Opioid Overdose: How to Recognize It and Use Naloxone (Narcan) Now

What are the three signs of opioid overdose?

You do not need to see all three signs. Any one is enough to act immediately.

1. Unresponsive — You cannot wake them by calling their name loudly, rubbing your knuckles firmly on their sternum (breastbone), or shaking their shoulders. 2. Breathing very slowly, shallowly, or not at all — Normal resting breathing is steady and quiet. Overdose breathing may sound like gurgling or snoring, or stop entirely. 3. Blue, gray, or pale lips, fingernails, or skin around the mouth — This means the body is not getting enough oxygen.

Other signs include extremely small (pinpoint) pupils, limp body, and choking or gurgling sounds.

Naloxone is safe to give even if you are not certain 1Ref 1Substance Abuse and Mental Health Services Administration (SAMHSA) (2023).Overdose Prevention and Response Toolkit.Supports step-by-step overdose response, naloxone administration, the naloxone wear-off window of 30–90 minutes, and the need for emergency services even after apparent recovery; also supports fentanyl potency context2Ref 2Centers for Disease Control and Prevention (2024).Reversing Opioid Overdoses with Lifesaving Naloxone.Supports naloxone availability without prescription, safety of giving it when opioids are uncertain, and timing of onset (2–5 minutes). If someone has not taken opioids, it does nothing. If they have, it can reverse the overdose rapidly. Give it.

What to do — in order

Step 1: Call 911. Tell them someone is unresponsive and may have overdosed. Stay on the line.

Step 2: Give naloxone. Naloxone (Narcan or generic) is available without a prescription at most pharmacies in the US 2Ref 2Centers for Disease Control and Prevention (2024).Reversing Opioid Overdoses with Lifesaving Naloxone.Supports naloxone availability without prescription, safety of giving it when opioids are uncertain, and timing of onset (2–5 minutes)3Ref 3Centers for Disease Control and Prevention (2024).5 Things to Know About Naloxone.Supports pharmacy access without prescription and the safety profile of naloxone for bystander use. - *Nasal spray:* Tilt their head back slightly. Insert the tip into one nostril and press the plunger firmly. - *Auto-injector:* Follow the voice instructions on the device.

Naloxone begins working in 2 to 5 minutes. If there is no response after 2 to 3 minutes and you have a second dose, give it in the other nostril.

Step 3: Lay them on their side (the recovery position) if they are breathing — this prevents choking if they vomit.

Step 4: Begin rescue breathing or CPR if they are not breathing and you know how. The 911 dispatcher can guide you.

Step 5: Stay with them. Naloxone wears off in 30 to 90 minutes. The overdose can return if the opioid is still in their system. They must be evaluated by paramedics even if they wake up 1Ref 1Substance Abuse and Mental Health Services Administration (SAMHSA) (2023).Overdose Prevention and Response Toolkit.Supports step-by-step overdose response, naloxone administration, the naloxone wear-off window of 30–90 minutes, and the need for emergency services even after apparent recovery; also supports fentanyl potency context.

Why fentanyl changes everything

Illicitly manufactured fentanyl and its analogs are far more potent than heroin or prescription opioids. A standard dose of naloxone may not be enough — multiple doses may be needed, and the overdose can recur quickly even after initial reversal 1Ref 1Substance Abuse and Mental Health Services Administration (SAMHSA) (2023).Overdose Prevention and Response Toolkit.Supports step-by-step overdose response, naloxone administration, the naloxone wear-off window of 30–90 minutes, and the need for emergency services even after apparent recovery; also supports fentanyl potency context. This is why calling 911 is essential even when naloxone appears to work. Paramedics can monitor for recurrence and administer additional doses as needed.

When naloxone works — what to expect

The person may wake up confused, disoriented, or agitated — even aggressive — because naloxone puts them into rapid opioid withdrawal. This is uncomfortable but not dangerous. Calmly explain what happened. Do not let them take more opioids to relieve withdrawal symptoms. Keep them with you until paramedics arrive.

Many US states have Good Samaritan laws that protect people who call 911 and give naloxone during an overdose from drug-related prosecution. Calling for help is the right decision.

How to get naloxone

Naloxone is available at most pharmacies in the US without a prescription 2Ref 2Centers for Disease Control and Prevention (2024).Reversing Opioid Overdoses with Lifesaving Naloxone.Supports naloxone availability without prescription, safety of giving it when opioids are uncertain, and timing of onset (2–5 minutes)3Ref 3Centers for Disease Control and Prevention (2024).5 Things to Know About Naloxone.Supports pharmacy access without prescription and the safety profile of naloxone for bystander use. Harm reduction organizations, community health programs, and many health departments also distribute it free of charge. Anyone who uses opioids — or who lives with or cares for someone who does — should keep naloxone on hand and make sure people nearby know where it is and how to use it.