Opioid Overdose Signs and Naloxone

Key takeaway

If they will not wake, are breathing slowly, have blue or purple lips or nails, or have gone limp, call 911 and give naloxone if you have it. Naloxone can restore breathing and then wear off. It does not treat opioid use disorder. Stay until emergency care arrives, and watch for two hours after the last dose.

Last updated: Mon Oct 05 2026 00:00:00 GMT+0000 (Coordinated Universal Time)

If they will not wake, are breathing slowly or not at all, have blue or purple lips or nails, or have gone limp, call 911. Say they are unresponsive and not breathing, and give a specific address. Give naloxone if you have it. Stay and follow the dispatcher.

For a mental health crisis when nobody is overdosing, call or text 988.

What you are looking at

Call if you see any of these:

The face is extremely pale or feels clammy
The body goes limp
Fingernails or lips are purple or blue
They vomit or make gurgling noises
They cannot be awakened or cannot speak
Breathing or heartbeat slows or stops

NIDA's list overlaps that one: unconsciousness, very small pupils, slow or shallow breathing, vomiting, an inability to speak, a faint heartbeat, limp arms and legs, pale skin, and purple lips and fingernails. You do not need every sign. If you are unsure, make the call anyway.

An overdose can follow an illicit opioid such as heroin, methadone, an extra dose, misuse of a prescribed opioid, or someone else's medicine. Mixing an opioid with alcohol or with a benzodiazepine such as alprazolam or diazepam can be fatal. If a child takes medicine that was not meant for them, make the same emergency call.

Give naloxone, then watch the breathing

Naloxone is an opioid antagonist. It attaches to opioid receptors, blocks other opioids, and can quickly restore breathing. It has no effect if opioids are not involved, and it does not treat opioid use disorder. The opioids named in these materials include heroin, fentanyl, oxycodone, hydrocodone, codeine, and morphine. People say Narcan for every product. That was the original brand. The generic name is naloxone. The SAMHSA toolkit also names nalmefene. Follow the instructions on the product in your hand. Do not swap doses between products. If the device is the prescription spray rather than naloxone, read nalmefene.

On March 29, 2023, the FDA approved Narcan 4 mg nasal spray as the first naloxone product sold without a prescription. The manufacturer sets the price and when it reaches stores. Other formulations stayed prescription-only. Ask a pharmacy, a community program, or a local health department how to get it where you live. Families of people who use opioids should keep it nearby, ask the person to carry it, and tell friends where it is.

Give it to anyone with these signs, or when an opioid overdose is suspected. Check the expiration date. Injectable naloxone and a prepackaged nasal spray are different devices. The nasal spray needs no assembly. The person lies on their back, and you spray into one nostril. An improvised kit made from injectable naloxone is not the FDA-approved device, and it is hard to assemble while someone is not breathing.

The public order is the emergency call, then CPR if breathing has stopped or is very weak, best done by someone with training, then naloxone or nalmefene if you have it. The toolkit says these medicines do not cause harm if the emergency is not an opioid overdose. Naloxone will not reverse a problem that is only alcohol, only a benzodiazepine, or only a stimulant. Those emergencies still need the ambulance. If breathing does not start within two to three minutes, give a second dose, and continue every two to three minutes until breathing starts. Some opioids need multiple doses. Do not delay the first dose, or the call, to hunt for a technique you have not been shown. Breathing matters more than waking the person up.

Naloxone works in the body for 30 to 90 minutes. Many opioids last longer, so the overdose can return. Watch constantly until emergency care arrives, and for another two hours after the last dose. When breathing returns, roll the person onto their side with the top leg bent, and encourage them to go with emergency medical services.

Naloxone can precipitate withdrawal in someone who is physically dependent on opioids: headache, changes in blood pressure, a rapid heart rate, sweating, nausea, vomiting, and tremors. The toolkit also names body aches, diarrhea, and irritability. It is uncomfortable and usually not life-threatening. The risk of death from the overdose is worse. Do not hold back a second dose because the person is irritable, if they are still not breathing.

Learn your state's Good Samaritan law later. The toolkit describes those laws as limited immunity from some consequences of drug use, or of helping, when the event is an overdose. Protections differ. Call anyway.

After everyone is breathing

Methadone, buprenorphine, and naltrexone reduce overdose deaths, and medication should be first-line treatment for opioid addiction, usually with counseling. If someone uses as much as they did before a break, they can overdose, because the body is no longer adapted to that amount. People on naltrexone have reduced tolerance, so a familiar dose can be life-threatening. What to do the day use returns is in relapse first steps. What harm reduction still includes, once this hour has passed, is in harm reduction.

Search FindTreatment.gov when you are looking for ongoing care. Call or text (800) 653-9376 after the person is with emergency clinicians, if you want help finding that care.

Additional Resources

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Common Questions

Which signs mean I should call 911?

Call if you see any sign SAMHSA lists: an extremely pale or clammy face, a limp body, purple or blue fingernails or lips, vomiting or gurgling, a person who cannot be awakened or cannot speak, or breathing or a heartbeat that slows or stops. NIDA also names unconsciousness, very small pupils, slow or shallow breathing, a faint heartbeat, limp arms and legs, and pale skin. You do not need every sign. If you are unsure, call anyway. Say the person is unresponsive and not breathing, and give a specific address.

What if I am not sure it was an opioid?

Give naloxone anyway if an opioid overdose is possible. The SAMHSA toolkit says these reversal medicines do not cause harm if the person is not having an opioid overdose. Naloxone will not reverse an emergency that is only alcohol, only a benzodiazepine, or only a stimulant. Those emergencies still need the ambulance. Mixing an opioid with alcohol or with a benzodiazepine such as alprazolam or diazepam can be fatal.

When do I give a second dose?

If the person does not start breathing or otherwise respond within two to three minutes, give a second dose, and continue every two to three minutes until breathing starts. Some opioids need multiple doses. Read the device you have. Do not delay the first dose, and do not delay the emergency call, to hunt for a technique you have not been shown. Breathing matters more than waking the person up.

How long does naloxone last?

NIDA says it reverses an opioid overdose in the body for 30 to 90 minutes. Many opioids last longer, so the overdose can return. Watch constantly until emergency care arrives, and for another two hours after the last dose. When breathing returns, roll the person onto their side with the top leg bent and encourage them to go with emergency medical services. On March 29, 2023, the FDA approved Narcan 4 mg nasal spray for sale without a prescription. The manufacturer sets the price. Ask a pharmacy, a community program, or a health department what they carry.

Should I be afraid to call because of the law?

Call anyway. SAMHSA's toolkit says to learn your state's Good Samaritan law. Those laws offer limited immunity from some consequences of drug use or of helping during an overdose. Protections differ by state. Fear of the legal outcome is a reason to learn the law later, not a reason to leave someone who is not breathing. Afterward, methadone, buprenorphine, or naltrexone should be first-line care, usually with counseling. A familiar dose after a break, or on naltrexone, can be life-threatening because tolerance is lower.