Unresponsive or not breathing normally?Call 911 now

What to do if someone is overdosing on opioids

Medically reviewed by Asia, RN, BSN

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

Price and class details checked .

Try to wake them by calling their name, give naloxone if you have it and call 911, and help their breathing with rescue breaths or CPR if you are trained. Stay with them at least 4 hours after the last naloxone dose, because naloxone can wear off in 30 to 90 minutes. If you are not sure whether it is an overdose, CDC says to treat it like one.

Study these steps before you ever need them: our SOS First Aid app lays out the BLS response to opioid emergencies in clear numbered steps, and its AI assistant answers your questions.

Signs of an opioid overdose

  • They cannot be woken up, or will not respond.
  • Slow or shallow breathing, or choking, gurgling or snoring sounds while they cannot be woken.
  • Blue or purple lips or nails. On darker skin, the skin may look pale, gray or ashen.
  • Very small pinpoint pupils that do not react to light.
CDCSAMHSA

Steps

  1. Check for a response.

    Call their name. If they do not respond, rub your knuckles on the center of their chest or on their upper lip.

    SAMHSA
  2. Give naloxone if you have it, and call 911.

    Anyone can give naloxone. It does not harm a person who is not having an opioid overdose. If they do not start breathing normally, a second dose may be needed; see where sources differ below.

    CDCSAMHSAAHA 2025
  3. Help them breathe.

    Breathing matters more than waking them up. If you are trained, give rescue breaths or CPR. If you are not, follow the 911 operator's instructions.

    SAMHSA
  4. When breathing returns, use the recovery position.

    Gently roll them onto their side with the top leg bent, so they do not choke.

    SAMHSACDC
  5. Stay for at least 4 hours after the last naloxone dose.

    Naloxone can wear off in 30 to 90 minutes, and the overdose can come back. Even if they wake up, they still need emergency care.

    SAMHSACDCRed Cross

What not to do

  • Do not slap them or try to force them awake.
  • Do not put them in a cold shower or bath.
  • Do not inject anything, such as saltwater, milk or stimulants.
  • Do not try to make them vomit.
SAMHSA

Where sources differ

Naloxone or 911 first. CDC lists giving naloxone and calling 911 together as one step. SAMHSA says that if the person is unresponsive, give naloxone as quickly as possible and then call 911. The Red Cross says to call 911, then give naloxone. If two people are there, one can call while the other gives naloxone.

When to give a second dose. CDC and SAMHSA say to wait 2 to 3 minutes for normal breathing before a second dose. The Red Cross says to give a second dose with a new device if there is no improvement after 5 minutes. Follow the product directions and the 911 dispatcher.

Breaths or chest compressions. SAMHSA puts breathing first and says to give rescue breaths if you can. The AHA's 2025 steps for the public say that if the person is not breathing or only gasping, start CPR and use an AED, and give naloxone if you have it. Our Narcan or CPR first guide puts every source side by side.

Learn it before you need it

Our SOS First Aid app is the easiest place to start: a pocket study guide for AHA BLS, ACLS, PALS and First Aid CPR/AED built on the 2025 guidelines, with practice quizzes to check what you remember. To practice on a manikin, we teach AHA Heartsaver First Aid CPR AED ($98) and, for healthcare workers, Red Cross BLS ($69), courses the AHA and the Red Cross list as covering opioid emergencies.

Questions people ask

How can I tell an overdose from someone who is just very high?

It can be hard to tell. CDC says that if you are not sure, treat it like an overdose. Signs include not waking up, slow or shallow breathing, choking or gurgling sounds, blue or purple lips or nails, and pinpoint pupils.

Can naloxone hurt someone who is not overdosing on opioids?

CDC says naloxone will not harm someone who is overdosing on drugs other than opioids, and SAMHSA says it does not cause harm if the person is not having an opioid overdose. In someone who is physically dependent on opioids, it can cause withdrawal symptoms.

How long does naloxone last?

SAMHSA says naloxone wears off after 30 to 90 minutes and overdose symptoms may return. CDC says to stay with them until emergency help arrives or for at least four hours, and SAMHSA says to stay at least 4 hours from the last dose.

What if I do not have naloxone?

Call 911 and support their breathing. SAMHSA says that if you do not have training in rescue breathing and chest compressions, follow the instructions of the 911 operator. When breathing returns, place them on their side.

Will I get in trouble for calling 911?

California law says it is not a crime to be under the influence, or to have drugs for personal use, when you seek medical help in good faith for someone who is overdosing and do not obstruct responders. It does not cover everything. Read what California law covers.

Related guides

Sources

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