If you suspect an opioid overdose, should you administer naloxone? (Plus When You’re Not Sure…)

Someone is unconscious.

They are breathing strangely. Maybe they are making a snoring or gurgling sound. You cannot get them to wake up.

You have naloxone.

But you don’t actually know whether they took opioids.

Should you give it anyway?

Yes.

If someone is showing signs of a possible opioid overdose and you have naloxone available, you do not need to be 100% sure opioids are involved before you use it.

And honestly, waiting until you are completely sure can waste time you may not have.

What does an opioid overdose actually look like?

There isn’t one perfect picture of an overdose.

Instead, there are a few signs that someone is experiencing a serious emergency.

The biggest things I want people to pay attention to are:

They won’t wake up, and

Their breathing isn’t normal.

That might mean their breathing is very slow, shallow, irregular, or completely absent. Someone making snoring, choking, or gurgling sounds is also not breathing normally. If you hear these sounds, take note because they can be mistaken for sleep.

If someone is genuinely sleeping, you should be able to wake them up.

If you cannot wake someone and their breathing sounds strange, DO NOT assume they are just sleeping it off.

Other signs can include a limp body, very small pupils, and changes in skin, lip, or nail color.

But you do not need every sign to appear before you act.

What if I don’t know what they took?

Still use the naloxone.

Naloxone works by temporarily blocking opioids from working at opioid receptors in the brain.

If opioids ARE causing breathing to slow or stop, naloxone can reverse those effects and allow them to breathe normally again.

If opioids aren’t involved, naloxone will kick in, but it will not reverse whatever is causing the person to need emergency care.

But it also is not going to hurt them simply because you guessed wrong.

That is one of the reasons naloxone is such an important community first aid tool.

You do not need a toxicology report.

You do not need to know whether someone used fentanyl, heroin, oxycodone, or something else.

You do not even need to know for sure that they intentionally used an opioid.

If the situation LOOKS like an opioid overdose, respond to what you see.

Okay. So what do I actually do?

If someone is unresponsive and you think an opioid overdose could be happening:

1. Try to wake them

Talk loudly to them and try to get a response. If they aren’t responding, this is an emergency.

2. Call 911

If someone else is nearby, send them to call while you stay with the person. Be specific. “You, call 911 and come back.”

This is one of those times where assigning someone a job works much better than yelling “Somebody call 911!” into a crowd.

3. Give naloxone

If you have nasal naloxone, remove it from the package, place the tip into ONE nostril, and press the plunger.

The device is single use. There is no dose for you and no dose for me. You are not trying to measure anything or divide the dose.

Use the entire device on ONE person.

4. Support their breathing

This part gets overlooked sometimes, but it matters a lot.

The immediate danger in an opioid overdose is that someone’s breathing becomes too slow or stops altogether.

If they are not breathing normally, follow CPR/rescue breathing guidance that is appropriate for your level of training. Also follow any instructions you are given by the 911 dispatcher.

If an AED is available and the person is not breathing or not breathing normally, get it. Turn it on and follow instructions.

5. Watch for a response

Naloxone does not necessarily work instantly.

Give it a couple minutes to see if the person responds.

If the person is not waking up appropriately and their breathing has not returned to normal, another dose of naloxone may be able to help if you have another dose available.

Continue following instructions from 911.

What if they wake up?

This is where I want people to know something really important:

THE EMERGENCY IS NOT OVER.

As soon as someone wakes up, many people assume you’re done. You may have treated the overdose, but naloxone is temporary.

It can wear off while opioids are still active in the person’s body, which means they can still become unable to wake up or their breathing can slow down too much again.

Stay with them. Explain what happened. Let them know you gave them naloxone. Tell them you’re concerned and why. And encourage them to allow EMS to evaluate them.

They may also feel absolutely terrible.

Naloxone can trigger opioid withdrawal symptoms in someone who is physically dependent on opioids. When given during an overdose, someone can wake up feeling nauseated, sweaty, anxious, confused, angry, physically uncomfortable, or vomiting.

That does not mean the naloxone hurt them.

It means you suddenly reversed the opioid effect their body was experiencing. They were unable to wake up because their breathing slowed too much from taking opioids. You gave them naloxone and suddenly they CAN wake up.

