Category: Health & Safety

What to Do When Someone May Have Overdosed

An overdose happens when a person takes or is exposed to enough of a medication, drug, alcohol, or other substance to cause serious harm. It may be accidental or intentional. It may involve a prescription medication, an over-the-counter product, an illegal drug, alcohol, or several substances taken together.

You do not need to know exactly what the person took before calling for help. If the person cannot be awakened, is having a seizure, has collapsed, or is not breathing normally, call 911 immediately.

When opioids may be involved, give naloxone if it is available. Naloxone can temporarily reverse the life-threatening effects of an opioid overdose, but it does not replace emergency medical care.

Stay calm, focus on the person’s breathing, and remain with them until emergency professionals arrive.

Recognizing a Possible Overdose

Overdose symptoms vary depending on the substance involved. Possible warning signs include:

• Inability to awaken the person
• Extreme sleepiness
• Confusion or unusual behavior
• Slow, shallow, irregular, or stopped breathing
• Gasping, gurgling, choking, or snoring-like sounds
• Blue, purple, gray, or unusually pale lips or fingernails
• Very small or very large pupils
• Vomiting
• Seizure
• Chest pain
• Very fast, slow, or irregular heartbeat
• Severe agitation or panic
• Hallucinations
• Extreme sweating
• Very high body temperature
• Loss of coordination
• Limpness
• Collapse or unconsciousness

Do not assume a person making snoring or gurgling sounds is sleeping safely. If the person cannot be awakened, those sounds may indicate that their airway or breathing is in danger.

When to Call 911

Call 911 immediately if the person:

• Cannot be awakened
• Has collapsed
• Is having a seizure
• Is not breathing normally
• Is breathing very slowly or irregularly
• Has blue, gray, or purple lips or fingernails
• Is making choking or gurgling sounds
• Has severe chest pain
• Is extremely agitated, violent, or confused
• Has a dangerously high body temperature
• May have intentionally taken an overdose
• May have taken an unknown substance
• May have taken multiple substances
• Is rapidly getting worse

If you are unsure whether the situation is serious, call 911. It is safer to have the person evaluated than to wait for symptoms to worsen.

Do not leave the person alone to make the call. Put your phone on speaker so you can provide care while speaking with the dispatcher.

Step 1: Check the Area for Danger

Before approaching, look for hazards such as:

• Loose powder
• Needles
• Broken glass
• Chemical fumes
• Drug-manufacturing materials
• Fire
• Weapons
• Violent behavior
• Traffic or other environmental dangers

Do not touch needles with bare hands. Avoid contact with unknown powders, liquids, patches, or chemicals. Wear gloves if they are available.

Routine skin contact with intact tablets is not usually an emergency, but unknown substances should still be handled cautiously. Do not taste, smell, or closely examine a powder to identify it.

If the area is unsafe, move away and tell the 911 dispatcher what you see.

Step 2: Check for Responsiveness

Speak loudly:

“Are you okay?”

Gently tap the person’s shoulders. Look for purposeful movement, speech, or eye opening.

Do not:

• Slap the person
• Kick them
• Shake them violently
• Pour water on them
• Put them in a cold shower
• Cause pain in an attempt to wake them

If the person does not respond normally, call 911 and check their breathing.

Step 3: Check for Normal Breathing

Look for chest movement and listen for breathing for no more than 10 seconds.

Dangerous breathing may be:

• Very slow
• Shallow
• Irregular
• Interrupted by long pauses
• Limited to occasional gasps
• Accompanied by choking, gurgling, or snoring-like sounds
• Completely absent

Gasping is not normal breathing.

If the person is unresponsive and not breathing normally, begin CPR and use an AED as soon as one becomes available.

If the Person Is Not Breathing Normally

If an adult or teen is unresponsive and not breathing normally:

1. Call 911 and put the phone on speaker.
2. Place the person on their back on a firm, flat surface.
3. Begin CPR.
4. Send someone to get an AED and naloxone.
5. Use the AED as soon as it arrives.
6. Give naloxone when opioid exposure is possible.
7. Continue following the dispatcher’s instructions.

For Hands-Only CPR:

• Place both hands in the center of the chest.
• Keep your arms straight.
• Push hard and fast.
• Give 100 to 120 compressions per minute.
• Allow the chest to return to its normal position after each compression.

Because an overdose often causes breathing to fail before the heart stops, rescue breaths can be especially helpful. If you have been trained in conventional CPR, provide chest compressions and rescue breaths according to your training.

If you are not trained or are unwilling to give breaths, continue chest compressions. Doing something is better than doing nothing.

CPR techniques differ for children and infants. Follow your current training and the 911 dispatcher’s instructions.

