The most effective way to reverse an opioid overdose is with naloxone, a medication available without a prescription that can restore breathing within two to three minutes. For stimulant overdoses (cocaine, methamphetamine), there is no reversal drug, but cooling the person down and calling 911 can save their life. The type of overdose determines what you do, so recognizing the signs is the critical first step.
Recognizing the Type of Overdose
Opioid and stimulant overdoses look very different, and the response for each is different. Opioid overdoses slow the body down: breathing becomes shallow or stops, the skin turns cold and clammy, lips or fingertips turn blue, and the pupils shrink to tiny pinpoints. The person may be unconscious and unresponsive, or they may be making gurgling or choking sounds. This is the type of overdose that naloxone reverses.
Stimulant overdoses speed the body up. The person may have a dangerously fast heart rate, dilated pupils, excessive sweating, chest pain, or extreme agitation. They may be overheating, confused, or experiencing paranoia or hallucinations. Seizures and stroke are possible. There is no medication a bystander can give for a stimulant overdose, but there are still things you can do.
When the substance is unknown or the person may have taken a mix, treat it as an opioid overdose. Naloxone will not harm someone who hasn’t taken opioids.
How to Use Naloxone Nasal Spray
Naloxone nasal spray (sold as Narcan and other brands) comes in a single-use device that delivers 4 mg per spray. It requires no medical training. You do not need to prime or test the device before using it. Here’s the process:
- Step 1: Lay the person on their back.
- Step 2: Peel back the packaging tab to remove the nasal spray device.
- Step 3: Hold it with your thumb on the bottom of the plunger and your first and middle fingers on either side of the nozzle.
- Step 4: Tilt the person’s head back, supporting the neck with your hand. Insert the nozzle tip into one nostril until your fingers rest against the bottom of the nose.
- Step 5: Press the plunger firmly. One press delivers the full dose.
- Step 6: Remove the device from the nostril.
After giving the dose, call 911 immediately if you haven’t already. Roll the person onto their side into the recovery position (more on that below) and watch them closely. If they don’t respond within two to three minutes, give a second dose using a new device in the other nostril. You can repeat every two to three minutes with a new device until the person responds or emergency help arrives.
Rescue Breathing While Waiting
If the person is not breathing or is barely breathing, rescue breathing can keep oxygen flowing to the brain while naloxone takes effect. Tilt their head back to open the airway, pinch their nostrils closed, form a seal over their mouth with yours, and deliver one breath every five seconds. Watch for the chest to rise with each breath. Continue until the person starts breathing on their own or help arrives.
If you are uncomfortable giving mouth-to-mouth, chest compressions alone still help. Any effort to circulate oxygen is better than waiting passively.
The Recovery Position
Once the person is breathing, placing them in the recovery position prevents them from choking if they vomit. Raise the arm closest to you above their head. Gently roll them toward you, guarding their head so it doesn’t hit the floor. Their head should rest in front of the raised arm, not directly on it. Tilt the head slightly upward to keep the airway open, and tuck the nearest hand under their cheek to hold that position. Check on them frequently.
What Happens After Naloxone Works
When naloxone reverses an opioid overdose, the person may wake up in a state of sudden withdrawal. This is called precipitated withdrawal, and it can include nausea, vomiting, body aches, agitation, and rapid heartbeat. These symptoms typically peak quickly and resolve within about two hours. The person may be confused or angry. Try to explain calmly what happened and why they need to stay until paramedics arrive.
The critical concern is that naloxone wears off faster than most opioids. Depending on the opioid involved, the overdose can return once naloxone leaves the system. This is especially true with long-acting synthetic opioids like fentanyl, which is now present in a wide range of street drugs. This is why emergency medical care is essential even after a successful reversal. A person who appears fine 10 minutes after naloxone can slip back into respiratory failure.
Responding to a Stimulant Overdose
No medication exists that a bystander can give to reverse a cocaine or methamphetamine overdose. What you can do is supportive care while waiting for emergency responders.
Call 911 first. Then focus on keeping the person safe and cool. Overheating is one of the most dangerous effects of stimulant toxicity, so offer water or a sports drink, apply a cool wet cloth to the skin, and move them to a cooler or less crowded area if possible. Reduce noise and stimulation around them. Speak calmly. Don’t restrain them unless they’re in immediate physical danger, as restraint can worsen agitation and raise body temperature further.
If the person is experiencing extreme anxiety or panic, the CDC recommends simple calming techniques: breathing exercises, offering food or water, or just sitting with them in a quiet space. In the emergency department, healthcare professionals can administer medications to lower heart rate, control blood pressure, treat seizures, and manage dangerous body temperatures with active cooling.
Benzodiazepine Overdoses
Benzodiazepine overdoses (from drugs like Xanax, Valium, or Klonopin) slow breathing similarly to opioids, but naloxone does not work on them. A reversal medication called flumazenil exists, but it is only administered by healthcare professionals in very specific situations. It carries serious risks, including triggering seizures in people who take benzodiazepines regularly. It is almost never used in unknown or mixed overdoses for this reason.
If you suspect a benzodiazepine overdose, call 911 and monitor the person’s breathing. If they stop breathing, perform rescue breathing. If there’s any chance opioids were also involved, give naloxone anyway.
Where to Get Naloxone
Naloxone nasal spray is available without a prescription at most pharmacies in the United States. It comes in kits with two devices. Higher-dose formulations (8 mg nasal spray and a 5 mg injectable) also exist for situations involving potent synthetic opioids. Many community health organizations, harm reduction programs, and local health departments distribute naloxone for free.
Keep naloxone at room temperature and check the expiration date periodically. If you or someone in your household uses opioids, whether prescribed or not, having naloxone on hand is a practical precaution.
Legal Protections for Helping
Most U.S. states have Good Samaritan laws that protect people who call 911 during an overdose. These laws typically provide immunity from arrest or prosecution for drug possession or paraphernalia charges for the person who calls and, in many cases, for the person experiencing the overdose. Separate naloxone access laws provide civil and criminal immunity for people who administer naloxone in good faith. The specifics vary by state, but the broad intent is the same: removing the fear of legal consequences so people will make the call that saves a life.