaritan laws protect people who call 911 during an overdose. The goal is to save lives - not punish them.

How to Get Naloxone

You don’t need a prescription in most places. In Oregon, where I live, you can walk into any pharmacy and ask for naloxone. Pharmacists hand it out like cough syrup. The cost? Around $25 to $50 for a two-dose kit. Many community health centers, harm reduction programs, and even some libraries give it out for free.

Look for organizations like Safe Injection Sites, Project Lazarus, or your local health department. They often train people on how to use it - and give you a kit to take home. Keep one in your car. In your bag. In your coat pocket. You never know when you’ll need it.

And if you’re worried about someone using opioids - give them naloxone. Don’t wait for a crisis. Make it part of your care.

What Happens After Naloxone?

When naloxone works, the person wakes up. They might be scared. Angry. Confused. Some people say it feels like being punched in the chest. That’s because their body is going into withdrawal - suddenly cut off from the drug it’s used to.

That’s not the end. It’s the beginning. After an overdose, the body needs to be checked for damage. Oxygen deprivation can hurt the heart, kidneys, and brain. Even if they seem fine, they need to go to the hospital.

And here’s the most important part: overdose survivors are at the highest risk of dying from another overdose - especially in the first two weeks. That’s when tolerance drops. If they use the same amount they used before, they can die.

Recovery doesn’t happen overnight. But it can happen. Medications like methadone, buprenorphine, and naltrexone can help. Therapy helps. Support groups help. But none of that matters if they’re dead.

Why This Matters - And What You Can Do

Opioid overdose isn’t a moral failure. It’s a medical emergency. And like a heart attack, it’s preventable - if you know what to do.

You don’t need to be a first responder. You don’t need to be a doctor. You just need to know the signs. You need to know where to find naloxone. And you need to be willing to act - even if you’re scared.

Someone you love might be at risk. Or someone you don’t even know. Maybe it’s the person sitting next to you on the bus. Or the neighbor you wave to every morning. Maybe it’s you.

Don’t wait for someone else to step in. Be the person who acts. Carry naloxone. Know the signs. Call 911. Stay until help arrives.

Because in the middle of an overdose, the only thing that matters is this: you’re there. And you didn’t look away.

Next Steps: Be Ready Before It Happens

Here’s what you can do today:

• Ask your pharmacist for naloxone - no prescription needed.
• Keep a kit in your car, purse, or backpack.
• Watch a 5-minute video on how to use naloxone (YouTube has free ones from CDC or Narcan).
• Teach one person how to recognize the signs and use it.
• Find your local harm reduction center. They often offer free training and supplies.

You don’t have to fix the opioid crisis. But you can save one life. And that’s more than enough.