How to Aid Someone Overdosing - Healthy Blue Zone

Overdoses are a critical, time-sensitive medical emergency. Recognizing the signs and knowing how to respond can be the difference between life and death. This guide provides a comprehensive, actionable framework for aiding someone experiencing an overdose, empowering you to act effectively and confidently in a crisis.

Recognizing the Signs of an Overdose

The first crucial step in aiding someone who is overdosing is to identify that an overdose is occurring. Signs vary depending on the substance, but there are common indicators to look for.

Opioid Overdose Signs

Opioids (heroin, fentanyl, oxycodone, morphine, etc.) are central nervous system depressants, meaning they slow down vital bodily functions. Recognizing an opioid overdose is particularly critical due to the widespread availability of highly potent synthetic opioids like fentanyl.

Pinpoint Pupils: The pupils of their eyes may be extremely small, like the head of a pin.
Slow, Shallow, or Absent Breathing: Their breathing will be significantly slowed, irregular, or they may stop breathing entirely. This is the most dangerous symptom, as it leads to oxygen deprivation. Listen for gurgling or snoring sounds, which can indicate airway obstruction.
Bluish or Grayish Skin, Lips, and Fingernails: This is due to a lack of oxygen. On darker skin tones, this may appear as an ashen or grayish discoloration of the mouth, gums, and under the fingernails.
Unresponsiveness: They may be difficult to awaken or completely unresponsive to shouting, shaking, or pain stimuli (like a sternum rub).
Limp Body: Their muscles may become completely relaxed, and their body will appear limp.
Slowed Heartbeat or Pulse: Their pulse may be weak or difficult to find.

Example: You walk into a room and find your friend slumped over, unresponsive. You try to shake them, but they don’t stir. You notice their breathing is very shallow, almost imperceptible, and their lips have a bluish tint. This combination of symptoms strongly suggests an opioid overdose.

Stimulant Overdose Signs

Stimulants (cocaine, methamphetamine, Adderall, ecstasy) speed up the central nervous system, leading to an opposite set of symptoms compared to opioids.

Chest Pain: This can be severe and may mimic a heart attack.
Seizures: Uncontrolled electrical activity in the brain can lead to convulsions.
Rapid Heartbeat and High Blood Pressure: Their heart will be racing, and their pulse will be very fast and strong.
Agitation, Paranoia, or Hallucinations: They may be extremely restless, anxious, or experience vivid sensory distortions.
High Body Temperature (Hyperthermia): Their skin may feel hot to the touch, and they may be sweating profusely.
Irregular Breathing: While not typically slowed like opioid overdoses, their breathing may be rapid and erratic.
Unconsciousness: In severe cases, they may lose consciousness.

Example: Your acquaintance is at a party and suddenly collapses, clutching their chest. They are sweating profusely, their eyes are wide and darting, and they begin to convulse. This scenario points toward a stimulant overdose.

Depressant Overdose Signs (Non-Opioid)

Depressants like benzodiazepines (Xanax, Valium) or alcohol also slow down the central nervous system but have distinct characteristics from opioids.

Extreme Drowsiness or Sedation: They may be very difficult to keep awake or completely unconscious.
Slowed or Shallow Breathing: Similar to opioids, but often less severe unless combined with other depressants.
Slurred Speech: Their words may be difficult to understand.
Loss of Coordination: They may stumble, fall, or have difficulty walking.
Confusion or Disorientation: They may not know where they are or what’s happening.
Nausea and Vomiting: Especially common with alcohol overdose.
Cold, Clammy Skin: Their skin may feel cool and moist.

Example: You find your roommate passed out on the floor after a night of heavy drinking. You can’t wake them, their breathing is very slow and shallow, and their skin is cool and clammy. This indicates a severe alcohol overdose.

Mixed Overdose Signs

It’s crucial to remember that individuals often mix substances, leading to a complex array of symptoms. For instance, combining opioids with benzodiazepines can drastically increase respiratory depression. Always assume the most dangerous possible scenario and err on the side of caution.

The Immediate Action Plan: Call for Help and Ensure Safety

Once you suspect an overdose, immediate action is paramount. Time is of the essence.

Call Emergency Services Immediately (911 or Local Equivalent)

This is the single most important step. Do not hesitate. Even if you have Narcan (naloxone) or other interventions, professional medical help is essential.

Clearly State the Emergency: When you call, calmly and clearly state that someone is overdosing and provide your exact location. “I need an ambulance! Someone is overdosing at [your address/cross streets/identifiable landmarks].”
Provide Details: If possible, tell them what substance you suspect was taken, how much (if known), and when. Describe the person’s current condition: “They are unconscious and not breathing,” or “They are having a seizure.”
Stay on the Line: Do not hang up until the operator tells you to. They may provide instructions for you to follow until paramedics arrive.

