How to Respond to Drug Overdose

STEP 1: EVALUATE FOR SIGNS OF OPIOID OVERDOSE-

Signs of OVERDOSE, which often results in death if not treated, include:

• Loss of consciousness
• Unresponsive to outside stimulus
• Awake, but unable to talk
• Breathing is very slow and shallow, erratic, or has stopped
• For lighter skinned people, the skin tone can turn bluish purple, for darker skinned people, grayish or ashen.
• Choking sounds, or a snore-like gurgling noise (sometimes called the “death rattle”)
• Vomiting
• Body is very limp
• Face is very pale or clammy
• Fingernails and lips turn blue or purplish black
• Pulse (heartbeat) is slow, erratic, or not there at all

If an opioid overdose is suspected, stimulate the person:

• Call the person’s name.
• If this doesn’t work, vigorously grind knuckles into the sternum (the breastbone in middle of chest) or rub knuckles on the person’s upper lip.
• If the person responds, assess whether he or she can maintain responsiveness and breathing.
• Continue to monitor the person, including breathing and alertness, and try to keep the person awake and alert.

STEP 2: CALL 911 FOR HELP

AN OPIOID OVERDOSE NEEDS IMMEDIATE MEDICAL ATTENTION. An essential step is to get someone with medical expertise to see the person as soon as possible. If no emergency medical services (EMS) or other trained personnel is on the scene, activate the 911 emergency system immediately. All you have to say is “Someone is unresponsive and not breathing.” Be sure to give a specific address and/or description of your location. After calling 911, follow the dispatcher’s instructions. If appropriate, the 911 operator will instruct you to begin CPR (technique based on rescuer’s level of training). If others are with you, point to someone and instruct them to call 911 ("You-call 911!") while you proceed to Step 3. 

STEP 3: ADMINISTER NARCAN

Narcan should be administered to anyone who presents with signs of opioid overdose or when opioid overdose is suspected. Narcan is approved by the Food and Drug Administration and has been used for decades by EMS personnel to reverse opioid overdose and resuscitate individuals who have overdosed on opioids. Research has shown that women, older people, and those without obvious signs of opioid use disorder are undertreated with Narcan and, as a result, have a higher death rate. Therefore, it is also important to consider Narcan administration in women and the elderly found unresponsive with opioid overdose.

Narcan is effective in reversing opioid overdose, including fentanyl-involved opioid overdoses, although overdoses involving potent (e.g., fentanyl) or large quantities of opioids may require more doses of Narcan.

DURATION OF EFFECT. The duration of effect of Narcan depends on dose, route of administration, and overdose symptoms and is shorter than the effects of some opioids. The goal of Narcan therapy should be to restore adequate spontaneous breathing, but not necessarily complete arousal. 

More than one dose of Narcan may be needed to revive someone who is overdosing.  If the person overdosing does not respond within 5-10 minutes after administering a dose of Narcan, administer a second dose.

Comfort the person being treated, as withdrawal triggered by Narcan can feel unpleasant. Some people may become agitated or confused, which may improve by providing reassurance and explaining what is happening. NARCAN INSRUCTIONS*

STEP 4: SUPPORT THE PERSON’S BREATHING

Ventilatory support is an important intervention and may be lifesaving on its own. Rescue breathing can be very effective in supporting respiration, and chest compressions can provide ventilatory support. Rescue breathing for adults involves the following steps:

1.  Be sure the person’s airway is clear (check that nothing inside the person’s mouth or throat is blocking the airway).
2. Place one hand on the person’s chin, tilt the head back, and pinch the nose closed.
3.  Place your mouth over the person’s mouth to make a seal and give two slow breaths.
4. Watch for the person’s chest (but not the stomach) to rise.
5. Follow up with one breath every 5 seconds.
6. Chest compressions for adults involve the following steps:
   • Place the person on his or her back.
   •  Press hard and fast on the center of the chest.
   • Keep your arms extended

STEP 5: MONITOR THE PERSON’S RESPONSE

All people should be monitored for recurrence of signs and symptoms of opioid toxicity for at least 4 hours from the last dose of Narcan. People who have overdosed on long-acting opioids should have more prolonged monitoring.

Most people respond by returning to spontaneous breathing. The response generally occurs within 2 to 3 minutes of Narcan administration but can sometimes take longer. (Continue resuscitation while waiting for the Narcan to take effect.)

Because Narcan has a relatively short duration of effect, overdose symptoms may return. Therefore, it is essential to get the person to an emergency department or other source of medical care as quickly as possible, even if the person revives after the initial dose of Narcan and seems to feel better. 

RESOURCES

Good Samaritan Law

Video-How to Recognize an Overdose and Use Narcan 

Do’s and Don’ts in Responding to Opioid Overdose

DO support the person’s breathing by administering oxygen or performing rescue breathing.

DO administer Narcan.

DO put the person in the “recovery position” on the side, if he or she is breathing independently.

DO stay with the person and keep him/her warm.

DON'T slap or try to forcefully stimulate the person — it will only cause further injury. If you are unable to wake the person by shouting, rubbing your knuckles on the sternum (center of the chest or rib cage), or light pinching, he or she may be unconscious.

DON'T put the person into a cold bath or shower. This increases the risk of falling, drowning or going into shock.

DON'T inject the person with any substance (salt water, milk, “speed,” heroin, etc.). The only safe and appropriate treatment is Narcan.

DON'T try to make the person vomit drugs that he or she may have swallowed. Choking or inhaling vomit into the lungs can cause a fatal injury.

NOTE: Narcan has  an expiration date, so it is important to check the expiration date and obtain replacement as needed.