Each year on August 31, International Overdose Awareness Day unites people around the world to remember those lost to overdose, support those affected and take action to prevent future deaths. This year’s theme, “25 Years On. Still Needed.,” recognizes a quarter century of advocacy while calling attention to a difficult truth: Overdose continues to affect individuals, families and communities everywhere.
Many overdose deaths are preventable. Knowing the risks, identifying the warning signs and understanding how to respond can save a life. So can access to naloxone, evidence-based treatment and judgment-free support.
If you suspect that someone is experiencing an overdose, call 911 immediately. Do not wait for every warning sign to appear.
What is an Overdose?
An overdose occurs when a drug or combination of substances overwhelms the body, disrupting vital functions such as breathing, heart rate, blood pressure and body temperature. It can involve illegal drugs, alcohol, prescription medications or over-the-counter medications.
Even prescribed medications can cause an overdose when taken incorrectly or combined with other substances. Following dosing instructions and discussing possible interactions with a doctor or pharmacist can reduce the risk.
Overdoses can be fatal or nonfatal, intentional or unintentional, and can affect people of every age and background.
A nonfatal overdose may cause lasting harm. If breathing slows or stops, a lack of oxygen can injure the brain, potentially causing coma, seizures or problems with movement, balance, vision, hearing, speech, concentration and memory.
A rapid response can reduce the risk of death and long-term complications.
What are the Signs of a Drug Overdose?
Signs of an overdose vary depending on the drug, amount taken, combination of substances, and the person’s health.
Warning signs of a drug overdose may include:
- An inability to wake
- Difficulty breathing
- Seizures
- Chest pain
- Severe confusion
- Agitation
- Hallucinations
- Vomiting
- Sudden changes in skin color
- Sudden changes in body temperature.
A person does not need to show every symptom to be in danger.
Understanding the warning signs associated with depressants and opioids, fentanyl, alcohol and stimulants can help you recognize an emergency and respond quickly. Overdose symptoms and the appropriate response can vary by substance. In every case, call 911 immediately and stay with the person until help arrives.
Warning signs for substance types are as follows:
Depressants
Depressants like Valium, Xanax and other barbiturates slow the central nervous system and overall brain activity. They are used to help people sleep and stop seizures.
Overdose signs include:
- Shallow or erratic breathing
- Slow or erratic pulse
- Loss of consciousness
- Vomiting
- Limp body
- Pale face
- Blue fingernails or lips
What to do:
- Do not give the person anything to eat or drink to try to induce vomiting.
- Check to be sure the person has a clear airway and plenty of space.
- Loosen any tight clothing.
- Stay until help arrives.
Opioids
Opioids like morphine, oxycodone and heroin specifically block pain and receptors causing feelings of euphoria and are used to treat patients after serious injuries.
Overdose signs include:
- Extreme sleepiness
- Inability to wake
- Slow or absent breathing
- Weak pulse
- Pinpoint (unusually small) pupils
- Pale, blue or gray lips, skin or fingernails.
- Snoring, choking or gurgling, which may indicate a blocked airway
What to do:
- Give naloxone if an opioid may be involved. If the person is unresponsive within two to three minutes, give another dose if available.
- Follow the 911 dispatcher’s instructions, place the person on their side if breathing and begin CPR if instructed.
- Do not let the person “sleep it off.”
Fentanyl
Fentanyl is a synthetic opioid used medically for severe pain. Illegally manufactured fentanyl may also be present in heroin, cocaine, counterfeit pills and other drugs without a person’s knowledge.
It is approximately 50 times more potent than morphine. Illegally manufactured fentanyl is extremely potent and exposure can cause a life-threatening overdose, particularly when its presence is unknown.
Overdose signs include:
- Fentanyl overdose generally causes the same symptoms as other opioid overdoses, including:
- an inability to wake
- slow or stopped breathing
- pinpoint (unusually small) pupils
- discolored lips or fingernails
What to do:
- Administer naloxone immediately. More than one dose may be needed because of fentanyl’s potency.
- Continue following the dispatcher’s instructions and monitor the person’s breathing until help arrives.
Alcohol
Alcohol poisoning occurs when alcohol begins shutting down areas of the brain that control breathing, heart rate and body temperature. Alcohol levels may continue rising after a person stops drinking.
Overdose signs include:
- Confusion
- Repeated vomiting
- Seizures
- Slow or irregular breathing
- Clammy or bluish skin
- Difficulty remaining conscious
What to do:
- Place the person on their side to reduce the risk of choking and monitor their breathing.
- Do not leave them alone, induce vomiting, give them coffee or put them in a cold shower.
- Never assume they can “sleep it off.”
Stimulants
Stimulants such as cocaine, methamphetamine, MDMA and certain ADHD medications increase activity in the brain and body. An overdose can place dangerous stress on the heart, brain and other organs.
Overdose signs include:
- High blood pressure
- Rapid or irregular heartbeat
- Overheating
- Heavy sweating
- Severe agitation
- Hallucinations
- Chest pain
- Seizures
Complications may include heart attack, stroke and organ damage.
What to do:
- Move the person to a quiet, cooler setting if it is safe.
- Reduce noise and stimulation, and remain calm.
- Do not restrain them unless necessary to prevent immediate injury.
- Follow the 911 dispatcher’s instructions and watch for changes in breathing or consciousness.
What Factors Increase an Overdose Risk?
Using more than one substance, mixing drugs or polysubstance use increases overdose risk by intensifying or masking effects. Combining opioids with alcohol or sedatives is especially dangerous because each can slow breathing.
Polysubstance use may be unintentional when a drug contains fentanyl or another unexpected substance. Risk also increases when using alone, taking an unfamiliar substance, obtaining pills outside a licensed pharmacy or returning to a previous dose after a period of abstinence, when tolerance may be lower.
Responding With Naloxone
Naloxone is a medication that can rapidly reverse an opioid overdose by blocking the effects of opioids and helping restore breathing. It is available as a nasal spray, including NARCAN®, and can be given by family members, friends, caregivers or bystanders.
Because fentanyl may be present in other drugs without the person’s knowledge, administer naloxone when an opioid overdose is possible. Follow the package directions and the emergency dispatcher’s instructions.
If the person is breathing but unresponsive, place them on their side to help keep the airway open and prevent choking.
If the person does not respond within 2–3 minutes, give another dose if available. Continue rescue breathing or CPR as directed by the 911 dispatcher. Naloxone works temporarily, while opioids may remain in the body much longer. Stay with the person until medical professionals arrive, even if they seem to recover.
Treatment and Recovery Are Possible
Education, naloxone access, quick medical care and evidence-based treatment save lives.
Compassion also matters. Substance use disorder is a health condition, not a character defect. Treating people with respect can make it easier for them to seek care.
If you are concerned about your substance use, speak with a medical professional. If you are worried about someone you care about, choose a calm time to voice concern, listen with an open mind and offer to help connect them with care.
Effective treatment is available, and recovery is possible. If you believe an overdose may be occurring, call 911 immediately, administer naloxone if opioids may be involved and stay with the person until help arrives.