Recognizing an Opioid Overdose

Opioids include:

• Fentanyl
• Heroin
• Oxycodone
• Hydrocodone
• Morphine
• Codeine
• Methadone
• Buprenorphine
• Tramadol
• Other prescription pain medications

Illegally manufactured fentanyl may also be present in counterfeit pills, cocaine, methamphetamine, or other drugs without the person knowing it.

Signs of an opioid overdose may include:

• Inability to awaken
• Limp body
• Slow, shallow, or stopped breathing
• Gurgling, choking, or snoring-like sounds
• Very small “pinpoint” pupils
• Pale, gray, blue, or purple skin, lips, or fingernails
• Slow heartbeat
• Vomiting

Do not wait for every sign to appear. If opioids might be involved and the person is unresponsive or breathing abnormally, give naloxone.

SAMHSA’s overdose guidance identifies inability to awaken, abnormal breathing, blue or purple lips, limpness, and gurgling sounds as signs requiring immediate action.

What Is Naloxone?

Naloxone is an emergency medication that temporarily blocks the effects of opioids. It may restore normal breathing within a few minutes.

Naloxone does not produce a high and cannot be misused to create opioid effects. It generally will not harm someone if opioids are not responsible for their condition.

Naloxone will not reverse overdoses caused only by:

• Alcohol
• Benzodiazepines
• Cocaine
• Methamphetamine
• Antidepressants
• Acetaminophen
• Other non-opioid medications

However, naloxone should still be given when opioids may be involved because people do not always know what a substance contains. Continue CPR or rescue breathing and obtain emergency help even after administering it.

Naloxone’s effects are temporary. Opioids may remain in the body longer than naloxone, which means the person’s breathing can slow again after they initially improve.

How to Use Naloxone Nasal Spray

Different products may contain different strengths or instructions. Follow the directions packaged with the device.

For a common single-use nasal spray:

1. Remove the device from its package.
2. Do not test or prime it.
3. Place the person on their back.
4. Support the back of the neck and tilt the head slightly back.
5. Insert the nozzle into one nostril until your fingers touch the bottom of the nose.
6. Press the plunger firmly to release the full dose.
7. Remove the device.
8. Note the time the dose was given.
9. Continue CPR or rescue breathing as needed.
10. Follow the 911 dispatcher’s instructions.

Each nasal device normally contains one dose. Do not attempt to reuse an empty device.

If the person does not respond or resume normal breathing after approximately two to three minutes, give another dose using a new device if one is available. Alternate nostrils when practical.

Stronger or long-acting opioids may require more than one naloxone dose. Do not delay breathing support while waiting for naloxone to work.

The CDC’s naloxone guidance recommends giving one dose, waiting two to three minutes for normal breathing to return, and giving another dose when necessary.

Injectable Naloxone

Injectable naloxone products have different devices, doses, and instructions.

If injectable naloxone is available:

• Follow the exact instructions supplied with the product.
• Use it only if you understand how that device is administered.
• Continue breathing support.
• Call 911.
• Do not delay care while struggling with unfamiliar equipment.

A pharmacist, healthcare professional, or community overdose-prevention program can provide training before an emergency occurs.

After Naloxone Is Given

A person may wake suddenly after receiving naloxone. They may be:

• Confused
• Frightened
• Agitated
• Nauseated
• Vomiting
• Sweating
• Shaking
• Experiencing body aches
• Experiencing sudden opioid withdrawal

Speak calmly and explain:

“You may have overdosed. I gave you naloxone. An ambulance is coming.”

Do not argue with or restrain the person unless immediate safety requires it. Give them space while protecting them from traffic, falls, weapons, or other dangers.

Do not allow the person to:

• Take more drugs
• Drink alcohol
• Drive
• Walk away alone
• Refuse monitoring simply because they feel better

The naloxone may wear off before the opioid does. Emergency evaluation is necessary even when the person appears fully awake.

If the Person Is Breathing but Unconscious

If the person is breathing normally but cannot be awakened:

1. Call 911.
2. Give naloxone if opioid exposure is possible.
3. Place the person in the recovery position.
4. Keep the airway open.
5. Watch their breathing continuously.
6. Be prepared to begin CPR.
7. Stay with them.

To use the recovery position:

• Roll the person onto their side.
• Position the lower arm so it does not remain trapped beneath the body.
• Bend the upper knee to stabilize them.
• Angle the face slightly downward.
• Keep the head positioned so the airway remains open.

This position helps prevent choking if the person vomits.

If a serious neck or back injury is possible, avoid unnecessary movement. However, maintaining an open airway and preventing choking take priority. Follow the dispatcher’s instructions.