Example: You’ve identified an opioid overdose. Your first action is to grab your phone and dial 911. As soon as someone answers, you say, “I need an ambulance, immediately. Someone is overdosing on opioids at 123 Main Street, apartment 4B. They’re unconscious and barely breathing. Their lips are blue.”

Ensure Safety for Yourself and the Person

Before approaching or administering aid, quickly assess the environment for any dangers.

Check for Hazmat or Sharps: Are there needles, broken glass, or hazardous chemicals around? If so, proceed with extreme caution or wait for professionals if the risk is too high.
Clear the Area: Move any objects that could cause injury if the person convulses or falls. For example, if they’re on a hard floor, try to slide a blanket or pillow under their head.
Protect Yourself: If there’s blood or other bodily fluids, wear gloves if available.

Example: You see a syringe on the floor next to the person who is overdosing. You carefully move it out of the way using a thick piece of cardboard or a shoe, ensuring you don’t touch it directly, before attending to the individual.

Administering Naloxone (Narcan) for Opioid Overdose

If you suspect an opioid overdose, and you have naloxone (Narcan), administer it immediately after calling emergency services. Naloxone is a life-saving medication that rapidly reverses the effects of an opioid overdose. It is safe and has no effect if opioids are not present.

How Naloxone Works

Naloxone is an opioid antagonist. It rapidly binds to opioid receptors in the brain, effectively blocking opioids from attaching and reversing their depressive effects on breathing. It works within minutes.

Types of Naloxone and Administration

Naloxone is available in various forms, most commonly as a nasal spray or an injectable.

Nasal Spray (e.g., Narcan Nasal Spray)

This is the most common and easiest form for laypeople to administer.

Peel Back Pouch: Remove the device from its packaging.
Hold with Thumb and Fingers: Hold the device with your thumb on the bottom of the plunger and your first and middle fingers on either side of the nozzle.
Insert into Nostril: Gently insert the tip of the nozzle into one nostril until your fingers are against the bottom of the person’s nose.
Press Plunger Firmly: Press the plunger firmly to release the dose into the nostril.
Wait and Observe: The person should start to show signs of improvement within 2-3 minutes. Their breathing should become more regular, and they may become more responsive.
Administer Second Dose if Needed: If there’s no improvement after 2-3 minutes, or if they continue to show signs of overdose, administer a second dose in the other nostril. Continue alternating nostrils for subsequent doses if more are available and needed.
Stay with Them: Remain with the person until emergency services arrive.

Example: Your friend is unconscious and showing opioid overdose signs. You grab your Narcan nasal spray. You open the package, insert the nozzle into their nostril, and firmly press the plunger. You then carefully watch for changes in their breathing and responsiveness.

Injectable (e.g., Evzio Auto-Injector or Vial/Syringe)

Injectable naloxone requires more training but is equally effective.

Evzio Auto-Injector: This device is designed for ease of use and often comes with verbal instructions. Follow the voice prompts, which typically involve placing the injector against the outer thigh and pressing down firmly.
Vial and Syringe: This requires drawing the correct dose from a vial into a syringe. The typical administration is intramuscular (into a large muscle like the thigh or deltoid).
1. Draw Up Dose: Remove the cap from the naloxone vial. Insert the needle into the vial and draw back the plunger to the correct dose (typically 0.4mg to 2mg, check the packaging or local guidelines).
2. Locate Injection Site: Identify a large muscle, such as the outer thigh or upper arm.
3. Clean Site: If possible, wipe the injection site with an alcohol swab.
4. Inject: Insert the needle straight into the muscle. Depress the plunger to inject the medication. Withdraw the needle.
5. Apply Pressure: Apply gentle pressure to the injection site.

Example: You have an Evzio auto-injector. You pull it out, turn it on, and listen to the clear voice instructions. You place it firmly against your friend’s outer thigh as instructed, and the device automatically delivers the dose.

After Naloxone Administration

Monitor Breathing: Continue to monitor their breathing closely. Naloxone’s effects can wear off, and they may fall back into an overdose state, especially if potent opioids like fentanyl are involved.
Turn to Recovery Position: If they start breathing independently but remain unconscious or are drowsy, turn them onto their side in the recovery position. This prevents them from choking on vomit if they become nauseous.
Stay with Them: Do not leave the person alone. They need continuous monitoring until medical professionals arrive.
Explain to Paramedics: When paramedics arrive, inform them that you administered naloxone, how much, and when.

