Drug Overdose

What to do if someone overdoses

You do not need to know which drug was taken to help. Act quickly.

1. Check responsiveness. Shout their name and rub your knuckles firmly on their breastbone.
2. Call 911 or your local emergency number. Say the person is unresponsive or not breathing normally. Most US states have Good Samaritan laws that protect people who call for help with an overdose from some drug charges.
3. Give naloxone (Narcan) if you have it and opioids could be involved, including any street pill or powder, which may contain fentanyl. Spray it into one nostril. If there is no response in 2 to 3 minutes, give a second dose. Naloxone does no harm if opioids are not involved.
4. Support breathing. If they are not breathing or only gasping, start CPR (hard, fast chest compressions in the center of the chest). Dispatchers can talk you through it.
5. Use the recovery position if they are breathing: on their side, top knee bent, head tilted back slightly so vomit can drain and the airway stays open.
6. Stay with them. Naloxone wears off in 30 to 90 minutes, sooner than many opioids, so breathing can slow again.
7. Collect information. Keep pill bottles, packaging or substances to show paramedics, and note the time taken if known.

For symptoms that point to specific drug groups, such as antidepressants, blood pressure medicines or seizure medicines, see our page on overdose signs by drug type.

Signs of a drug overdose

Signs depend on whether the drug slows the body down or speeds it up.

Mixtures are the most dangerous. Opioids combined with alcohol or benzodiazepines cause most fatal breathing failures, and many street drugs sold as stimulants or counterfeit pills now contain fentanyl.

Accidental overdose

Not every overdose involves drug misuse. Common accidental patterns include:

• Children finding medicines, especially in handbags, on counters or in pill organizers. Opioids, heart medicines, diabetes tablets and iron can be dangerous in a single adult dose.
• Older adults taking a dose twice, or taking several medicines that contain the same ingredient.
• Hidden duplicates, such as a cold remedy and a pain reliever that both contain acetaminophen.
• Lost tolerance after a break from opioids, for example after prison release, hospital stays or detox. The old dose can now be fatal.
• Changes in health, such as kidney or liver disease, that slow how fast a drug is cleared.

Hospital treatment

Emergency teams follow a set order: airway, breathing and circulation first, then identifying and treating the specific poison.

• Breathing support: oxygen, a bag-valve mask, or a breathing tube and ventilator.
• Antidotes: naloxone for opioids, acetylcysteine for acetaminophen, and others for specific drugs.
• Activated charcoal: sometimes given within about an hour for some swallowed drugs in a person who is awake and can protect their airway.
• Monitoring: heart tracing (ECG), blood levels of drugs such as acetaminophen and aspirin, kidney and liver tests and blood sugar.
• Treating complications: seizures, high temperature, dangerous heart rhythms and low blood pressure.

Even when someone recovers quickly, doctors often observe them for several hours because some drugs, including long-acting opioids and extended-release tablets, cause delayed effects.

Possible complications

• Brain injury from lack of oxygen
• Aspiration pneumonia from inhaling vomit
• Liver failure (acetaminophen) or kidney injury
• Muscle breakdown from lying still for hours
• Heart attack, stroke or dangerous arrhythmias with stimulants

After an overdose: recovery and next steps

The weeks after a nonfatal overdose are a high-risk time for another one. Useful steps include:

• Treatment for substance use: medicines for opioid use disorder, such as buprenorphine or methadone, cut the risk of death substantially. Ask the ER or a primary care doctor for a referral. Learn more about substance use disorder and treatment options.
• Mental health support: after an intentional overdose, a mental health assessment is part of standard care. People with suicidal thoughts can call or text 988 at any time.
• Carry naloxone: most US pharmacies sell it without a prescription.
• Never use alone, start low after any break, and test drugs with fentanyl test strips where legal.

Preventing accidental overdose

• Keep medicines in their original containers, locked and out of children's sight.
• Use one pharmacy so duplicates and interactions are flagged.
• Read active ingredients on every over-the-counter product and follow the label dose.
• Do not mix opioids or sleeping medicines with alcohol.
• Dispose of leftover opioids at a pharmacy take-back site.
• Save the Poison Control number, 1-800-222-1222, in your phone.

Frequently asked questions

What are the signs of a drug overdose?

Common signs are extreme sleepiness or not waking up, slow, shallow or stopped breathing, blue lips, pinpoint or very large pupils, confusion, vomiting, seizures, chest pain or a very high temperature. Signs differ by drug, but any unresponsive person with abnormal breathing needs 911 called immediately.

What should you do if someone overdoses?

Call 911, give naloxone if opioids might be involved, and start CPR if they are not breathing. If they are breathing, roll them onto their side in the recovery position. Stay with them until help arrives and give paramedics any pill bottles or substances you find.

Can you survive an overdose without going to the hospital?

Some people do, but it is risky to rely on. Breathing can slow again once naloxone wears off, acetaminophen damage appears days later, and some tablets release drug for many hours. Anyone who has overdosed, even if they seem to recover, should be checked by emergency services.

Is it safe to give naloxone if you are not sure it was opioids?

Yes. Naloxone only reverses opioids and has no effect on someone who has not taken them. It cannot get a person high and is very unlikely to cause harm. Someone dependent on opioids may wake up in sudden withdrawal, which is unpleasant but rarely dangerous.

How long after taking too much acetaminophen do symptoms appear?

Often not for 24 hours or more. People may feel well or only mildly sick on day one, then develop liver damage on days two to four. That is why anyone who has taken more than the label maximum needs urgent medical advice, even without symptoms.