If the Person Vomits

If the person vomits while breathing:

• Turn them onto their side.
• Allow the vomit to drain from the mouth.
• Wipe away material that is clearly visible.
• Do not reach blindly into the mouth.
• Continue watching their breathing.

If vomiting occurs during CPR:

1. Briefly roll the person onto their side.
2. Clear visible material from the mouth.
3. Return them to their back.
4. Resume CPR immediately.

Do not give food, water, coffee, or medication by mouth to a person who is unconscious, confused, seizing, or unable to swallow safely.

If the Person Has a Seizure

Some overdoses can cause seizures.

During a seizure:

• Move dangerous objects away.
• Protect the person’s head with something soft.
• Do not hold them down.
• Do not place anything in their mouth.
• Do not give food, liquid, or medication by mouth.
• Time the seizure.
• Call 911.
• Check breathing when the movements stop.
• Begin CPR if the person is not breathing normally.

Place the person on their side after the seizure if they are breathing normally and no injury prevents safe movement.

Stimulant Overdose

Cocaine, methamphetamine, MDMA, and other stimulants may produce a different overdose pattern.

Possible signs include:

• Severe agitation
• Panic or paranoia
• Hallucinations
• Chest pain
• Very fast or irregular heartbeat
• Heavy sweating
• Hot or flushed skin
• Very high body temperature
• Tremors
• Seizures
• Severe headache
• Stroke-like symptoms
• Collapse

Call 911 immediately.

While waiting:

• Move unnecessary people away.
• Reduce noise, bright lights, and stimulation.
• Speak calmly.
• Do not argue about hallucinations or paranoid beliefs.
• Remove nearby objects that could cause injury.
• Do not physically restrain the person unless required to prevent immediate harm.
• Move them to a cooler area if this can be done safely.
• Remove excess outer clothing.
• Apply cool, damp cloths when overheating is suspected.
• Do not place the person in an ice bath.
• Do not give medications, alcohol, or other drugs.

Give naloxone if opioid contamination is possible, particularly when the person becomes unresponsive or develops abnormal breathing.

Sedative or Alcohol Overdose

Alcohol, benzodiazepines, sleep medications, muscle relaxants, and other sedating substances can dangerously slow breathing. Combining them with opioids greatly increases overdose risk.

Possible signs include:

• Inability to awaken
• Slow or irregular breathing
• Confusion
• Loss of coordination
• Vomiting
• Pale, clammy, or bluish skin
• Low body temperature
• Seizure
• Loss of bladder or bowel control
• Collapse

Do not assume the person can “sleep it off.”

Do not:

• Give coffee
• Put them in a cold shower
• Make them walk
• Leave them alone
• Try to make them vomit
• Place them flat on their back when they are unconscious and breathing

Call 911, protect the airway, place the breathing person on their side, and monitor them continuously.

Prescription and Over-the-Counter Medication Overdose

Common medications can cause serious or fatal poisoning when too much is taken. These may include:

• Acetaminophen
• Aspirin
• Antidepressants
• Heart medications
• Blood pressure medications
• Diabetes medications
• Sleep aids
• Anti-anxiety medications
• Seizure medications
• Cold and cough products
• Antihistamines
• Iron supplements
• Opioid pain medication

Some dangerous overdoses cause few early symptoms. For example, a person who takes too much acetaminophen may initially feel well even though serious liver injury is developing.

Do not wait for symptoms.

If the person is awake, breathing normally, and not experiencing severe symptoms, immediately call Poison Help at 1-800-222-1222 in the United States. The service is free, confidential, and available 24 hours a day. Poison Control

Call 911 instead if the person has collapsed, is having a seizure, cannot be awakened, or has difficulty breathing.

Do Not Make the Person Vomit

Do not induce vomiting after a suspected overdose unless a poison specialist or qualified healthcare professional specifically instructs you to do so.

Do not use:

• Ipecac
• Salt water
• Mustard
• Fingers in the throat
• Activated charcoal
• Milk
• Oil
• Lemon juice
• Another home remedy

Vomiting can cause choking, aspiration, chemical injury, or additional damage to the throat.

Poison Control advises against inducing vomiting and recommends obtaining substance-specific instructions immediately. Poison Control first-aid guidance

Do Not Try to “Balance Out” the Substance

Never give another medication or drug in an attempt to reverse the first substance.

Do not give:

• Stimulants to someone who took a sedative
• Sedatives to someone who took a stimulant
• Alcohol to calm the person
• Insulin, sugar, or other medication based on a guess
• Someone else’s prescription medication

These actions can worsen the overdose or create another medical emergency.

Naloxone is the important exception when an opioid overdose is possible because it is specifically designed to reverse opioid effects.

