Immediate Steps for Suspected Opioid Overdose
In a suspected opioid overdose, immediately activate emergency response systems, assess for breathing and pulse, provide rescue breathing or CPR as needed, and administer naloxone if available while continuing resuscitation efforts until emergency services arrive. 1
Recognition of Opioid Overdose
Early recognition is critical for survival. Look for:
- Respiratory depression (slow, shallow, or absent breathing)
- Unresponsiveness or decreased consciousness
- Pinpoint pupils (miosis)
- Cyanosis (bluish discoloration of lips/nails)
- Evidence of drug use nearby (needles, pill bottles)
Step-by-Step Emergency Response Algorithm
1. Ensure Scene Safety
- Check for hazards before approaching
- Use personal protective equipment if available
2. Check Responsiveness
- Shake the person and shout
- If unresponsive, proceed immediately
3. Activate Emergency Response System
- Call 911 or local emergency number immediately
- Do not delay this step while waiting for response to naloxone 1
4. Assess Breathing and Pulse
- Check for normal breathing (not just gasping)
- Check for pulse (if trained to do so)
5. Provide Appropriate Resuscitation
If breathing is absent or abnormal but pulse is present:
- Open airway
- Provide rescue breathing (1 breath every 5-6 seconds)
- Administer naloxone if available 1
If no pulse is detected:
- Begin high-quality CPR immediately (compressions plus ventilation)
- Focus on CPR quality rather than naloxone administration
- Naloxone can be given during CPR if it doesn't delay resuscitation efforts 1
6. Administer Naloxone (if available)
- Give intranasal or intramuscular naloxone according to instructions
- Intranasal route is preferred for lay responders due to ease of use 2
- Typical dose is 0.4-2 mg (follow package instructions)
- May repeat dose every 2-3 minutes if no response 2, 3
7. Continue Resuscitation Until Help Arrives
- Do not stop resuscitation efforts even if naloxone is administered
- Continue rescue breathing or CPR until normal breathing returns or EMS arrives 1
8. Position the Person Appropriately
- If breathing returns, place in recovery position (on side)
- Continue to monitor breathing and pulse
Important Considerations
Naloxone Administration
- Naloxone temporarily reverses opioid effects but wears off faster than many opioids 2
- Person may return to overdose state after naloxone wears off
- Multiple doses may be needed for potent synthetic opioids 2
- Naloxone has an excellent safety profile and is unlikely to cause harm if given to someone who hasn't used opioids 1
After Naloxone Administration
- Person may experience sudden withdrawal symptoms
- They may be confused, agitated, or combative upon waking
- Do not let the person use more opioids
- Insist on medical evaluation even if they appear to recover 2
Common Pitfalls to Avoid
- Delaying emergency activation while waiting for naloxone response 1
- Focusing only on administering naloxone without providing breathing support 1
- Leaving the person alone after they wake up (overdose can recur) 2
- Assuming the person doesn't need medical care if they wake up 1, 2
- Failing to recognize polysubstance overdose (naloxone only works for opioids) 2
Training and Preparation
- First aid providers should receive training in opioid overdose response 1
- Community-based naloxone distribution programs save lives 4, 5
- Smartphone apps can alert nearby trained responders to overdose emergencies 5
Remember that early intervention with proper resuscitation techniques and naloxone administration significantly improves survival outcomes in opioid overdose cases 1, 2.