Opioid Overdose First Aid: Warning Signs, How to Use Naloxone Nasal Spray and What to Do Until Help Arrives

Quick answer: if someone is very hard to wake, breathing slowly or not at all, or making gurgling or snoring sounds, and opioids could be involved, call 911 and give naloxone right away. Spray one dose of nasal naloxone into one nostril, try to keep the person breathing, and lay them on their side if they are breathing. If they do not respond in two to three minutes, give a second dose in the other nostril. Stay with them until responders arrive, because naloxone can wear off before the opioid does.

Opioid overdoses happen in apartments, hallways, restrooms, cars and transit stations, and the person who finds someone first is usually a neighbor, roommate, relative or stranger rather than a paramedic. A few minutes without enough oxygen can cause brain injury or death, so the steps you take before responders arrive matter a great deal. The good news is that the main tool, naloxone, is now sold without a prescription and is designed to be used by people with no medical training.

This guide is part of our emergency first aid guide for city households. It explains how to recognize an overdose, how to give nasal naloxone, what to do afterward and how to keep naloxone at home. It is general safety information, not medical advice. If you think someone is overdosing, call 911.

Sources: Centers for Disease Control and Prevention (CDC) pages on preventing opioid overdose, signs of an overdose and fentanyl; Substance Abuse and Mental Health Services Administration (SAMHSA) Opioid Overdose Prevention Toolkit; U.S. Food and Drug Administration (FDA) announcements approving Narcan nasal spray for over-the-counter sale (March 2023) and RiVive (July 2023); National Institute on Drug Abuse (NIDA) naloxone fact sheet; SAMHSA National Helpline. Product directions vary, so always follow the instructions printed on the package you have. Checked November 2026. This article is general safety information, not medical advice.

What an Opioid Overdose Looks Like

Opioids include prescription pain medicines such as oxycodone, hydrocodone and morphine, the illegal drug heroin, and synthetic opioids such as fentanyl. In large enough amounts, these drugs slow and then stop the part of the brain that controls breathing. That is what makes an overdose deadly: the person stops getting enough oxygen.

The CDC lists these signs of a possible opioid overdose:

• Small, constricted “pinpoint” pupils
• Falling asleep or losing consciousness
• Slow, weak or no breathing
• Choking or gurgling sounds
• A limp body
• Cold or clammy skin
• Discolored skin, especially in the lips and nails

Someone who is very drowsy but still talking may be close to overdosing. A person who will not wake up when you shout their name and rub their breastbone firmly with your knuckles needs emergency help now.

Why fentanyl changed the picture

Illegally made fentanyl is now involved in a large share of overdose deaths in the United States, according to the CDC. It is far stronger than heroin or morphine, and it is often mixed into other drugs, including counterfeit pills made to look like prescription medicines and stimulants such as cocaine or methamphetamine. That means a person who does not think they took an opioid at all can still overdose on one. If someone is unresponsive and not breathing normally after using any drug, treat it as a possible opioid overdose.

Step 1: Check for a Response and Call 911

Start by trying to wake the person. Shout their name, tap their shoulders and, if that does not work, rub the center of their chest with your knuckles. If they do not respond, or their breathing is slow, irregular or absent, call 911 immediately.

Tell the dispatcher that the person is unresponsive and not breathing normally. Give your exact address, including the building entrance, floor and unit number. In a large building, send someone to meet responders at the lobby or hold the elevator if you can. If you are alone, put your phone on speaker so your hands are free.

Dispatchers can coach you through naloxone and CPR. You do not need to say anything about drugs if you do not want to, but describing what you see helps them send the right help.

Step 2: Give Naloxone Nasal Spray

Naloxone is a medicine that quickly reverses an opioid overdose by blocking the effects of opioids in the brain. It can restore normal breathing within a few minutes. According to NIDA and SAMHSA, it will not harm someone who has not taken opioids, so if you are unsure, give it.