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Preserve Useful Information

Emergency responders and Poison Control need accurate information. Without delaying care, gather:

• Medication bottles
• Pill packages
• Drug containers
• Naloxone packages
• The person’s medication list
• Notes or messages
• The substance’s name, if known
• Approximate amount taken
• Time it may have been taken
• Whether alcohol or other substances were involved
• The person’s age and approximate weight
• Known medical conditions
• Allergies
• Symptoms and when they started

Do not clean up pills, patches, powders, containers, or vomit unless leaving them creates an immediate danger.

Do not place loose unknown substances into an unprotected pocket or bag. Leave hazardous materials where they are and show responders from a safe distance.

Tell responders:

• When the person was last seen acting normally
• Whether CPR was performed
• When naloxone was given
• How many naloxone doses were used
• Whether the person vomited or had a seizure
• Whether they woke after naloxone
• Whether they may have fallen or hit their head

Be honest about what may have been taken. Accurate information helps the medical team choose the safest treatment.

If an Intentional Overdose Is Possible

An intentional overdose is both a medical and mental-health emergency.

Call 911 immediately. Do not leave the person alone.

If they are awake:

• Speak calmly and without judgment.
• Remove access to additional medication, drugs, alcohol, or weapons when this can be done safely.
• Do not argue, lecture, threaten, or shame them.
• Do not promise to keep the overdose secret.
• Tell them help is coming.
• Listen without demanding an explanation.

Once immediate medical care is underway, the person should also receive a suicide-risk and mental-health evaluation.

In the United States, people experiencing suicidal thoughts or emotional crisis can call or text 988 for the Suicide & Crisis Lifeline. An active overdose or immediate physical danger still requires 911 first.

Good Samaritan Laws

Many states have overdose Good Samaritan laws that provide some legal protection to people who seek emergency help during an overdose. The exact protections differ by state and may have limitations.

Fear of legal consequences should not prevent a lifesaving 911 call. Tell the dispatcher that someone may have overdosed and needs medical help.

The CDC notes that Good Samaritan protections exist in most states, although their scope varies. CDC naloxone information

Preventing Future Overdoses

An overdose can happen to someone using an illegal substance, misusing a prescription, accidentally taking the wrong dose, or combining medications without realizing the risk.

Risk may be reduced by:

• Taking medications exactly as directed
• Using one pharmacy when possible
• Reviewing all medications with a pharmacist or doctor
• Avoiding alcohol with medications that cause sedation
• Never sharing prescriptions
• Keeping medications in their original containers
• Using a pill organizer carefully
• Avoiding counterfeit or non-prescribed pills
• Keeping naloxone available
• Teaching household members how to use naloxone
• Checking naloxone expiration dates
• Avoiding the use of opioids alone
• Seeking treatment for substance-use concerns
• Using community harm-reduction services
• Safely disposing of unused medication
• Storing medication away from children and other vulnerable people

Overdose risk can be higher after a period of not using opioids because tolerance may decrease. This can occur after detoxification, hospitalization, incarceration, residential treatment, or a period of recovery.

People prescribed opioids should ask their doctor or pharmacist whether they should keep naloxone at home.

Common Mistakes to

What to Do When Someone May Have Overdosed

Category: Health & Safety

What to Do When Someone May Have Overdosed

An overdose can happen when someone takes more of a medication or drug than their body can safely handle. It may be accidental, intentional, or caused by an unexpected substance in a counterfeit or contaminated drug.

Overdoses are not limited to illegal drugs. They can involve prescription pain medication, anxiety or sleep medication, over-the-counter products, alcohol, stimulants, diabetes medication, heart medication, or several substances taken together.

You do not need to know exactly what the person took before calling for help. If someone cannot be awakened, is having a seizure, has collapsed, or is not breathing normally, call 911 immediately.

Acting quickly, giving naloxone when opioids may be involved, supporting the person’s breathing, and staying until emergency responders arrive can save a life.

When to Suspect an Overdose

Possible warning signs include:

• The person cannot be awakened
• Extreme sleepiness or sudden unconsciousness
• Slow, shallow, irregular, or stopped breathing
• Gasping, gurgling, choking, or snoring-like sounds
• Blue, purple, gray, or very pale lips or fingernails
• A limp body
• Confusion or unusual behavior
• Loss of coordination
• Repeated vomiting
• Seizure
• Chest pain
• Very fast, very slow, or irregular heartbeat
• Severe agitation, panic, or paranoia
• Very high body temperature
• Heavy sweating
• Cold or clammy skin
• Very small or very large pupils
• Prescription bottles, drug materials, alcohol containers, or unknown pills nearby

Do not assume a person making snoring or gurgling sounds is sleeping. An unconscious person with abnormal breathing may be experiencing a life-threatening overdose.

