Opioid Overdose: Signs to Know and How to Use Naloxone

The CDC and Texas Health and Human Services list signs that may mean someone is overdosing on opioids:

• Unconscious or unable to wake up, or unable to speak
• Slow, shallow or stopped breathing
• Choking sounds or a gurgling or snoring noise from a person who can’t be woken up
• Discolored skin, especially purple or blue fingernails or lips
• An extremely pale face that feels cold or clammy
• A limp body
• Small, constricted “pinpoint pupils” that don’t react to light
• Vomiting

If you aren’t sure whether it is an overdose, treat it as one. The CDC notes that naloxone will not harm someone if you give it to them and they are not overdosing on an opioid.

The CDC’s response steps are:

1. 1Give naloxone or another opioid overdose reversal medication, if available, and call 911. Texas HHS advises calling 911 right away.
2. 2Try to keep the person awake and breathing.
3. 3Lay the person on their side to prevent choking.
4. 4Stay with the person until emergency help arrives.

When you call, tell the 911 call-taker your exact location and that you suspect an overdose. Stay on the line and follow their instructions, and tell the EMS crew when they arrive whether naloxone was given and how many doses.

Naloxone “quickly reverses an overdose by blocking the effects of opioids,” according to the CDC. It can restore normal breathing within 2 to 3 minutes in a person whose breathing has slowed or even stopped.

• It comes in more than one form. The CDC notes that naloxone is available as a prefilled nasal spray and as an injectable medication, and that it can be given by bystanders.
• One dose first. The CDC advises giving one dose and waiting 2 to 3 minutes to see if normal breathing returns before giving a second dose.
• No special training needed. Texas DSHS states that “anyone can use naloxone without needing special medical training.” Read the package directions ahead of time so you’re ready.
• It’s safe across ages. The CDC says naloxone can be given safely to people of all ages, from infants to older adults.

On March 29, 2023, the U.S. Food and Drug Administration approved Narcan 4 mg naloxone nasal spray for over-the-counter use, calling it “the first naloxone product approved for use without a prescription.”

• Over the counter: Texas HHS notes that over-the-counter naloxone is available without a prescription in many Texas pharmacies, convenience stores, grocery stores, gas stations and online.
• Free by request: Texas HHS says Texans can request naloxone at no cost through NaloxoneTexas.com.
• Free locations near you: The Texas DSHS Texas Naloxone Locator map helps people find free or reduced-cost naloxone.
• Ask a professional: The CDC suggests talking with your doctor or pharmacist if you or someone you know takes prescribed opioids or uses illegal opioids.

Keep naloxone somewhere you and others can find it quickly, and let family members know where it is.

Some people hesitate to call 911 during an overdose because they are worried about legal trouble. The CDC notes that “most states have Good Samaritan Laws that may protect a person who is overdosing or the person who called for help from legal trouble.” Protections differ from state to state and have limits, so this is not legal advice. What matters most in the moment is getting help on the way.

Surviving an overdose can be a turning point. SAMHSA’s National Helpline, 1-800-662-HELP (4357), is a free, confidential, 24/7, 365-day-a-year treatment referral and information service, in English and Spanish, for individuals and families facing mental and/or substance use disorders. TTY users can call 1-800-487-4889.