Opioid Overdose: Signs, How to Use Naloxone (Narcan) and What to Do Until Help Arrives

Quick answer: signs of an opioid overdose include pinpoint pupils, falling asleep or losing consciousness, slow, weak or no breathing, choking or gurgling sounds, limp body, and cold, clammy or discolored skin. Call 911, give naloxone (such as a nasal spray) if you have it, and support breathing. If the person does not respond within 2 to 3 minutes, give another dose. Lay them on their side in the recovery position once breathing, and stay with them until help arrives, because naloxone can wear off before the opioid does.

Opioid overdoses happen in apartments, offices, restaurants, transit stations and parks, and they affect people who use opioids by prescription as well as those who use illicit drugs. Illicitly made fentanyl, which is highly potent and often mixed into other drugs without the user knowing, has made overdoses faster and more common.

Naloxone, often known by the brand name Narcan, can reverse an opioid overdose and restore breathing. The FDA approved the first over-the-counter naloxone nasal spray in 2023, so it can be bought at pharmacies and other stores without a prescription. Keeping it in your home and knowing how to use it is a simple step that can save a life. This guide is part of our apartment emergency kit guide.

Sources: CDC, “Preventing Opioid Overdose” and “Lifesaving Naloxone”; SAMHSA, Opioid Overdose Prevention Toolkit; FDA, approval of over-the-counter naloxone nasal spray (March 2023) and naloxone information; National Institute on Drug Abuse, naloxone drug facts; Network for Public Health Law, Good Samaritan overdose law summaries; SAMHSA National Helpline. Checked November 2026. General safety information, not medical advice.

Signs of an Opioid Overdose

The CDC lists these signs:

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

It can be hard to tell whether someone is very high or overdosing. The CDC advises that if you are unsure, treat it like an overdose; you could save a life.

Check for responsiveness

Shout the person’s name and rub your knuckles firmly on their breastbone (sternum). Someone who is just sleeping will usually respond. No response or very slow breathing is a medical emergency.

What to Do: Step by Step

The CDC and SAMHSA describe these steps.

1. Call 911. Tell the dispatcher the person is not breathing or is unresponsive, and give your exact location, including apartment number and floor. You can put the phone on speaker.
2. Give naloxone. If you have nasal naloxone, lay the person on their back, tilt their head back, insert the nozzle into one nostril until your fingers touch the bottom of the nose and press the plunger firmly to give the full dose.
3. Support breathing. If you are trained, give rescue breaths. If the person is not breathing and you are not trained, follow the 911 dispatcher’s instructions, which may include CPR.
4. Watch and repeat. If there is no response in 2 to 3 minutes, give a second dose of naloxone in the other nostril with a new device. Some people need more than one dose, especially with fentanyl.
5. Recovery position. Once the person is breathing, lay them on their side with the top knee bent and hand supporting the head, to keep the airway open and prevent choking if they vomit.
6. Stay with them. Naloxone usually works for 30 to 90 minutes, according to the National Institute on Drug Abuse, while some opioids last longer. The person can stop breathing again once naloxone wears off, so stay until emergency help arrives and encourage them to get medical care.

Our hands-only CPR and AED basics guide explains compressions if the person has no pulse and is not breathing.

About Naloxone

Naloxone is an opioid antagonist. It attaches to opioid receptors in the brain and blocks the effects of opioids, which can quickly restore normal breathing.

Key facts from the CDC, FDA and NIDA:

• It is safe. Naloxone has no effect on someone who does not have opioids in their system, so it will not harm a person who is unconscious for another reason. When in doubt, give it.
• It is easy to use. Nasal sprays are ready to use with no assembly. Injectable and autoinjector forms also exist.
• It is available without a prescription. Since 2023, over-the-counter nasal naloxone has been sold in pharmacies, supermarkets and online. Many health departments and community organizations give it out free.
• It works only on opioids. It does not reverse overdoses from alcohol, benzodiazepines or stimulants alone, but many overdoses involve mixed drugs, and naloxone is still recommended when opioids may be involved.
• It can cause withdrawal. People who are dependent on opioids may wake up with withdrawal symptoms such as agitation, vomiting, sweating and body aches. These are uncomfortable but not usually life-threatening. Stay calm and reassure them.

Storage

Keep naloxone at room temperature and away from light, following the package instructions. Check the expiration date and replace it when it expires. Store it where family members, roommates and visitors can find it quickly, such as with your first aid kit or in a labeled spot in the kitchen, and carry one in a bag if you or someone close to you is at risk. Our first aid kit for a small apartment guide has storage ideas.

Who Should Keep Naloxone

The CDC encourages people to carry naloxone if they or someone they know:

• Takes high-dose prescription opioids
• Takes opioids along with benzodiazepines or other sedating medicines
• Uses illicit drugs, which may contain fentanyl
• Is in recovery and may have reduced tolerance
• Has had an overdose before

Many people who are not at personal risk also carry it, including teachers, coaches, building managers, restaurant workers and neighbors. Overdoses happen in public places, and the person nearby is often the first to help.

Common Myths About Overdose Response

Several popular ideas about reviving someone are not just ineffective but can cause harm. SAMHSA’s Opioid Overdose Prevention Toolkit and many health departments warn against them.