Call 911 Immediately When

Call 911 if the person:

• Cannot be awakened
• Has collapsed
• Is unconscious
• Is having a seizure
• Is not breathing normally
• Is breathing very slowly
• Is only gasping
• Has blue, gray, or purple lips or fingernails
• Has severe chest pain
• Is dangerously agitated or overheated
• Has taken an unknown amount or substance and appears seriously ill
• May have intentionally overdosed
• May have taken fentanyl or another opioid
• Is a child who may have swallowed medication or drugs
• Is pregnant and may have overdosed
• Is getting worse while you watch

If you are uncertain, call. Emergency dispatchers can help determine the next steps.

Poison Control advises calling 911 immediately when a person collapses, has a seizure, has trouble breathing, or cannot be awakened. Poison Control emergency guidance

Step 1: Check the Area for Danger

Before approaching, look for:

• Loose needles
• Broken glass
• Unknown powders
• Chemical fumes
• Aggressive behavior
• Weapons
• Fire or electrical hazards
• Traffic or other environmental dangers

Do not touch needles or unknown substances with bare hands. Avoid stirring up or breathing visible powders. Wear gloves if they are readily available, but do not delay lifesaving care while searching for protective equipment.

If the environment is unsafe, move away and tell the 911 dispatcher what you see. Do not enter a location where chemical fumes or violence may place you in danger.

Step 2: Check for Responsiveness

Call the person’s name loudly.

Tap their shoulders and say:

“Can you hear me?”

“Are you okay?”

Look for purposeful movement, speech, or eye opening.

Do not:

• Slap the person
• Kick them
• Put them in a cold shower
• Pour water on their face
• Apply ice
• Cause pain in an attempt to wake them
• Let them “sleep it off”

If the person does not respond normally, call 911.

Step 3: Check Their Breathing

Look at the chest and listen for breathing for no more than 10 seconds.

Breathing is not normal if it is:

• Absent
• Very slow
• Shallow
• Irregular
• Interrupted by long pauses
• Limited to occasional gasps
• Accompanied by gurgling, choking, or unusual snoring sounds

If the person is not breathing normally or is only gasping, begin CPR and follow the dispatcher’s instructions.

Members of the general public should not delay care while trying to locate a pulse. Responsiveness and breathing are the most important immediate observations.

Step 4: Give Naloxone if Opioids May Be Involved

Naloxone is a medication that temporarily reverses the effects of opioids. It may restore breathing after an opioid overdose.

Opioids include:

• Fentanyl
• Heroin
• Oxycodone
• Hydrocodone
• Morphine
• Codeine
• Methadone
• Buprenorphine
• Prescription opioid pain medications
• Counterfeit pills containing an unexpected opioid

A person may not know that they took an opioid. Counterfeit pills and other drugs may contain fentanyl without the user’s knowledge.

If an opioid overdose is possible, give naloxone. The CDC states that naloxone will not harm someone whose overdose was caused by a substance other than opioids. CDC naloxone guidance

Naloxone does not reverse overdoses caused only by alcohol, benzodiazepines, cocaine, methamphetamine, or other non-opioid drugs. However, it may still help if opioids were taken along with those substances.

How to Use Naloxone Nasal Spray

Different naloxone products may contain different doses. Follow the instructions packaged with the product.

For a typical single-use nasal spray:

1. Remove the device from its packaging.
2. Do not test or prime it.
3. Place the person on their back.
4. Support the back of the neck and allow the head to tilt back.
5. Insert the nozzle into one nostril until your fingers touch the bottom of the nose.
6. Press the plunger firmly to release the entire dose.
7. Remove the device from the nostril.
8. Note the time the dose was given.
9. Continue supporting breathing or performing CPR.
10. If the person does not respond adequately after two to three minutes, give another dose using a new device, following the product directions.

Use each single-dose nasal device only once, even if it appears that medication remains inside.

Some naloxone products are injected rather than sprayed into the nose. Use an injectable product only according to its instructions and your training.

The CDC reports that naloxone may restore breathing within two to three minutes and that more than one dose may be required, particularly when potent opioids are involved. CDC information about lifesaving naloxone

Naloxone Does Not Replace CPR or 911

Naloxone may take several minutes to work, and its effect is temporary. Some opioids remain in the body longer than naloxone does, which means the person can stop breathing again after initially improving.

After giving naloxone:

• Make sure 911 has been called.
• Support the person’s breathing.
• Use an AED if needed and available.
• Give another naloxone dose when directed.
• Stay with the person.
• Do not assume the emergency is over if they wake up.

