Unresponsive or not breathing normally?Call 911 now

Do you give Narcan or start CPR first?

Medically reviewed by Asia, RN, BSN

Written by Justin Alcalde, AHA and American Red Cross instructor, CPR West Covina

Price and class details checked October 19, 2026.

Breathing decides it. If the person is not breathing or only gasping, the AHA's 2025 steps for the public say to call for help, start CPR, and give naloxone if you have it, then go right back to CPR. If they cannot be woken but are still breathing, CDC, SAMHSA and the California Department of Public Health put naloxone and 911 first, then support their breathing. Either way, naloxone does not replace a 911 call.

To have this decision settled before you face it, study with our SOS First Aid app: its BLS section covers CPR, AED use and opioid emergencies, built on the 2025 AHA guidelines.

Start with what you see

What you see	What the sources say to do
Not breathing, or only gasping	Call 911 and get an AED. Start CPR. If you suspect an opioid overdose, give naloxone if you have it, then resume CPR. (AHA 2025)
Cannot be woken, breathing slow or shallow	Give naloxone and call 911. Keep them breathing: rescue breaths if you are trained, otherwise follow the 911 operator. (CDC, SAMHSA, CDPH)
Cannot be woken, breathing normally	Call 911. The Red Cross says CPR is not needed while they breathe normally: place them on their side and keep checking their breathing.
Wakes up after naloxone	Stay with them. Naloxone can wear off in 30 to 90 minutes (SAMHSA), and they still need emergency care (Red Cross).

What each authority says

Source	Naloxone and 911	Breathing and CPR	Second dose
CDC	Give naloxone if available and call 911, listed as one step.	Keep them awake and breathing, and lay them on their side. CDC's steps do not mention CPR.	Wait 2 to 3 minutes for normal breathing before a second dose.
SAMHSA toolkit (2024)	If they are unresponsive, give naloxone as quickly as possible, then call 911.	Rescue breaths if you can. If you are not trained, follow the 911 operator. Recovery position once breathing returns.	After 2 to 3 minutes with no breathing or response, and every 2 to 3 minutes after that.
AHA 2025, steps for the public	Not breathing or only gasping: call for help and get an AED first.	Start CPR. Give naloxone if overdose is suspected, then resume CPR.	Not covered in the chart.
Red Cross (2026 naloxone article)	Check the scene and the person, call 911, then give naloxone.	Breathing normally: on their side, no CPR. Not breathing normally: CPR and an AED.	If there is no improvement after 5 minutes, use a new device.
California Department of Public Health	Give naloxone and call 911.	If they are not breathing, you can do rescue breathing or CPR. Lay them on their side.	After 2 to 3 minutes, with a new container.

CDC SAMHSA AHA 2025 Red Cross CDPH

The AHA and the Red Cross also wrote a joint first aid guideline in 2024. It says a first aid provider who finds someone with a suspected opioid overdose who is unresponsive and not breathing normally should call for emergency help, give high-quality CPR with compressions and breaths, and give naloxone.

AHA and Red Cross 2024

Where sources differ

Which comes first, naloxone or 911. CDC joins them in one step, SAMHSA says naloxone then 911, and the Red Cross says 911 then naloxone. The AHA chart for the public starts with calling for help when the person is not breathing normally. All of them say to do both, right away.

Breaths or compressions. SAMHSA says breathing is the goal and to give rescue breaths if you can. The AHA 2025 chart for the public shows compressions plus naloxone, and the 2024 first aid guideline says compressions plus breaths. CDC does not mention either. If you are unsure, follow the 911 dispatcher and what you were trained to do.

Timing of a second dose. CDC, SAMHSA and CDPH say 2 to 3 minutes. The Red Cross says 5 minutes.

More than one dose for fentanyl. CDC says more than one dose may be needed when stronger opioids like fentanyl are involved. SAMHSA says more than one dose may not be necessary for a known fentanyl overdose.

Learn it before you need it

Our SOS First Aid app helps the order stick: practice quizzes test you on the BLS steps, and a Pro subscription adds the full exam and unlimited AI scenarios. When you want your hands on a manikin, our Heartsaver First Aid CPR AED class ($98) and Red Cross BLS ($69) both include opioid emergencies.

Questions people ask

Does CPR work on an overdose?

It helps, and it is not enough on its own. The AHA says ventilation is essential in conditions such as opioid overdose, so breaths matter. CPR does not reverse the opioid, which is why every source we read also says to give naloxone and call 911.

Should I do Hands-Only CPR or give breaths?

The AHA 2025 chart for the public shows compressions, while the 2024 AHA and Red Cross first aid guideline says compressions plus breaths for a suspected opioid overdose. SAMHSA says to give rescue breaths if you can. If you are not trained in breaths, follow the 911 dispatcher.

Can I give naloxone to someone in cardiac arrest?

The AHA 2025 guidelines say it may be reasonable for lay and trained rescuers, as long as it does not get in the way of high-quality CPR with breaths. The AHA notes there are no clinical trials on this, and no known harm from giving naloxone in cardiac arrest.

Is the order different for nurses and other healthcare providers?

Yes. The AHA 2025 BLS chart for healthcare providers checks breathing and pulse together. With a pulse but abnormal breathing, give rescue breaths and naloxone if available; with no pulse, start CPR and consider naloxone. See the BLS steps for opioid overdose.

Sources

This page is education, not medical or legal advice. In an emergency, call 911 first.