Medical Disclaimer
This page provides first-aid guidance for drug-related emergencies. It is not a substitute for professional medical advice, diagnosis, or treatment. Always call emergency services in a life-threatening situation. The information here is compiled from public health sources and harm reduction organizations. It has not been reviewed by a licensed physician. Use at your own risk.
Opioid Overdose: What to Do Right Now
Fentanyl, heroin, nitazenes, oxycodone — recognition and immediate response
Recognition
- •Unresponsive or cannot be woken up
- •Slow or stopped breathing (fewer than 8 breaths per minute)
- •Choking or gurgling sounds (the 'death rattle')
- •Blue or gray lips, fingernails, or skin
- •Pinpoint pupils (very small)
- •Body is limp, pulse is weak or absent
What to Do
Call emergency services immediately
Dial 911 (US/CA), 999 (UK), 000 (AU), 112 (EU). Say 'someone is unresponsive and not breathing.' You do not need to mention drugs — paramedics need to know what to treat, not who to arrest. Most jurisdictions have Good Samaritan laws that protect you from prosecution when reporting an overdose.
Administer naloxone (Narcan)
If available, give one dose immediately. Nasal spray: insert into nostril and press plunger. Intramuscular: inject into thigh or upper arm muscle. If no response within 2-3 minutes, give a second dose. Naloxone is safe — you cannot harm someone by giving it when it is not needed.
Begin rescue breathing
Tilt the head back, lift the chin. Pinch the nose closed. Give 2 slow breaths, watching the chest rise. Continue at 1 breath every 5-6 seconds. Rescue breathing is the most important thing you can do while waiting for paramedics — brain damage begins after 4 minutes without oxygen.
Place in recovery position
If the person is breathing but unconscious, roll them onto their side. Bend the top knee forward to stabilize. Tilt the head back slightly to keep the airway open. This position prevents choking if they vomit.
Stay with them until help arrives
Do not leave the person alone. Monitor breathing continuously. If breathing stops again, resume rescue breathing. Give additional naloxone doses if needed — there is no maximum dose in an emergency.
When to Call Emergency Services
- →The person cannot be woken up — call immediately, do not wait
- →Breathing is under 8 breaths per minute — count for 15 seconds and multiply by 4
- →Lips or fingertips are turning blue — this is oxygen deprivation, brain damage follows
- →You administered naloxone and they woke up — they still need medical assessment
- →The person is a first-time user or has been abstinent (relapse after abstinence is highest risk)
What NOT to Do
Myth: Put them in a cold shower to wake them up
Truth: Never do this. Cold water shock can cause cardiac arrest. Keep the person warm with a blanket or jacket.
Myth: Inject them with salt water or milk
Truth: This does nothing and can cause infection, vein damage, or anaphylaxis. There is no home remedy that reverses an opioid overdose except naloxone.
Myth: Slap them or cause pain to wake them
Truth: Sternal rubs (knuckles on the breastbone) are a medical assessment technique. Slapping, burning, or other pain is not effective and can cause injury.
Myth: If they wake up after naloxone, they're fine
Truth: Naloxone wears off in 30-90 minutes — shorter than most opioids. The person can slip back into overdose after the naloxone wears off. They need medical observation.
Prevention
- ✓Test every batch with fentanyl strips. A single grain of fentanyl can be lethal. Test from multiple spots in the bag.
- ✓Never use alone. The majority of overdose deaths occur when no one is present to respond.
- ✓Start low and go slow. Tolerance changes. A dose that was safe last week may not be safe today.
- ✓Carry naloxone. It is available without prescription in most US states and Canadian provinces. Many harm reduction organizations give it away free.
- ✓Avoid mixing opioids with alcohol, benzodiazepines, or other sedatives. Combined respiratory depression is the leading cause of polydrug overdose death.
Testing & Resources
IMPORTANT: This guide is for informational purposes only and does not constitute medical advice. Drug use carries inherent risks. No substance use is completely safe. Always call emergency services (911 in the US/Canada, 999 in the UK, 000 in Australia, 112 in the EU) in a life-threatening situation. TestSubstances.com is not responsible for any actions taken based on this information. If you or someone you know is struggling with substance use, contact SAMHSA (1-800-662-4357) or your local health authority.