Naloxone may cause sudden opioid withdrawal. The person may awaken confused, frightened, nauseated, sweating, vomiting, or in pain. Speak calmly and explain that naloxone was given because they were not breathing normally.

Do not let the person use more opioids to treat withdrawal symptoms. That can cause another overdose.

If the Person Is Not Breathing Normally

If the person is unresponsive and not breathing normally:

1. Call 911 and put the phone on speaker.
2. Place the person on their back on a firm, flat surface.
3. Give naloxone if opioids may be involved.
4. Begin CPR.
5. Use an AED as soon as it is available.
6. Continue until the person begins breathing normally or emergency responders take over.

Chest compressions

For an adult:

• Place two hands in the center of the chest.
• Keep your arms straight.
• Push hard and fast.
• Compress at a rate of 100 to 120 times per minute.
• Push down at least 2 inches.
• Allow the chest to return fully after each compression.

If you are trained in conventional CPR, provide 30 chest compressions followed by 2 rescue breaths.

Because an overdose commonly causes breathing to slow or stop before the heart stops, rescue breaths can be particularly important. Follow your CPR training and the 911 dispatcher’s directions.

If you are not trained or are unwilling or unable to give rescue breaths, continue chest compressions. Doing something is better than doing nothing.

If the Person Has a Pulse but Is Not Breathing Adequately

A trained rescuer may be instructed to provide rescue breathing when the person has signs of circulation but is not breathing adequately.

Follow your current CPR training and the dispatcher’s instructions. A common adult rescue-breathing technique involves:

1. Opening the airway with a head-tilt and chin-lift
2. Pinching the nose closed
3. Making a seal over the mouth
4. Giving a breath lasting approximately one second
5. Watching for the chest to rise
6. Continuing at the rate directed by the dispatcher or your training

Use a breathing barrier if one is immediately available. Do not delay ventilation while searching for equipment.

Reassess frequently. Begin full CPR if the person loses signs of circulation or the dispatcher tells you to begin compressions.

If the Person Is Unconscious but Breathing Normally

If the person is unconscious but breathing normally:

1. Call 911.
2. Give naloxone if an opioid overdose is possible.
3. Place the person on their side in the recovery position.
4. Angle the mouth downward so vomit can drain.
5. Keep the airway open.
6. Continue watching the chest.
7. Be prepared to begin CPR.
8. Stay with the person.

Do not place an unconscious person in a seated position or leave them lying flat on their back if they may vomit.

If a head, neck, or spinal injury is possible, avoid unnecessary movement. However, protecting the airway and breathing takes priority. Follow the dispatcher’s instructions.

If the Person Vomits

Overdose can cause vomiting, and an unconscious person may choke or inhale vomit into the lungs.

If the person vomits while breathing:

• Roll them onto their side.
• Allow fluid to drain.
• Wipe away material that is clearly visible around the mouth.
• Do not place your fingers blindly into the mouth.
• Continue monitoring their breathing.

If vomiting occurs during CPR:

1. Turn the person briefly onto their side.
2. Clear visible material.
3. Return them to their back.
4. Resume CPR immediately.

Do not leave the person alone after vomiting.

If the Person Has a Seizure

If a seizure occurs:

• Call 911 if this has not already been done.
• Move dangerous objects away.
• Protect the person’s head with something soft.
• Do not hold them down.
• Do not put anything in their mouth.
• Do not give food, liquid, or medication by mouth.
• Time the seizure.
• Check their breathing when the movements stop.
• Begin CPR if they are not breathing normally.
• Place them on their side if they are breathing normally.

Tell emergency responders how long the seizure lasted and whether it happened more than once.

Do Not Make the Person Vomit

Do not induce vomiting after a suspected overdose.

Do not use:

• Ipecac
• Salt water
• Mustard
• Fingers in the throat
• Any other home remedy

Vomiting may cause choking, chemical injury, aspiration into the lungs, or additional damage as a substance returns through the throat.

Do not give activated charcoal unless Poison Control or a healthcare professional specifically directs you to do so.

Do Not Give Food, Drinks, or Stimulants

Unless Poison Control or a qualified professional gives specific instructions, do not give the person:

• Coffee
• Energy drinks
• Food
• Milk
• Water
• Alcohol
• Another medication
• A cold shower
• Ice
• Household remedies

Anything given by mouth may cause choking if the person becomes less responsive.

Coffee, walking, and cold showers do not reverse an overdose. They may delay effective treatment or cause injury.

When to Call Poison Control

If the person is awake, breathing normally, and not showing emergency symptoms, call Poison Help at 1-800-222-1222 in the United States or use the online tool at Poison Control.

This service is free, confidential, and available 24 hours a day.