Basic Life Support (BLS) Measures

While waiting for emergency services, if the person is unresponsive and not breathing, or only gasping, you may need to perform basic life support.

Assess Responsiveness and Breathing

Shout and Shake: Gently shout their name and shake them.
Check for Breathing: Look, listen, and feel for breathing. Look for chest rise, listen for breath sounds, and feel for air movement from their nose or mouth. If they’re not breathing normally or are only gasping, assume they are in cardiac arrest.

Open the Airway (Head-Tilt, Chin-Lift)

If the person is unconscious, their tongue can fall back and block their airway.

Place Hand on Forehead: Place one hand on their forehead.
Place Fingers Under Chin: Place the fingers of your other hand under the bony part of their chin.
Tilt Head and Lift Chin: Gently tilt their head back while lifting their chin forward to open the airway. Be careful not to press on the soft tissues of the neck, as this can obstruct the airway.

Example: You’ve checked for breathing and found none. You then place your hand on their forehead and gently lift their chin, immediately noticing that their chest seems to rise slightly as if their airway is now clear.

Provide Rescue Breaths (If Trained and Willing)

If the person is not breathing, but has a pulse, rescue breaths can provide vital oxygen. Only perform rescue breaths if you are trained and comfortable. In the era of COVID-19, chest compressions are often prioritized for lay rescuers, but rescue breaths are crucial in an opioid overdose where respiratory arrest is the primary issue.

Maintain Open Airway: Keep the airway open using the head-tilt, chin-lift maneuver.
Pinch Nose: Pinch their nose closed.
Create Seal: Take a normal breath and place your mouth tightly over theirs, creating a good seal.
Deliver Breaths: Give two slow breaths, each lasting about 1 second, watching for chest rise. Allow the chest to fall between breaths.
Continue: Continue giving one breath every 5-6 seconds (about 10-12 breaths per minute) until breathing resumes or paramedics arrive.

Example: After opening their airway, you pinch their nose, seal your mouth over theirs, and deliver two slow breaths, observing their chest rise with each breath. You then continue with one breath every few seconds.

Chest Compressions (CPR)

If the person is unresponsive, not breathing, and has no pulse, begin chest compressions immediately. Hands-Only CPR is acceptable if you are not trained in rescue breaths.

Position: Lie the person on their back on a firm, flat surface.
Locate Hand Position: Kneel beside the person. Place the heel of one hand in the center of their chest, directly on the lower half of the breastbone. Place your other hand on top of the first, interlocking your fingers.
Arm Position: Keep your arms straight and your shoulders directly over your hands.
Compressions: Push hard and fast, compressing the chest at least 2 inches (5 cm) deep at a rate of 100-120 compressions per minute. Allow the chest to fully recoil after each compression.
Continue: Continue compressions until emergency services arrive, an AED (Automated External Defibrillator) is available and ready for use, or the person shows signs of life.

Example: Your friend is unconscious, not breathing, and you can’t feel a pulse. You immediately position your hands on their chest, lock your elbows, and begin pushing down hard and fast, counting to ensure you’re at the correct rate.

The Recovery Position

If the person begins to breathe on their own but remains unconscious or becomes drowsy, placing them in the recovery position is vital to prevent them from choking on vomit or their tongue.

How to Place Someone in the Recovery Position

Kneel Beside Them: Kneel next to the person’s side.
Straighten Arm: Place the arm closest to you straight out, at a right angle to their body, palm facing up.
Bring Other Arm Across: Bring their other arm across their chest and hold the back of their hand against the cheek closest to you.
Bend Leg: With your other hand, grasp the leg furthest from you just above the knee and pull it up so the foot is flat on the ground.
Roll Towards You: Keeping their hand pressed against their cheek, gently pull on the bent knee to roll them onto their side, facing you.
Adjust Position: Adjust the top leg so both hip and knee are bent at right angles. This stabilizes the position. Ensure their top arm supports their head and neck.
Check Airway: Make sure their airway remains open.

Example: After administering Narcan, your friend starts to take shallow breaths but is still unresponsive. You carefully roll them onto their side, supporting their head with their arm, ensuring their airway is clear and stable.

What Not to Do During an Overdose

Knowing what not to do is as important as knowing what to do. Misguided interventions can cause further harm.

