Opioids
Opioid Overdoses: What to Know and How to Respond
Oct 24, 2025
A Life-Threatening Emergency
Opioid overdoses are medical emergencies that require immediate action. They occur when an individual consumes a toxic amount of opioids, causing vital body systems to slow down and even outright fail. Without rapid intervention, opioid overdoses can be fatal within minutes.
If you suspect someone is experiencing an opioid overdose<sup>1</sup>:
Call 911 immediately.
Stay with the person until emergency responders arrive.
Administer naloxone (Narcan) if available.
Provide rescue breathing if the person is not breathing normally.
Continue monitoring until emergency services arrive.
Following these steps can save a life. Even if you are unsure whether an individual is overdosing, it is always safer to act.
The Scope of the Opioid Crisis
Since 2009, drug overdoses have been the leading cause of injury-related death in the United States. Opioids account for the vast majority of these deaths.<sup>2</sup>
According to data from the Centers for Disease Control and Prevention (CDC), opioids were involved in approximately 75% of overdose deaths in 2022.<sup>3</sup> Synthetic opioids are now the primary drivers of these fatalities, contributing to over 90% of opioid-related deaths in some U.S. regions.<sup>4</sup>
Between 1999 and 2023, the rate of overdose deaths involving<sup>5</sup>:
Prescription opioids increased more than 4x.
Heroin overdose deaths rose approximately 2.5x.
Synthetic opioids (excluding methadone) increased more than 100x.
Opioids: What They Are and How They Work
Opioids are a class of drugs that include both prescription medications and illicit substances. Clinically, they are used to relieve moderate to severe pain following surgery or injury. When used correctly under medical supervision, they can be effective and safe for short-term pain management.
Common prescription opioids include:
Oxycodone (OxyContin®, Percocet®)
Hydrocodone (Vicodin®, Norco®)
Morphine (MS Contin®, Kadian®)
Codeine
Hydromorphone (Dilaudid®)
Methadone (used in opioid treatment programs)
Illicit opioids include:
Heroin
Fentanyl and analogues (e.g., carfentanil)
Opium
From a physiological standpoint, opioids exert their effects by binding to mu-opioid receptors in the brain and spinal cord. This reduces the perception of pain and induces euphoria. However, opioids also suppress the brain’s respiratory centers, slowing breathing and heart rate. These suppressions play a key mechanism behind overdose fatalities <sup>6</sup>.
Recognizing the Signs of an Opioid Overdose
Knowing the hallmark symptoms of an opioid overdose can mean the difference between life and death. Key signs include<sup>7</sup>:
Unresponsiveness or loss of consciousness
No response to voice, touch, or pain stimuli (e.g., sternal rub)
Slow, shallow, or absent breathing
Choking or gurgling sounds (often referred to as agonal breathing)
Slow or absent pulse
Pinpoint pupils (miotic pupils)
Bluish or grayish skin tone, especially around lips and fingertips
If several of these symptoms are present, act immediately by calling emergency services and administering naloxone if possible.
Overdose Risk Factors
While any opioids puts users at some degree of risk, certain circumstances significantly elevate the danger<sup>8</sup>:
Unknown drug purity or composition: Illicit drugs may be mixed with fentanyl or other potent substances.
Polysubstance use: Combining opioids with alcohol, benzodiazepines, or other depressants compounds respiratory suppression.
Reduced tolerance: After a period of abstinence (following detox, incarceration, or treatment), tolerance decreases rapidly, making previously manageable doses potentially lethal.
History of previous overdoses: Individuals who have overdosed before are at higher risk for recurrence.
Health conditions: Respiratory illnesses, sleep apnea, or liver disease can increase overdose susceptibility.
Using opioids in isolation: No bystanders means no one is available to administer naloxone or call for help.
Naloxone (Narcan): A Lifesaving Antidote
Naloxone, commonly known by its brand name Narcan, is an opioid antagonist—a medication that binds to the same receptors as opioids but blocks their effects. When administered during an overdose, it can rapidly restore normal breathing and consciousness.
