Opioid Overdose: How to Recognize Symptoms and Use Naloxone to Save a Life

When someone overdoses on opioids, they don’t always look like they’re in trouble. They might be slumped over, quiet, or even asleep. But if you don’t act fast, they could stop breathing-and die. Opioid overdoses are happening every day across the U.S. and Canada. In 2023 alone, nearly 87,000 people in the U.S. died from opioid overdoses, mostly because of fentanyl, a synthetic opioid up to 100 times stronger than morphine. The good news? You can reverse an overdose with naloxone. And you don’t need to be a doctor to do it.

What Happens During an Opioid Overdose?

Opioids-like heroin, oxycodone, fentanyl, and morphine-slow down your breathing. That’s how they relieve pain. But when too much gets into the body, the brain’s breathing control center shuts down. The person stops breathing, or breathes so slowly that their blood doesn’t get enough oxygen. Brain damage can start in as little as four minutes. Without oxygen, the heart can stop. Death follows quickly.

The signs aren’t always obvious. Someone might be unresponsive, even if you shake them hard or shout their name. Their lips or fingernails might turn blue, purple, or gray. Their skin may feel cold and clammy. Their pupils will be tiny-like pinpricks. You might hear a gurgling sound, like they’re drowning in their own saliva. This is called the "death rattle." It means their airway is blocked because they’re not breathing deeply enough to clear it.

People with darker skin tones may not show blue discoloration. Instead, their skin might look ashen or gray. Don’t wait for the classic blue color. If someone is unresponsive and breathing very slowly-fewer than two breaths every 15 seconds-that’s an overdose.

How Naloxone Works

Naloxone is not a cure. It’s a temporary fix. But it’s life-saving. Developed in 1961 and approved by the FDA in 1971, naloxone works by kicking opioids off the brain’s receptors. Think of it like a key that fits better than the original. It grabs the receptor first, pushes the opioid out, and lets breathing restart.

Naloxone doesn’t work on cocaine, meth, alcohol, or benzodiazepines. That means if you’re not sure what someone took, giving naloxone won’t hurt them. It’s safe. It’s also not addictive. You can’t get high from it. And it wears off in 30 to 90 minutes. That’s the problem. Many opioids, especially fentanyl, last much longer. So the person can slip back into overdose after naloxone wears off.

That’s why calling 911 is non-negotiable-even if they wake up. Medical teams need to monitor them for at least a few hours. Rebound overdose is real. In 2023, the CDC reported that 60% of naloxone reversals required more than one dose, especially with fentanyl.

How to Administer Naloxone

There are three main ways to give naloxone: nasal spray, injection, or auto-injector. The easiest for most people is nasal spray-like Narcan or the newer generic versions.

1. Check for responsiveness. Shake the person’s shoulder and shout their name. If they don’t respond, assume overdose.
2. Call 911. Don’t wait. Even if you’re scared, call. Good Samaritan laws protect you in 47 U.S. states and all Canadian provinces if you’re seeking help for an overdose.
3. Give naloxone. For nasal spray: Tilt the head back slightly. Insert the nozzle into one nostril. Press the plunger firmly. That’s one dose. If you have a two-pack, keep the second one ready.
4. Start rescue breathing. Pinch the nose shut. Give one breath every five seconds-about 10 to 12 per minute. Watch for the chest to rise. Keep going until they breathe on their own or help arrives.
5. Wait and watch. If they don’t respond in 2 to 3 minutes, give the second dose. Keep doing rescue breathing. Don’t leave them alone. Even if they wake up, they need medical care.

For intramuscular injections (like Evzio), inject into the outer thigh through clothing if needed. The auto-injector talks you through it. But nasal spray is simpler, cheaper, and just as effective for most cases.

What Not to Do

There are dangerous myths about overdose response. Don’t do any of these:

• Don’t put them in a cold shower or bath. You risk drowning.
• Don’t slap them or try to make them "wake up" with pain. It won’t help.
• Don’t give them coffee, salt, or stimulants. That can make things worse.
• Don’t assume one dose is enough. Fentanyl overdoses often need two or three doses.
• Don’t leave them alone after they wake up. They can go back under.

One Reddit user, who’s reversed three overdoses in 2022, said: "The first time, it took four minutes for him to start breathing again. The second time, I had to use two sprays because the heroin was laced with fentanyl. He woke up coughing, then threw up. I turned him on his side. That saved him from choking."

Where to Get Naloxone

You don’t need a prescription in any U.S. state. You can walk into most pharmacies and ask for naloxone. Prices range from $25 to $130, depending on where you are and whether it’s brand-name Narcan or a generic. Many community health centers, syringe exchange programs, and harm reduction groups give it away for free.

Some libraries, shelters, and even public restrooms in cities like Philadelphia and Vancouver now have naloxone kits in boxes labeled "Overdose Rescue." They’re designed for anyone to grab and use.

Storage matters. Naloxone loses effectiveness if it gets too hot. Keep it out of direct sunlight. Don’t leave it in a car in summer. The ideal temperature is below 104°F (40°C). Check the expiration date. Most last two to three years.

Why This Matters

Since 2019, widespread naloxone distribution has prevented an estimated 27,000 deaths a year in the U.S., according to Johns Hopkins. But we’re still falling short. The CDC estimates we need 2.1 million naloxone kits available for people at risk. We’re only distributing about half that.

Why? Cost. Fear. Ignorance. Some people worry about legal trouble. Others don’t know how to use it. A 2022 survey found 24% of bystanders didn’t call 911 because they feared immigration consequences or parole violations. That’s why training matters. Community programs like Next Distro report 92% of people still remember how to use naloxone six months after training.

And yes, naloxone isn’t a solution to the opioid crisis. It’s a bandage on a wound that needs surgery. People need access to treatment-medication-assisted therapy, counseling, housing, jobs. But while we fix the system, naloxone saves lives today.

Dr. Sarah Wakeman from Massachusetts General Hospital put it bluntly: "Without addressing the root causes of addiction, overdose reversal is just a temporary fix." But sometimes, temporary is all you need to keep someone alive long enough to get help.

What to Do After You Use Naloxone

Even if the person wakes up, they need to go to the hospital. Naloxone can cause sudden withdrawal-nausea, vomiting, sweating, agitation. That’s uncomfortable, but not deadly. The bigger risk is pulmonary edema (fluid in the lungs) or another overdose once the naloxone wears off.

After a reversal, the person should be monitored for at least two hours. If they’re stable, they can be referred to a treatment program. Many hospitals now have peer navigators who can connect people to methadone, buprenorphine, or counseling right away.

And if you’re the one who used naloxone? You’re a hero. Don’t feel guilty. Don’t second-guess. You did exactly what needed to be done. Save the receipt. Some programs offer free training or extra kits for people who’ve reversed an overdose.

Next Steps

If you use opioids-or know someone who does-get a naloxone kit today. Keep it in your bag, your car, your drawer. Don’t wait for an emergency to find out you don’t have one. Train yourself and your friends. Share the video. Talk about it. Overdose deaths aren’t inevitable. They’re preventable. And you can be the reason someone lives to see another day.