If your loved one is using drugs, knowing how to recognise an overdose and what to do in the first minutes is one of the most important things you can learn. This is not about expecting the worst. It is about being ready for the worst so that, if it happens, you can respond effectively rather than freeze.

Overdose by Substance: What to Look For

Opioid Overdose (heroin, fentanyl, prescription painkillers)

Opioid overdose is a medical emergency that kills through respiratory depression — the drug suppresses the drive to breathe until breathing stops altogether.

• Unconscious or impossible to rouse — no response to voice or a firm sternal rub
• Breathing very slowly (fewer than one breath per 5 seconds), shallowly, or not at all
• Gurgling or rattling breathing — a serious warning sign
• Lips, fingertips, or face turning blue, grey, or purple (in lighter skin); ashen or grey in darker skin
• Pinpoint pupils — very small even in low light
• Completely limp body, no muscle tone
• Skin may be pale, clammy, or cold

Stimulant Overdose (cocaine, methamphetamine)

Stimulant overdose typically looks very different — agitation rather than sedation.

• Extremely rapid or irregular heartbeat
• Chest pain
• Severe agitation, confusion, or paranoia
• High body temperature — skin hot to the touch
• Seizures
• Stroke symptoms: sudden facial drooping, arm weakness, slurred speech

Alcohol Overdose (alcohol poisoning)

• Unconscious or semi-conscious, cannot be wakened
• Breathing very slowly — fewer than 8 breaths per minute — or irregular
• Skin pale, bluish, or cold and clammy
• Vomiting while unconscious — extremely high risk of choking
• Seizures

Benzodiazepine Overdose

Similar to opioid overdose — sedation, slowed breathing — but rarely fatal unless combined with alcohol or other depressants, in which case it can be rapidly life-threatening.

What to Do: Step by Step

Step 1: Try to rouse them

Call their name loudly. Rub your knuckles firmly on their sternum (breastbone). If there is no response, assume overdose and act immediately.

Step 2: Call emergency services immediately

999 in the UK. 911 in the US. Do this first — do not waste time trying other interventions before calling. Emergency services can talk you through what to do while they are on their way.

Many US states have Good Samaritan laws that protect people who call for help during an overdose from drug possession charges. Do not let fear of police stop you from calling.

Step 3: For suspected opioid overdose — give naloxone

If you have naloxone (Narcan), give it immediately. Nasal spray: one spray into one nostril. If no response after 2–3 minutes, give a second dose. See our full guide: Naloxone: A Family Guide →

Step 4: Position them safely

If they are breathing, place them in the recovery position — on their side, with their top knee bent forward to prevent them rolling onto their back. This prevents choking on vomit.

If they are not breathing and you are trained in CPR, begin rescue breaths. Do not give up — naloxone can take several minutes to take effect.

Step 5: Stay with them

Do not leave them alone under any circumstances. Stay on the line with emergency services. If naloxone was given, monitor closely — it wears off in 30–90 minutes and the overdose can return before the opioid has fully cleared the system.

After an Overdose

An overdose is a medical crisis — and it is also an inflection point. Once the immediate danger has passed, it is often the moment when conversation about treatment becomes possible in a way it has not been before. Many people who enter treatment do so following an overdose. The window of openness that follows should be used gently but purposefully.

See our guide: How to Find a Rehab for Your Loved One →