How to Recognize and Respond to an Opioid Overdose

What an Opioid Overdose Actually Is

Opioid overdose occurs when the amount of opioid in someone's system exceeds what their body can tolerate, suppressing the brain's signals to breathe. Death from opioid overdose almost always occurs because the person stopped breathing, not because of cardiac arrest. This matters because it means there's typically a window — sometimes brief, sometimes longer — during which intervention can reverse the overdose.

Signs of Opioid Overdose

Recognizing the overdose is the first step. Key signs:

Critical Signs (life-threatening, requires immediate action)

• Slow or stopped breathing — fewer than 12 breaths per minute, very shallow, or no breathing at all
• Blue or gray lips, fingertips, or skin (cyanosis)
• Unconscious or unresponsive to stimulation (shouting, sternal rub)
• Gurgling, rattling, or snoring sounds ("death rattle")
• Pinpoint pupils — pupils tiny and unchanging in light
• Limp body, like a rag doll
• Cold, clammy skin
• Vomiting while unconscious (aspiration risk)

Concerning Signs (may precede critical signs)

• Severe sedation — falling asleep mid-conversation or activity
• Confusion or difficulty speaking
• Loss of motor coordination
• Slowed reaction times
• Severe drowsiness

If you see concerning signs and they're worsening, treat them like critical signs — the situation can deteriorate rapidly.

What to Do — The 5 Steps

Step 1 — Call 911 Immediately

Don't wait. Don't try to handle it alone. Even if you have naloxone and successfully reverse the overdose, the person needs medical evaluation. The opioid may continue to act after naloxone wears off, and re-overdose can occur.

California's Good Samaritan law (AB 472) provides legal protection for people who call 911 to report an overdose, even if controlled substances are present at the scene. Fear of legal consequences should never prevent calling for help.

Step 2 — Administer Naloxone (Narcan) If Available

Naloxone reverses opioid overdose by displacing opioids from receptors in the brain. It works within minutes for most opioid overdoses. For fentanyl overdoses, multiple doses are often needed.

Nasal spray (Narcan) instructions:

• Hold the device with thumb on the plunger, fingers on the nozzle
• Insert tip into one nostril until fingers touch the person's nose
• Press plunger firmly to deliver the entire dose
• If no response in 2-3 minutes, administer a second dose in the other nostril
• Continue rescue breathing and wait for EMS

Injectable naloxone:

• Available in some areas; requires drawing up and injecting into thigh muscle
• Less common than nasal spray; if you have it, learn from your prescriber or pharmacist

Step 3 — Rescue Breathing If Needed

If the person isn't breathing or is breathing very slowly:

• Tilt head back, lift chin to open airway
• Pinch nose closed, make seal over mouth
• Give one rescue breath every 5 seconds (watch chest rise)
• Continue until naloxone takes effect or EMS arrives

Step 4 — Position Person on Side

If the person is breathing, place them in the recovery position — on their side with head tilted slightly down. This prevents choking if they vomit.

Step 5 — Stay With Them

Stay until emergency services arrive. The person may wake up after naloxone — sometimes confused, sometimes in withdrawal, sometimes wanting to leave. They need medical evaluation. Naloxone wears off in 30-90 minutes, and the opioid may still be active — re-overdose risk is real.

After Naloxone — What to Expect

• The person may wake up suddenly — sometimes confused, sometimes agitated
• They may go into immediate opioid withdrawal — sweating, vomiting, anxiety, body aches; uncomfortable but not dangerous
• They may be angry — naloxone reversal interrupts the high; this isn't ingratitude but neurochemistry
• They may refuse further medical care; EMS should still transport for monitoring
• Some opioids (particularly fentanyl) outlast naloxone — re-overdose can occur 30-90 minutes after naloxone if the person isn't monitored

How to Get Naloxone

• Available without prescription at most pharmacies in California (CVS, Walgreens, Rite Aid, independent pharmacies)
• Often covered by insurance; uninsured cost typically $40-150 for a two-dose pack
• Available free through many community organizations, harm reduction programs, and county health departments
• California's Naloxone Distribution Project provides free naloxone to organizations that work with at-risk populations
• Pharmacists can train you on how to use it at the time of purchase

Who Should Have Naloxone

• Anyone using opioids — prescription or illicit
• Anyone using illicit drugs of any kind (fentanyl contamination is widespread)
• Family members of anyone using opioids
• Partners of anyone using opioids
• Friends who spend time with people who use opioids
• People who use prescription opioids for pain — particularly at higher doses or alongside other CNS depressants
• Anyone recently released from incarceration with prior opioid use (overdose risk is dramatically elevated post-release)
• Anyone returning from detox or residential treatment (tolerance has reset, prior use levels can cause overdose)

Overdose Risk Factors

• Mixing opioids with other depressants — alcohol, benzodiazepines, sleep medications
• Using after a period of abstinence (tolerance reset)
• Using alone — no one available to intervene
• Using counterfeit pills or unknown substances (fentanyl contamination)
• Using stronger formulations than usual
• Using when sick or dehydrated
• Co-occurring medical conditions affecting breathing (sleep apnea, COPD)
• Older age

Prevention — What Reduces Risk

• Naloxone available and family/friends trained
• Never using alone ("Never Use Alone" hotline: 1-800-484-3731 — someone stays on the line while you use)
• Fentanyl test strips for any substance not from a verified pharmacy
• Avoiding mixing opioids with alcohol or benzodiazepines
• Starting low after any period of abstinence
• Medication-Assisted Treatment (MAT) — reduces overdose risk by approximately 50%
• Treatment for the underlying use — eliminates the highest-risk variable

How Anchored Tides Helps

Anchored Tides doesn't provide in-house detox — coordinates with trusted partners for medical detox when needed. Where ATR can help: outpatient programming after medical stabilization, coordination with MAT prescribers, family programming including naloxone education, and integrated treatment for the conditions underneath opioid use.

• Naloxone education for women in recovery and their families
• Coordination with MAT prescribers for buprenorphine, methadone, or naltrexone — MAT reduces overdose risk by approximately 50%
• Partner-referral for medical detox when needed
• Three outpatient levels of care (PHP, IOP, OP)
• Trauma-informed therapy with EMDR, DBT, CBT
• Dual-Diagnosis / Co-Occurring Disorders treatment for the conditions that often accompany OUD
• Mental Health track for women whose primary need is mental health
• Family programming — including overdose response training
• In-network with HMOs, EPOs, and PPOs across Blue Shield, BCBS, Anthem, Highmark, Regence, Premera, Multiplan, and Horizon

Take the Next Step

If opioid use is part of your life — your own, a family member's, a friend's — the next step is making sure you have naloxone available and know how to use it. Free or low-cost naloxone is available throughout California. Beyond that, treatment for opioid use disorder is the most effective prevention, and the path is more accessible than the cultural framing suggests.

Call (866) 329-6639 or Verify Your Insurance — confidential, no obligation.