Some key facts about naloxone<sup>7</sup>:
It can be safely administered by non-medical personnel with minimal training.
It is available as a nasal spray (Narcan®, Kloxxado®) or intramuscular injection.
It works within 2 to 3 minutes, though multiple doses may be required for stronger opioids such as fentanyl.
Its effects are temporary, typically lasting 30 to 90 minutes, after which opioids may rebind to receptors and cause a recurrence of overdose symptoms.
Because of its safety profile, administering naloxone to someone who is not overdosing will not cause harm.
Many U.S. states have implemented Good Samaritan laws that protect individuals who administer naloxone or call 911 in good faith during an overdose emergency. These laws aim to remove fear of legal consequences and encourage lifesaving action<sup>9</sup>.
Step-by-Step: How to Respond to an Opioid Overdose
If you encounter someone who may be overdosing, act quickly and follow these steps<sup>7</sup>:
Check the immediate area. Before attempting aid, make note of any substances, bodily fluids, or needles that may be in the area. Doing so can prevent accidental exposures that may put you or others at risk.
Assess responsiveness. Attempt to wake the person by shaking their shoulders or performing a sternal rub (firmly rubbing your knuckles along their breastbone).
Call 911 immediately. Provide as much information as possible, including the person’s age, symptoms, and any known substances used.
Administer naloxone (Narcan).
If using the nasal spray: place the tip in one nostril and press the plunger firmly.
If using an injectable form: follow the package instructions and inject into the outer thigh or upper arm.
Perform rescue breathing or CPR if trained, or follow dispatcher guidance over the phone.
Place the individual in the recovery position (on their side, with mouth facing downward and one knee bent) if breathing resumes but they remain unconscious.
Stay with the person until emergency responders arrive.
Be prepared for withdrawal symptoms. Rapid reversal of opioids may cause vomiting, agitation, sweating, rapid heart rate, or confusion. These are temporary and not typically dangerous. Maintain a safe distance from the individual after administering Narcan unless CPR or additional Narcan administration is necessary.
Click HERE to watch a video outlining step-by-step instructions on how to respond to an opioid overdose<sup>10</sup>.
Even if the person seems alert after receiving naloxone, they must be evaluated by medical professionals.
Naloxone’s Limitations and Side Effects
While naloxone is effective and safe to use in most instances of opioid overdose, there are important limitations and precautions to note<sup>8</sup>:
Short duration: Naloxone’s half-life (30–90 minutes) is shorter than most opioids, meaning its effects wear off sooner than the opioid itself.
Rebound overdose risk: Once naloxone is metabolized, respiratory depression can recur if additional opioids remain in the system.
Common side effects: Nausea, vomiting, sweating, rapid heartbeat (tachycardia), tremors, or agitation. These symptoms usually subside as the drug wears off.
Aggression or confusion: Some individuals may awaken abruptly and appear disoriented or combative. Maintain calm reassurance and ensure safety for both the rescuer and the individual.
Prevention and Harm Reduction Strategies
Reducing opioid overdose deaths requires us to intervene in both community-level and individual spaces:
Education: Teaching people how to recognize overdoses and use naloxone effectively.
Access to naloxone: Distributing free kits through community health centers, pharmacies, and harm reduction programs.
Safe use practices: Encouraging individuals not to use alone and to test substances for fentanyl contamination when possible.
Substance use treatment: Connecting individuals with medication-assisted treatment (MAT) programs using buprenorphine, methadone, or naltrexone.
Public health policy: Expanding Good Samaritan laws and funding community-based harm reduction services.
Overdoses Are Preventable and Reversible
Opioid overdoses are among the most urgent public health challenges of our time, but they are both treatable and preventable. With proper education, access to naloxone, and timely medical intervention, thousands of lives can be saved each year.