This is also a moment where how we treat people really matters.

They just woke up from a medical emergency. Please do not respond by saying:

“What were you thinking?”

“You almost died.”

“Why would you do this?”

or

“You need to get your life together.”

Yes, they may have put themselves at risk. But you are speaking from a place of safety. They are not.

They need care. Medical attention. Someone to sit with them and talk with them.

There can be other conversations later.

But what if they get angry that I gave it?

They might.

Someone waking up while in opioid withdrawal will feel awful and may not completely understand what happened.

Remain matter of fact. “You weren’t waking up and your breathing wasn’t normal. I was worried you were overdosing, so I gave you naloxone.” That’s it.

You do not need to argue with someone about their substance use.

You do not need them to justify anything they put into their body.

You helped with the emergency happening in front of you. Let medical professionals worry about the rest.

Do overdoses only happen to people who use heroin or fentanyl?

No.

This is another misconception I really want us to move away from.

Opioid overdoses can involve illegally manufactured fentanyl or heroin YES. But they can also involve prescription opioids.

And because fentanyl can be added to pills or other substances without someone knowing, the person having an opioid overdose might not even know they took an opioid.

Again, that is another reason I don’t want community responders to get hung up on:

“But they said they didn’t take opioids.”

Maybe they didn’t know they did.

Maybe you don’t have the whole story.

Maybe something else is going on entirely.

None of those things change the immediate problem:

THEY ARE NOT WAKING UP and THEIR BREATHING ISN’T NORMAL.

Respond to the emergency first. Treat the person.

Who should carry naloxone?

I would actually flip this question around.

Why WOULDN’T we have naloxone available in more places?

You don’t need to personally use opioids to care about someone who does.

You don’t need to have a family member with opioid addiction to care about your community.

You don’t need to work in healthcare to recognize an emergency happening right in front of you.

Naloxone is an emergency medication.

We put AEDs in hospital hallways and on walls because someone might experience cardiac arrest.

People carry epinephrine auto-injectors because someone might experience anaphylaxis.

We put fire extinguishers in public buildings because there might be a fire.

Having naloxone available doesn’t mean you expect someone to overdose. It means if someone does overdose, help is available.

If you or someone you know uses opioids of any kind, naloxone nasal spray is available over the counter WITHOUT a prescription. You also do not need to be a medical professional to use it.

Naloxone is not encouraging drug use

I want to address this directly because this idea continues to come up even years into widespread naloxone availability.

Just because someone overdoses does NOT mean they would have died if someone didn’t have naloxone available.

Keeping naloxone available does not encourage people to use drugs. Teaching someone CPR does not encourage them to experience cardiac arrest.

Providing condoms does not encourage people to have sex.

Putting a fire extinguisher in the kitchen does not encourage anyone to light the stove on fire.

Fact: the majority of overdoses can be reversed with timely administration of naloxone.

The more naloxone available in our communities, the more lives we can save.

Naloxone keeps someone alive long enough to have whatever comes next.

That might be treatment.

It might be recovery.

It might be another conversation.

It might simply be tomorrow.

People have to be alive for any of those things to matter.

The goal is not to become an overdose expert

This is the part I want people to leave with.

You do not need to look at some unconscious stranger and KNOW that they are having an opioid overdose.

You need to notice: This person is not waking up. Their breathing is not normal. I have something that may reverse this if opioids were caused this.

Then ACT.

Try to wake them. Call 911. Give naloxone. Support their breathing. Stay with them.

That is community first aid.

It isn’t about knowing everything that could possibly happen to you or the people around you.

It’s about knowing enough to do the next useful thing.

At EQUIP Medical, naloxone and overdose response are just one part of how we approach community first aid, event medical care, harm reduction, and emergency education. Not because every single emergency is an overdose, but because when one IS happening, the person standing nearby may be the only person who gets the chance to save that person’s life.

And that person does not need to be a medical professional

They just need to be prepared.

This resource is for general education purposes only and does not replace individualized medical advice, calling emergency medical services, or hands-on overdose response/CPR/first aid training from a certified trainer.