Call even when:

• The person has no symptoms yet
• The amount taken is unknown
• The medication belongs to someone else
• A child may have swallowed something
• The wrong medication was taken
• Two doses may have been taken accidentally
• Several medications were mixed
• You are unsure whether the amount is dangerous

Do not wait for symptoms. Some substances cause serious organ damage before the person feels ill.

Call 911 instead of relying on the online tool when the person:

• Cannot be awakened
• Has collapsed
• Is having a seizure
• Has trouble breathing
• Is seriously confused
• Is rapidly worsening

Medication Overdoses May Have Delayed Effects

A person may look well immediately after taking a dangerous amount of medication. Symptoms can appear later, after serious damage has begun.

Potentially dangerous overdoses include:

• Acetaminophen
• Aspirin
• Heart medication
• Blood-pressure medication
• Diabetes medication
• Antidepressants
• Seizure medication
• Sleep medication
• Anti-anxiety medication
• Opioids
• Cold and cough products
• Iron supplements
• Extended-release medication

Do not use the absence of symptoms as proof that the person is safe.

Acetaminophen is included in many pain, cold, flu, and sleep products. Someone can unintentionally take too much by combining products with different brand names but the same active ingredient.

Call Poison Control immediately for any suspected medication overdose.

Signs of an Opioid Overdose

Opioid overdose commonly causes:

• Inability to awaken
• Very slow or absent breathing
• Gurgling or snoring-like sounds
• Limpness
• Pale, clammy skin
• Blue, gray, or purple lips and fingernails
• Very small pupils

Not every person will have every sign. Pupil size can also be affected by other medications, lighting, eye conditions, or injury.

If the person cannot be awakened and is not breathing normally, treat the situation as an overdose, give naloxone, call 911, and support breathing.

Signs of a Sedative Overdose

Alcohol, benzodiazepines, sleep medications, and other sedatives may cause:

• Extreme sleepiness
• Slurred speech
• Poor coordination
• Confusion
• Vomiting
• Slow or irregular breathing
• Low body temperature
• Unconsciousness

Combining sedatives with opioids greatly increases the risk of stopped breathing.

Naloxone will only reverse the opioid portion of a mixed overdose. The person may remain dangerously sedated from other substances and still needs emergency care.

Do not assume an intoxicated person can safely “sleep it off.”

Signs of a Stimulant Overdose

Cocaine, methamphetamine, amphetamine products, and other stimulants may cause:

• Extreme agitation
• Panic or paranoia
• Hallucinations
• Chest pain
• Very fast or irregular heartbeat
• High blood pressure
• Heavy sweating
• Severe headache
• High body temperature
• Tremors
• Seizure
• Collapse

Call 911.

While waiting:

• Reduce noise, crowding, and bright lights.
• Speak calmly.
• Do not argue with or restrain the person unless immediate safety requires it.
• Remove nearby hazards.
• Do not give food, drink, or medication.
• Do not place the person in a bath or shower.
• Follow the dispatcher’s instructions.

A severely agitated person may behave unpredictably. Keep a safe distance and wait for trained responders when approaching would place you in danger.

Alcohol Poisoning

Alcohol poisoning can be fatal.

Warning signs include:

• Inability to awaken
• Confusion
• Repeated vomiting
• Seizure
• Slow or irregular breathing
• Pale, bluish, or clammy skin
• Low body temperature
• Loss of protective reflexes

Call 911.

Do not:

• Leave the person alone
• Let them sleep on their back
• Give coffee
• Put them in a cold shower
• Make them walk
• Encourage vomiting

Place a normally breathing unconscious person on their side and watch their breathing continuously.

Unknown or Mixed Substances

Many overdoses involve more than one substance. Counterfeit pills may look like legitimate prescription medication while containing fentanyl or another unexpected drug.

When the substance is unknown:

• Treat the symptoms as an emergency.
• Give naloxone if opioids could be involved.
• Call 911.
• Support breathing.
• Use an AED if needed.
• Save available containers or identifying information.
• Do not taste, smell closely, or touch unknown substances.

Naloxone may reverse the opioid component without reversing the effects of other drugs. Continued unresponsiveness after naloxone does not mean you should stop helping.

Information to Gather for Responders

Without delaying care, collect:

• The person’s age and approximate weight
• Known medical conditions
• Prescription medications
• Allergies
• What may have been taken
• Approximate amount
• When it was taken
• Whether alcohol or other drugs were involved
• Whether the substance was swallowed, inhaled, injected, or absorbed
• When the person was last seen acting normally
• Number and timing of naloxone doses
• Whether CPR or rescue breathing was performed
• Whether the person vomited or had a seizure

Gather pill bottles, packages, medication lists, or photographs of labels. Leave unknown powders and needles where they are unless they create an immediate danger. Tell responders where they are located.

