Signs of Opioid Overdose Family and Friends Should Know

Seeing someone “not acting right” after using a prescription pain medication, heroin, or something that may contain fentanyl can be scary and disorienting. A lot of people freeze in that moment—not because they don’t care, but because their brain is trying to catch up. You’re not alone in that.

An opioid overdose is a medical emergency. The most important thing to remember is simple: opioids can slow breathing so much that the body doesn’t get enough oxygen. Acting quickly can save a life. Take one steady breath, and focus on what you can do next.

Signs of Opioid Overdose

The clearest red flag is breathing trouble. Someone may breathe very slowly, take long pauses between breaths, or stop breathing.

Other overdose warning signs can include:

• Unresponsiveness (can’t be awakened, doesn’t respond to shouting or a firm rub on the breastbone)
• Very sleepy or “nodding off” and hard to keep awake
• Blue, gray, or pale lips or fingertips (color changes may be harder to see on darker skin, so look for “ashen” tone or cooler skin)
• Gurgling, snoring, or choking sounds that seem unusual
• Pinpoint pupils (very small pupils)
• Cold, clammy skin or a very slow heartbeat

It’s common for people to feel unsure—especially if they don’t know what substance was used. Still, when breathing is slow or someone can’t be awakened, treat it like an emergency.

Knowing the signs of opioid overdose can help you move from panic to clear action in a few seconds.

Next step: when you’re scanning quickly, check breathing first.

How Opioid Overdose Happens

Opioids attach to receptors in the brain and body that can reduce pain and create sedation. In higher amounts—or when mixed with alcohol, benzodiazepines, or other sedating drugs—opioids may suppress the “drive” to breathe. With potent opioids like illicitly manufactured fentanyl, this can happen fast, and it may be hard to know how strong a dose was.

None of this means someone “wanted” to be in danger. Overdose can happen to people using opioids for many different reasons, including people who are trying to cope, people who are dependent, and people who are taking medication as prescribed but have unexpected risk factors.

Next step: remind yourself that this is a medical crisis, not a moment for blame.

Responding to an Opioid Overdose

When you think someone may be overdosing, prioritize safety and speed:

1. Call 911 (or your local emergency number). Tell them you suspect an opioid overdose and share what you observe (slow/no breathing, unresponsive).
2. Try to wake the person by calling their name and using a firm breastbone rub.
3. Support breathing. If you know how and it’s safe for you, give rescue breaths. If the person is breathing but very out of it, place them on their side (recovery position) to help protect their airway.
4. Stay with them until help arrives. Overdose can return after someone briefly seems better, especially if a long-acting opioid was involved.

If this feels like a lot, it’s okay to focus on just two things: call for help and watch breathing.

Next step: save emergency numbers in your phone now, before you ever need them.

Reversing Opioid Overdose with Naloxone

Naloxone is a medication that can rapidly reverse opioid effects, including dangerously slowed breathing. Many communities provide it without a personal prescription, and some people keep it at home or carry it.

Naloxone may wear off before the opioid does, and some situations may require more than one dose—so emergency medical care is still essential even when someone wakes up. With fentanyl exposure, the situation can be especially unpredictable, which is one reason quick follow-up care matters.

Next step: consider where naloxone is available in your community, workplace, or home.

Opioid Overdose Is a Sign You Might Need Mental Health Counseling

After an overdose, the body and brain can feel “shaken” for days—fear, shame, anger, numbness, or a strong urge to pretend it didn’t happen. Those reactions are common, and they don’t mean you failed.

Overdose can be connected to opioid use disorder, trauma, depression, anxiety, or intense stress. Evidence-based treatment—often involving medication and counseling—may reduce future overdose risk and support long-term recovery. For family and friends, support can look like helping someone get medical follow-up, offering a ride, or simply saying, “I’m glad you’re here.”

Next step: choose one supportive, non-judgmental sentence you can say if this happens again.

Conclusion

Recognizing an overdose quickly is an act of care. You don’t have to be perfect—you just have to act. When someone’s breathing is slow or they can’t be awakened, treat it as an emergency, call for help, and stay with them. After the crisis passes, it’s okay to seek support for yourself, too; witnessing an overdose can be traumatic.

Safety Disclaimer

If you or someone you love is in crisis, call 911 or go to the nearest emergency room. You can also call or text 988, or chat via 988lifeline.org to reach the Suicide & Crisis Lifeline. Support is free, confidential, and available 24/7.