Do NOT Leave Them Alone: Even if they seem to be recovering, their condition can rapidly deteriorate. Stay with them until medical help arrives.
Do NOT Induce Vomiting: This is dangerous and ineffective. The person could choke on their vomit, especially if they are unconscious.
Do NOT Put Them in a Cold Shower: This can lead to shock and further complications like hypothermia.
Do NOT Try to “Walk It Off”: Forcing someone to walk or move around can worsen their condition, especially with stimulant overdoses that can strain the heart.
Do NOT Give Them Stimulants (e.g., Coffee, Energy Drinks): This can dangerously interact with depressants and worsen stimulant overdoses. It can also cause seizures or heart problems.
Do NOT Inject Them with Saltwater or Milk: These are ineffective and can introduce infections or other complications.
Do NOT Slap or Hit Them: This is abusive and unhelpful. It can cause injury without providing any benefit.
Do NOT Blame or Shame Them: The priority is saving a life. Judgment can wait, or ideally, be avoided entirely. Focus solely on providing aid.
Do NOT Assume They Are “Faking”: Always treat suspected overdose as a life-threatening emergency.

Example: Your initial thought might be to splash cold water on your friend to wake them up. However, recalling this guide, you know this is dangerous and instead focus on calling 911 and monitoring their breathing.

After the Immediate Crisis: Supporting Recovery and Preventing Future Incidents

Saving a life is the immediate goal, but the aftermath of an overdose is critical for long-term recovery and prevention.

The Importance of Medical Evaluation

Even if naloxone revives someone or they appear to recover on their own, they still need to be evaluated by medical professionals.

Naloxone Wears Off: Naloxone’s effects are temporary (30-90 minutes). The person can fall back into an overdose once it wears off, especially with long-acting opioids or highly potent ones like fentanyl.
Underlying Complications: Overdoses can cause hidden damage to organs (brain, heart, kidneys) due to lack of oxygen or direct drug toxicity.
Other Substances: They may have taken other substances that require different medical interventions.
Mental Health: An overdose can be a sign of underlying mental health issues or addiction that require professional intervention.

Example: Your friend is awake and talking after Narcan, insisting they are fine and want to go home. You firmly but kindly explain that they need to be checked by paramedics to ensure they don’t fall back into an overdose and to assess for any other complications.

Open Communication and Support

Approaching the situation with empathy and non-judgment is crucial for supporting the individual.

Create a Safe Space: Let them know you’re there to help, not to judge.
Express Concern, Not Anger: Focus on your concern for their well-being.
Encourage Professional Help: Once the immediate crisis is over, gently encourage them to seek professional help for substance use disorder. Offer to help them find resources.
Listen Actively: Be prepared to listen without interruption or immediate solutions. Sometimes, just being heard can be a significant step.

Example: After the paramedics have left, you sit down with your friend. Instead of lecturing, you say, “I was really scared for you. I care about you, and I want to help you get through this. Have you thought about talking to someone about what happened?”

Connecting to Resources

Providing information about available resources can be life-changing.

Addiction Treatment Centers: Help them locate local treatment centers, both inpatient and outpatient.
Support Groups: Suggest Narcotics Anonymous (NA), Alcoholics Anonymous (AA), or other peer support groups.
Harm Reduction Services: Direct them to harm reduction services, such as needle exchange programs, naloxone distribution sites, or safe consumption sites (where legal). These services aim to reduce negative health and social consequences associated with drug use.
Mental Health Professionals: Overdose can be linked to underlying mental health conditions. Suggest therapists or psychiatrists who specialize in co-occurring disorders.
Crisis Hotlines: Provide numbers for crisis hotlines if they are experiencing suicidal thoughts or severe distress.

Example: You do some research online and find a local NA meeting schedule and the number for a nearby harm reduction center that distributes naloxone. You write these down and offer them to your friend, emphasizing that you’re not forcing them, but these options are available when they’re ready.

Personal Preparedness: Carrying Naloxone

If you know someone at risk of opioid overdose, carry naloxone and learn how to use it. Many states and countries have laws that allow pharmacists to dispense naloxone without a personal prescription, making it more accessible.

Get Trained: Many community organizations offer free training on overdose recognition and naloxone administration.
Keep it Accessible: Store naloxone in an easily accessible place, like a first-aid kit or a readily available bag.
Inform Others: Let family and friends know you carry it and how to use it in an emergency.

Example: After this experience, you decide to get certified in Narcan administration and keep a kit in your car and backpack, just in case you ever encounter someone experiencing an opioid overdose again. You also tell your family where it’s stored.

Conclusion

Responding to an overdose is a daunting but incredibly vital skill. By understanding the signs, acting quickly to call for help, and knowing how to administer naloxone and perform basic life support, you can make a profound difference. Remember, your calm, swift, and compassionate actions can be the critical link that saves a life, offering a chance for recovery and a healthier future.