Do not clean the scene or discard containers before emergency personnel arrive.

If the Person Wakes Up After Naloxone

When naloxone works, the person may awaken suddenly.

They may be:

• Confused
• Frightened
• Angry
• Nauseated
• Sweating
• Shaking
• Vomiting
• Experiencing pain or withdrawal

Explain calmly:

“You stopped breathing normally. I gave you naloxone, and an ambulance is coming.”

Encourage them to remain where they are. Do not allow them to drive, walk away alone, or take more drugs.

If they refuse help, continue encouraging evaluation. Naloxone may wear off before the opioid does, causing another episode of stopped breathing.

Continue watching for:

• Increasing sleepiness
• Slowed breathing
• Blue or gray lips
• Vomiting
• Loss of consciousness

Give another dose according to the product instructions or dispatcher’s directions if overdose symptoms return.

Good Samaritan Laws

Many states have overdose Good Samaritan laws that provide some legal protection to people who call for emergency help during an overdose. The exact protections and limitations vary by state.

Concern about legal consequences should not prevent someone from calling 911 when a life may be at risk. Tell the dispatcher that the person is unresponsive or not breathing normally so emergency care is sent quickly.

After an Intentional Overdose

An intentional overdose requires both medical treatment and mental-health support.

Do not leave the person alone, even if they appear physically well. Remove access to additional medication, weapons, or other immediate dangers only when this can be done safely.

Call 911 for an overdose or immediate danger.

After emergency medical needs have been addressed, the 988 Suicide & Crisis Lifeline is available in the United States by calling or texting 988. This does not replace 911 during an active overdose or medical emergency.

Respond without blame or criticism. The immediate priorities are survival, safety, and connection to professional support.

Preparing for a Possible Opioid Emergency

People at risk of opioid overdose—and those around them—can prepare by:

• Keeping naloxone available
• Learning how to use it
• Checking expiration dates
• Telling others where it is stored
• Carrying more than one dose
• Learning CPR and rescue breathing
• Avoiding opioids with alcohol or sedatives
• Taking medications only as prescribed
• Storing medications securely
• Never taking a pill that was not obtained from a licensed pharmacy
• Discussing overdose risk with a doctor or pharmacist
• Seeking treatment for opioid use disorder when needed

Naloxone is available over the counter in all 50 states and may also be available through pharmacies, health departments, and community programs.

Common Mistakes to Avoid

During a suspected overdose:

• Do not wait for the person to “sleep it off.”
• Do not assume snoring means they are safe.
• Do not leave them alone.
• Do not put them in a shower or bath.
• Do not give coffee or energy drinks.
• Do not force them to walk.
• Do not induce vomiting.
• Do not put anything in the mouth of an unconscious person.
• Do not delay naloxone because you are uncertain opioids were involved.
• Do not assume one naloxone dose will always be enough.
• Do not stop monitoring after the person wakes.
• Do not allow fear of judgment or legal trouble to delay 911.
• Do not discard containers or identifying information.
• Do not touch loose needles or unknown powders.
• Do not respond with blame or shame.

A Simple Overdose-Response Checklist

When someone may have overdosed:

1. Check the area for danger.
2. Try to wake the person.
3. Call 911 if they cannot be awakened, have a seizure, collapse, or are not breathing normally.
4. Check breathing for no more than 10 seconds.
5. Give naloxone if opioids may be involved.
6. Begin CPR or rescue breathing as directed.
7. Give another naloxone dose after two to three minutes if needed and directed.
8. Place a normally breathing unconscious person on their side.
9. Do not give food, drinks, or home remedies.
10. Gather medication containers and useful information.
11. Stay with the person.
12. Continue monitoring until emergency professionals take over.

Suggested Guides

• What to Do When Someone Is Unconscious
• Understanding CPR & How to Use an AED
• What to Do After a Poisoning or Chemical Exposure
• What to Do When Someone Has a Seizure
• Responding to Serious Difficulty Breathing or an Asthma Attack
• Understanding Prescriptions & Medication Labels

Important Health & Safety Notice

The information in this guide is provided for general educational purposes only. Independence Answers is not a medical provider, and this content is not a substitute for professional medical advice, diagnosis, treatment, or supervision. Always follow the instructions of your doctor, pharmacist, or other qualified healthcare professional, especially if you have a medical condition, take medication, or are unsure whether an action is safe for you.

Do not ignore or delay seeking professional care because of something you read here. If you believe someone may be experiencing a serious or life-threatening emergency, call 911 or your local emergency number immediately.