Most people will use a nasal spray device. The package instructions are the final word, but the general steps are similar across brands:

1. Peel back the package and hold the device with your thumb on the plunger and two fingers on either side of the nozzle.
2. Tilt the person’s head back and support the neck with one hand.
3. Insert the nozzle into one nostril until your fingers touch the bottom of the nose.
4. Press the plunger firmly to give the full dose. The device does not need to be primed or tested first.
5. Remove the device and move the person into a safe position (see the next step).

Each device holds one dose. Do not try to spray it twice.

When to give a second dose

If the person does not wake up or breathe normally within two to three minutes, use a new device and give a second dose in the other nostril. Very strong opioids, including fentanyl, may need more than one dose. Keep giving doses every two to three minutes, alternating nostrils, until the person responds or responders take over, as long as you have devices left.

Injectable naloxone

Some kits contain naloxone for injection into the muscle of the thigh or upper arm, often with a syringe or a prefilled device. If that is what you have, follow the printed directions or the instructions from whoever gave you the kit. A dispatcher can also talk you through it.

Step 3: Support Breathing and Positioning

Naloxone needs oxygen moving in and out of the lungs to keep someone alive while it works, so breathing is your next focus.

If the person is breathing on their own, roll them onto their side in the recovery position. This keeps the airway open and lets fluid or vomit drain out of the mouth rather than into the lungs. Bend the top knee so they do not roll onto their stomach.

If the person is not breathing, or is only gasping, start CPR. The American Heart Association teaches untrained bystanders to give Hands-Only CPR: push hard and fast in the center of the chest, about 100 to 120 times a minute. SAMHSA’s toolkit notes that rescue breathing is especially useful in overdoses because the core problem is a lack of breathing, so if you have been trained in CPR with breaths, use those skills. If an AED is nearby, turn it on and follow its voice prompts.

Step 4: Stay Until Help Arrives

Once someone wakes up after naloxone, it is tempting to think the danger has passed. It may not have. Naloxone usually lasts somewhere between 30 and 90 minutes, while many opioids last longer. When the naloxone wears off, the person can slip back into an overdose, even if they seemed fine.

Stay with the person until emergency responders arrive and take over. If you have to leave the room briefly, put them in the recovery position first. Keep watching their breathing and how easily they can be woken.

What the person may feel when they wake up

Naloxone can trigger sudden opioid withdrawal in someone who uses opioids regularly. Symptoms can include agitation, sweating, nausea, vomiting, body aches, a runny nose and a fast heartbeat. These symptoms are unpleasant but are generally not life-threatening in adults, according to SAMHSA. The person may be confused or upset, and they may want to use more opioids to stop the withdrawal, which raises the risk of another overdose once the naloxone fades.

Speak calmly. Explain what happened, that you gave them naloxone and that help is on the way. Give them space if they are agitated, and avoid restraining them.

What Not to Do

Several common ideas about reviving someone are useless or harmful:

• Do not put the person in a cold bath or shower. They can drown or become dangerously cold.
• Do not try to make them vomit.
• Do not give them other drugs, coffee or alcohol to “wake them up.”
• Do not slap or hit them hard. Firm chest rubs and loud speech are enough to check for a response.
• Do not leave them alone to “sleep it off.” People who are snoring or gurgling after using opioids may be struggling to breathe.

Where to Get Naloxone

In March 2023, the FDA approved Narcan 4 mg naloxone nasal spray for sale without a prescription, and it later approved a second over-the-counter nasal spray, RiVive. That means you can buy naloxone off the shelf at many pharmacies, grocery stores and online retailers, depending on the store and the state. Prescription naloxone products are still available as well, and many insurance plans cover them.

Free naloxone is widely available too. Local health departments, harm reduction programs, community organizations and some libraries and vending machines give it out at no cost. Your city or state health department website is the best place to find current locations. Some community groups also offer short trainings that cover overdose response and how to use the devices.

