Opioid Overdose
A medical emergency that slows or stops breathing
Quick Facts
- Type: Medical emergency / poisoning
- Key danger: Breathing slows or stops
- Antidote: Naloxone (Narcan)
- Action: Call emergency services immediately
Overview
An opioid overdose is a medical emergency. If you suspect one, call emergency services (such as 911) right away.
Opioids include prescription pain medicines such as oxycodone, hydrocodone, morphine, and fentanyl, as well as illegal drugs such as heroin. In high doses they suppress the part of the brain that controls breathing. When breathing slows or stops, the body and brain are starved of oxygen, which can quickly become fatal.
Overdose can be reversed if it is recognized early and the antidote naloxone is given while emergency help is on the way. Many overdose deaths are preventable.
Symptoms
Warning signs of an opioid overdose include:
- Slow, shallow, irregular, or stopped breathing
- Unresponsiveness, or being unable to be woken even with shaking or shouting
- Very small, pinpoint pupils
- Limp body and pale, clammy, or bluish skin, especially the lips and fingertips
- Gurgling, choking, or snoring-like sounds
- Slow or no pulse
If a person is breathing very slowly and cannot be woken, treat it as an overdose and act immediately.
Causes
An overdose happens when the amount of opioid in the body overwhelms the brain's control of breathing. Contributing factors include:
- Taking a higher dose than the body can handle, including taking extra doses or using illegal opioids of unknown strength
- Mixing opioids with alcohol, sedatives, or other drugs that also slow breathing
- Reduced tolerance after a period without opioids, such as after hospitalization, treatment, or incarceration
- Contamination of street drugs with potent opioids such as fentanyl
Risk Factors
- Use of high-dose opioids or use of illegal opioids
- Combining opioids with alcohol or sedatives such as benzodiazepines
- A history of substance use disorder or previous overdose
- Returning to opioid use after a period of abstinence
- Underlying lung or breathing problems
Diagnosis
Overdose is recognized clinically by the combination of slowed breathing, unresponsiveness, and pinpoint pupils, often with information about opioid use. In the hospital, doctors monitor oxygen and breathing, may use blood or urine tests, and watch for the overdose returning as naloxone wears off. Do not wait for tests if someone is overdosing; emergency treatment comes first.
Treatment
Quick action saves lives:
- Call emergency services immediately.
- Give naloxone if available: Naloxone (such as the nasal spray Narcan) rapidly reverses opioid effects. Give it and repeat as directed if there is no response, since strong opioids may need more than one dose.
- Support breathing: Keep the airway open and give rescue breaths or CPR if trained and the person is not breathing.
- Stay and monitor: Place the person on their side to prevent choking and stay until help arrives, because the overdose can return as naloxone fades.
In the hospital, breathing is supported and the person is observed until the opioid is out of their system.
Prevention
- Take prescription opioids exactly as directed and never share them
- Avoid mixing opioids with alcohol or sedatives
- Keep naloxone on hand if you or someone you know uses opioids, and learn how to use it
- Store medicines safely away from children and others
- Seek treatment for opioid use disorder; effective help is available
When to See a Doctor
Call emergency services immediately if a person has slow or stopped breathing, cannot be woken, has pinpoint pupils, or has blue-tinged lips or skin after taking opioids. Give naloxone if you have it, then stay with the person. Even if naloxone seems to work, the person still needs emergency evaluation, because the overdose can return.
Frequently Asked Questions
What should I do first if I think someone is overdosing on opioids?
Call emergency services immediately. If naloxone is available, give it right away and repeat as directed if there is no response. Keep the person's airway open, give rescue breaths or CPR if trained, place them on their side, and stay with them until help arrives.
Does naloxone always work?
Naloxone reverses most opioid overdoses, but very potent opioids like fentanyl may require more than one dose. It also wears off after a while, so the overdose can return. Always call emergency services even if naloxone appears to work.
What are the warning signs of an opioid overdose?
Key signs are very slow or stopped breathing, being unable to wake the person, pinpoint pupils, limp body, and pale or bluish lips and skin. If someone cannot be woken and is breathing very slowly after opioid use, treat it as an overdose.
Can naloxone harm someone who is not overdosing?
Naloxone only affects opioids and is considered safe to give if you are unsure. It will not harm a person who has not taken opioids, so it is reasonable to use it when an opioid overdose is suspected.
How can opioid overdose be prevented?
Take opioids only as prescribed, never mix them with alcohol or sedatives, keep naloxone available, store medicines safely, and seek treatment for opioid use disorder. Reduced tolerance after a break from opioids greatly raises overdose risk.
References
- Centers for Disease Control and Prevention (CDC). Opioid Overdose.
- Substance Abuse and Mental Health Services Administration (SAMHSA). Opioid Overdose Prevention.
- MedlinePlus, U.S. National Library of Medicine. Opioid overdose.
- World Health Organization (WHO). Opioid overdose.