What To Do During an Overdose: A Practical Harm Reduction Guide
Learn what to do during an overdose involving opioids, cocaine, MDMA, benzodiazepines or unknown substances, including naloxone and aftercare.
An overdose is a medical emergency, but not every overdose looks the same. And not every overdose can be treated with naloxone.
Naloxone has become one of the most important harm reduction tools available because it can rapidly reverse an opioid overdose and restore breathing. However, naloxone only works against opioids. It does not reverse an overdose caused by cocaine, MDMA, methamphetamine, benzodiazepines, alcohol, or other non-opioid substances.
This distinction matters.
Someone experiencing an opioid overdose may primarily need their breathing restored and naloxone administered. Someone experiencing severe cocaine or MDMA toxicity may instead be suffering from seizures, dangerous overheating, cardiovascular complications or other forms of acute toxicity. Someone who has taken a large amount of benzodiazepines may become deeply unconscious and develop breathing problems, particularly when other depressants are involved.
There is no single medication that reverses every type of overdose.
The most important response is therefore to recognize that something is seriously wrong, contact emergency services, check breathing and responsiveness, provide appropriate first aid, and tell medical professionals what substances may have been involved.
First: Treat a Suspected Overdose as an Emergency
If someone is unconscious, difficult to wake, having a seizure, struggling to breathe, breathing abnormally, experiencing severe chest pain, showing signs of a stroke, dangerously overheated, or otherwise appears critically ill after taking drugs, call emergency services.
Do not wait until you know exactly what they took.
If you know what substances were used, tell emergency responders. If you do not know, say that too.
Drug mixtures can make symptoms difficult to interpret, and people may not always know exactly what was in a substance they consumed.
The priority is keeping the person alive until professional medical help arrives.
Recognizing an Opioid Overdose
Opioids such as heroin, fentanyl, oxycodone and other opioids can suppress the body’s ability to breathe.
Common warning signs include:
- The person cannot be woken or is extremely difficult to wake
- Breathing is very slow, shallow or has stopped
- Gurgling, choking or unusual breathing sounds
- Blue, grey or pale lips or fingertips
- Very small or “pinpoint” pupils
- Limpness or loss of consciousness
If an opioid overdose is suspected, naloxone should be administered if it is available.
Naloxone works by temporarily blocking the effects of opioids and can restore breathing. It is specifically an opioid antidote, it does not reverse other types of drug toxicity.
After giving naloxone, continue providing first aid and follow the instructions of emergency responders. Naloxone can wear off before some opioids have left the body, meaning the person can become unresponsive again.
The Important Naloxone Distinction
This is worth stating clearly: Naloxone is not a universal overdose antidote.
Naloxone can reverse an opioid overdose.
It cannot reverse:
- Cocaine toxicity
- MDMA toxicity
- Methamphetamine toxicity
- Benzodiazepine toxicity
- Alcohol poisoning
- Most other non-opioid overdoses
This does not mean naloxone is useless when the substance is unknown.
If opioids could be involved in an unknown or mixed overdose, administering naloxone is still appropriate when available. Naloxone is generally safe when opioids are not present, but it will not solve the underlying problem if the overdose is caused by another substance.
The important thing is not to give naloxone and assume the emergency is over.
What To Do During a Cocaine or Stimulant Overdose..
Stimulants such as cocaine and methamphetamine can cause severe cardiovascular and neurological complications.
Possible signs of serious stimulant toxicity include:
- Severe agitation, confusion or paranoia
- Very high body temperature
- Chest pain
- Rapid or irregular heartbeat
- Difficulty breathing
- Seizures
- Loss of consciousness
- Stroke symptoms
- Collapse
There is currently no take-home medication equivalent to naloxone that simply reverses stimulant toxicity.
The response is therefore different.
Call emergency services and keep the environment as calm as possible. Avoid unnecessary physical confrontation or restraint, particularly if the person is extremely agitated or confused.
If the person is dangerously hot, move them away from excessive heat if it can be done safely and remove unnecessary layers of clothing.
If they have a seizure, protect them from nearby objects that could cause injury. Do not put anything in their mouth and do not attempt to physically restrain them.
If they become unconscious, check their breathing and follow emergency-dispatch instructions.
What To Do During an MDMA Overdose
MDMA can produce serious toxicity, particularly when someone becomes dangerously overheated.
Warning signs can include:
- Very high body temperature
- Severe confusion or agitation
- Seizures
- Loss of consciousness
- Rapid heartbeat
- Difficulty breathing
- Collapse
Severe overheating is a medical emergency.
Call emergency services and move the person away from excessive heat if it is safe to do so. Monitor their condition while waiting for help.
Do not assume someone who becomes extremely confused, unconscious or dangerously hot simply needs to “sleep it off.”
And again, naloxone does not reverse MDMA toxicity.
If opioids may also have been involved, naloxone can still be given because it may reverse the opioid component of a mixed overdose. It will not treat the MDMA toxicity itself.
What To Do During a Benzodiazepine Overdose
Benzodiazepines such as diazepam, alprazolam and other drugs in this class can cause extreme sedation and loss of consciousness when taken in excessive amounts.
The risk becomes particularly serious when benzodiazepines are combined with opioids, alcohol or other central nervous system depressants.
Possible signs include:
- Extreme sleepiness
- Confusion
- Poor coordination
- Loss of consciousness
- Slow or difficult breathing
Naloxone does not reverse benzodiazepine poisoning.
