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Opioid overdose: first aid and naloxone

Emergency numbers differ by country. This page uses 911, the number for the United States and Canada. Many other countries use 112, 999, or another number. Find the number for your country.

An opioid overdose is a life-threatening medical emergency caused by drugs such as prescription pain relievers, heroin, or fentanyl. Prompt action and naloxone (Narcan) can reverse an overdose in minutes.

Do this now

  1. Check for responsiveness. Shout their name and rub your knuckles firmly on their breastbone (sternal rub).
  2. Call your local emergency number (911 in the United States, 112 in Europe, 999 in the United Kingdom) immediately.
  3. Administer naloxone (Narcan) nasal spray if available into one nostril.
  4. If the person is not breathing normally, begin rescue breathing or hands-only CPR.
  5. If no response after 2 to 3 minutes, give a second dose of naloxone in the opposite nostril.

Recognizing an opioid overdose

Look for the three main signs (the opioid triad):

  • Pinpoint (extremely small) pupils.
  • Unconsciousness or inability to wake up.
  • Very slow, shallow, irregular breathing, or no breathing at all.

Other warning signs include: - Blue, gray, or pale lips, fingernails, or skin. - Gurgling, choking, or snoring sounds coming from the throat. - Limp body and unresponsiveness to loud noise or pain.

How to give naloxone (Narcan nasal spray)

Naloxone is safe, easy to use, and does not cause harm if given to someone who is not having an overdose.

  1. Peel back the package wrapper to take out the nasal spray device.
  2. Hold the spray with your thumb on the bottom plunger and two fingers on the nozzle.
  3. Insert the tip of the nozzle gently into one nostril until your fingers touch the bottom of the person's nose.
  4. Press the plunger firmly with your thumb to spray the full dose into their nose.
  5. Stay with the person until medical assistance arrives.

Rescue breathing and recovery position

If the person is not breathing:

  • Place them on their back, tilt their head back slightly, and lift the chin.
  • Pinch their nose shut, cover their mouth with yours (using a CPR mask if available), and give 1 slow breath every 5 seconds.
  • Continue rescue breathing until they breathe on their own or emergency responders take over.

If you must leave the person briefly (for example, to get naloxone or call 911), roll them onto their side in the recovery position so they do not choke if they vomit.

Connecting to professional addiction treatment

An overdose emergency is a critical opportunity to connect individuals to life-saving medical care and ongoing recovery support.

  • Hospital evaluation: Always encourage hospital evaluation even after naloxone successfully reverses an overdose. Naloxone wears off in 30 to 90 minutes, whereas some synthetic opioids (such as fentanyl) stay in the body longer, carrying a risk of recurring overdose.
  • Substance use helplines: Contact professional referral hotlines for free, confidential guidance on medical detoxification, residential rehab, and Medication-Assisted Treatment (MAT):
  • United States: SAMHSA National Helpline: 1-800-662-4357.
  • United Kingdom: NHS National Alcohol and Drug Helpline: 0300 123 6600.
  • Canada: Mental Health & Substance Use Crisis Helpline: 988.

... note "Naloxone access" Naloxone is available over the counter without a prescription in many pharmacy locations and community health centers. Taking a basic overdose response course saves lives.