Putting someone in a cold bath or shower does not reverse an overdose. It wastes time, can cause hypothermia and creates a drowning risk for a person who cannot hold up their head. Slapping, hitting or inflicting pain is not a treatment either. A firm sternal rub is a way to check responsiveness, not a cure.

Injecting another substance, such as salt water, milk or stimulants, will not help and can introduce infection or other dangers. Making the person vomit risks choking. Letting them “sleep it off” is one of the most dangerous choices, because breathing can slow and stop while the person appears to be resting.

What works is simple: call 911, give naloxone, support breathing and stay with the person. Those steps are easy to remember and require no special skills.

Overdoses in Apartment Buildings and Public Places

Overdoses often happen in shared spaces, such as stairwells, lobbies, laundry rooms and restrooms. Building managers, doormen and maintenance staff are increasingly trained to respond, and some buildings keep naloxone with their AEDs. Tenants can ask building management whether naloxone is available and suggest adding it to the first aid supplies if it is not.

Many cities place naloxone in public vending machines or wall-mounted boxes in libraries, transit stations and community centers. Local health departments often offer free training, which usually takes less than an hour and covers recognizing an overdose, giving naloxone and rescue breathing.

Responding to an overdose can be frightening. Afterward, rescuers sometimes feel shaken or anxious. It is normal to need support, and talking with a friend, counselor or the helplines listed below can help.

Talking With Family and Roommates

If someone in your household takes prescription opioids or uses drugs, a calm conversation about overdose safety can protect everyone. Agree on where naloxone will be kept, make sure each adult knows how to use it and confirm that anyone who finds a person unresponsive will call 911 first. Practicing with a trainer device or watching the manufacturer’s instructional video together builds confidence. Teenagers should also know that counterfeit pills sold online or through social media may contain fentanyl.

Good Samaritan Laws

People sometimes hesitate to call 911 because they fear arrest. Most states and Washington, D.C., have Good Samaritan overdose laws that offer some legal protection to people who seek help during an overdose, according to the Network for Public Health Law and the CDC. The protections differ by state; many cover possession of small amounts of drugs for the caller and the person overdosing. Check your state’s rules, but always call 911 in an overdose emergency.

Many states also have laws protecting people who give naloxone in good faith from civil liability.

Overdose Risks in Specific Situations

Prescription opioids at home

Accidental overdoses can happen when someone takes more medicine than prescribed, mixes opioids with alcohol or sleep aids, or when a child or pet gets into medicine. Store opioids locked up and out of reach, and dispose of unused medicine through pharmacy take-back programs or DEA take-back days. Our guide to an emergency medication plan covers safe storage for all medicines.

Children

Children can overdose on a very small amount of an adult’s opioid medication. Call 911 and Poison Help (1-800-222-1222) right away if a child may have swallowed one. Naloxone is safe to give to children.

Reduced tolerance

After a period without opioids, such as after detox, treatment or jail, tolerance drops. SAMHSA warns that taking a previous dose can be deadly. People in recovery and their families should keep naloxone handy.

Fentanyl

Illicit fentanyl is far more potent than heroin or morphine and is often found in counterfeit pills and mixed into other drugs. Fentanyl test strips, which detect fentanyl in drugs, are distributed by many health departments and are now legal in many states.

Getting Help for Substance Use

Overdoses are often a sign that someone needs support. The SAMHSA National Helpline at 1-800-662-4357 is free, confidential and available 24 hours a day, 7 days a week, offering referrals to treatment and support groups. Findtreatment.gov lists treatment providers, including those offering medications for opioid use disorder. The 988 Suicide and Crisis Lifeline is also available by call or text for anyone in crisis.

After an Overdose

After a person recovers from an overdose, emergency medical care is still important, even if they insist they feel fine and want to leave. Paramedics can monitor breathing, give more naloxone if the opioid outlasts the first doses and check for injuries from a fall. Hospitals and many emergency departments can also start medication for opioid use disorder, such as buprenorphine, and connect the person with follow-up care. Naloxone may wear off, and medical staff can check for other injuries or substances. It is also a chance to connect with treatment. Replace any used naloxone so it is ready next time.

Frequently Asked Questions

Can naloxone hurt someone who is not overdosing on opioids?

No. Naloxone has no effect on people without opioids in their system, so it is safe to give when you are unsure.

Do I need a prescription for Narcan?

No. The FDA approved over-the-counter naloxone nasal spray in 2023. It is sold at pharmacies and other stores.

How long does naloxone last?

About 30 to 90 minutes, according to NIDA. Some opioids last longer, so the person can stop breathing again. Stay with them and call 911.

How many doses should I give?

Give one dose and wait 2 to 3 minutes. If there is no response, give another dose. Some overdoses require more than one.

Will I get in trouble for calling 911?

Most states have Good Samaritan laws offering some protection for people who call for help during an overdose. Protections vary by state.

The Bottom Line

Watch for pinpoint pupils, unresponsiveness, slow or no breathing, gurgling, limp body and blue or gray lips. Call 911, give nasal naloxone, support breathing and repeat after 2 to 3 minutes if needed. Put the person in the recovery position once breathing and stay with them, since naloxone can wear off. Naloxone is safe, available without a prescription and worth keeping in every home.