There is a medical drug called flumazenil that can reverse benzodiazepine effects in specific circumstances, but it is not a general take-home antidote for bystanders. It can also be inappropriate or dangerous in some overdose situations.
The priority outside a medical setting is therefore emergency assistance, monitoring breathing and protecting the person’s airway.
If opioids may also be involved, administer naloxone if available.
What If You Don’t Know What They Took?
This situation is common.
You may find someone unconscious without knowing what they consumed, or they may have taken several substances.
Do not waste valuable time trying to identify the exact drug before calling for help.
Instead:
- Check whether they respond.
- Check whether they are breathing normally.
- Call emergency services.
- If opioid involvement is possible, administer naloxone if available.
- If they are unconscious but breathing normally, place them in the recovery position.
- If they are not breathing normally, follow emergency-dispatch instructions for rescue breathing and CPR.
- Stay with them and continue monitoring them.
- Tell medical professionals anything you know about what they may have taken.
Mixed overdoses can produce complicated symptoms. A stimulant does not simply “cancel out” a depressant, and taking multiple substances can create additional risks rather than balancing their effects.
If They Are Not Breathing Normally
Breathing is one of the most important things to check.
If someone is unconscious and not breathing normally, call emergency services immediately and follow the dispatcher’s instructions.
If you are trained and able to provide rescue breathing and CPR, do so according to your training and local emergency guidance.
For suspected opioid overdose, administer naloxone as soon as possible if it is available.
Do not spend several minutes trying to determine whether the person took heroin, fentanyl or another opioid before acting.
If They Are Unconscious But Breathing
If someone is unconscious but breathing normally, placing them in the recovery position can help keep their airway open and reduce the risk of choking if they vomit.
Continue monitoring their breathing.
Do not leave them alone simply because they appear to be breathing.
A person’s condition can change quickly, particularly following a drug overdose.
What Not To Do
There are many myths surrounding overdoses.
Do not:
- Leave the person alone
- Assume they can simply “sleep it off”
- Force them to drink coffee or water
- Induce vomiting
- Put anything in the mouth of someone having a seizure
- Physically restrain someone during a seizure
- Put an unconscious person into a cold shower or bath
- Delay calling emergency services while trying to identify the substance
- Assume that naloxone has solved the entire problem
- Assume that a person is safe simply because they wake up
The goal is to keep the person alive and prevent additional injury until professional help arrives.
After Naloxone
Naloxone can restore breathing, but it does not necessarily mean the danger has passed.
Its effects can wear off while an opioid remains in the person’s system. The person can therefore become unconscious or develop breathing problems again.
Stay with them and continue monitoring their condition.
Naloxone can also trigger sudden opioid withdrawal in someone who is physically dependent on opioids. They may wake up confused, uncomfortable or distressed.
That reaction can be difficult, but it does not mean the naloxone was unnecessary. Restoring breathing is the priority.
The person should also understand that taking more opioids immediately after receiving naloxone can create another overdose risk.
After the Emergency
Surviving an overdose can be frightening, confusing and sometimes embarrassing.
There is no benefit in lecturing someone while they are recovering.
Once the immediate emergency has passed, there are several useful things to consider.
Get medical attention
An overdose can cause complications that are not immediately obvious. Medical professionals can assess whether further treatment or observation is necessary.
Understand That Tolerance Can Change
After a period without using opioids, tolerance can decrease. Returning to a previous amount can therefore carry a higher overdose risk.
Keep Naloxone Available
For anyone who may encounter opioids, having naloxone nearby can make an enormous difference.
But naloxone should be viewed as one part of an overdose-response plan, not the entire plan.
Consider what caused the overdose..
Was the substance unexpectedly strong? Was it mixed with another drug? Was alcohol involved? Was the amount different from what was expected?
Understanding what happened can help reduce the likelihood of another emergency.
Consider drug checking where available
Drug checking cannot make drug use safe, but where legitimate services are available, testing can provide information about unexpected substances or adulterants.
Overdose Witnesses Need Support Too
Watching someone overdose can be traumatic.
A person who has just experienced an overdose may also feel frightened or ashamed. Treating them with dignity can make it easier for them to seek medical care and talk honestly about what happened.
The immediate priority is survival.
The conversation about what happened can come later.
A Simple Overdose Checklist
If you remember nothing else, remember these steps:
1. Check the person.
Are they responsive? Are they breathing normally?
2. Call emergency services.
Do not wait until you know exactly what substance is involved.
3. Give naloxone if opioid involvement is possible.
Remember: naloxone reverses opioids, not cocaine, MDMA, benzodiazepines or other non-opioid drugs.
4. Support breathing.
Follow emergency-dispatch instructions and provide CPR or rescue breathing if trained and able.
5. Use the recovery position when appropriate.
If someone is unconscious but breathing normally, protect their airway and continue monitoring them.
6. Stay with them.
Do not assume the danger has passed because they wake up.
7. Tell medical professionals what you know.
Knowing what substances may have been taken can help responders provide appropriate treatment.
Overdose response should never be reduced to “give naloxone.”
Naloxone is an extremely important harm reduction tool and can save someone’s life during an opioid overdose. But it does not reverse cocaine toxicity, MDMA toxicity, benzodiazepine poisoning or other non-opioid overdoses.
Different substances can cause different medical emergencies.
The most important steps are to recognize when something is seriously wrong, call emergency services, check responsiveness and breathing, provide appropriate first aid, administer naloxone when opioid involvement is possible, and stay with the person until professional help takes over.
Knowing the difference can save a life.