Who should keep naloxone at home

The CDC recommends that people who are at higher risk of an overdose, and the friends and family around them, carry naloxone. That includes households where someone:

• Takes prescription opioids, especially at higher doses or alongside sedatives such as benzodiazepines
• Uses illegal drugs of any kind, since the supply may contain fentanyl
• Has had an overdose before
• Is in recovery and may have lower tolerance after a period without opioids

There is also a strong case for any household or building to keep a kit. Overdoses can happen to guests, neighbors and passers-by, and the person who responds is the one who has naloxone within reach.

Storing and Checking Your Naloxone

Keep naloxone in the box it came in, at room temperature and away from direct sunlight, as the package directs. Avoid leaving it in a hot car or on a sunny windowsill for long periods.

Store it where people can find it quickly: a kitchen drawer, a labeled spot in your apartment first aid kit or a bag you carry every day. Tell the people you live with where it is.

Check the expiration date when you restock other supplies, and replace expired or used devices. Many harm reduction programs will swap expired kits for new ones. If expired naloxone is the only kind available during an emergency, the general guidance from public health agencies has been that it is still better to use it than to use nothing, while also calling 911.

Good Samaritan Laws

Fear of police involvement keeps some people from calling 911 during an overdose. To address that, most states and the District of Columbia have passed Good Samaritan or overdose immunity laws. These laws generally give some legal protection to a person who seeks emergency help for an overdose, and often to the person who overdosed, against certain drug possession charges. Many states also protect people who give naloxone in good faith from civil liability.

The details vary a lot from state to state, including which offenses are covered and whether the protection applies to people on probation or parole. Your state health department or attorney general’s office usually publishes a summary. The core message from public health agencies is consistent: call 911 every time.

Lowering the Risk of an Overdose

Responding well matters, but preventing an overdose in the first place matters even more. The CDC and SAMHSA suggest these practical steps:

• Take prescription opioids only as prescribed, and do not combine them with alcohol or sedatives unless a clinician has said it is safe.
• Store prescription opioids locked up and out of reach of children, teens and visitors. Accidental poisoning is a real risk for young children; our guide to poison emergencies and Poison Control covers what to do if a child gets into medicine.
• Dispose of unused opioids at a pharmacy take-back kiosk or a DEA Take Back Day event.
• Never use drugs alone. If someone does use, having another person nearby with naloxone can save a life.
• Be aware that counterfeit pills bought online or on the street may contain fentanyl.

For confidential treatment referrals and information, the SAMHSA National Helpline is free and open 24 hours a day at 1-800-662-4357. If someone is in emotional crisis or thinking about suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline.

A Quick Checklist to Keep Near Your Kit

Print or save this list next to your naloxone:

1. Shout and rub the breastbone. No response or poor breathing? Call 911.
2. Give one naloxone spray in one nostril.
3. Breathing: recovery position. Not breathing: CPR.
4. No response in two to three minutes: second dose, other nostril.
5. Stay until help arrives. Naloxone can wear off.

Frequently Asked Questions

Can naloxone hurt someone who did not take opioids?

No. Federal health agencies say naloxone has no effect on someone who has no opioids in their system, which is why bystanders are told to give it whenever an opioid overdose is possible.

Do I need training to use nasal naloxone?

No formal training is required. The over-the-counter nasal sprays are designed for people without medical training and include printed instructions. A short community training can still make you more confident.

Will naloxone work on fentanyl?

Yes, naloxone reverses overdoses involving fentanyl. Because fentanyl is so potent, a person may need more than one dose, given two to three minutes apart.

Should I still call 911 if the person wakes up?

Yes. Naloxone can wear off before the opioid does, and the person can stop breathing again. Responders can monitor them and treat other problems.

Can I get in trouble for helping?

Most states have Good Samaritan laws that offer some legal protection to people who call for help during an overdose, and many protect people who give naloxone in good faith. The details vary by state.

Does naloxone treat overdoses from other drugs?

Naloxone only reverses the effects of opioids. It will not reverse alcohol, benzodiazepine or stimulant overdoses on their own, but because many drug supplies contain fentanyl, giving it is still recommended when an overdose is possible.