Quick Summary
An opioid overdose can turn deadly fast, so acting quickly matters. This guide covers the signs CDC tells people to watch for, the steps to take, how naloxone (Narcan) works, why stimulant overdoses look different, what Texas law says about calling 911, and what to do after someone survives. Everything here comes from CDC, FDA, NIDA, SAMHSA and other public health sources. If you think someone is overdosing right now, give naloxone if you have it and call 911.
Key Takeaways
- Key opioid overdose signs include being unable to wake up, slow or stopped breathing, gurgling or snoring sounds, discolored lips or nails, and pinpoint pupils.
- CDC’s steps: give naloxone if available and call 911, keep the person breathing, lay them on their side, and stay until help arrives.
- Naloxone nasal spray has been approved for over-the-counter sale since 2023. It will not harm someone who is not overdosing on an opioid.
- Naloxone wears off in 30 to 90 minutes, and some opioids last longer, so the person still needs emergency care.
- U.S. overdose deaths fell to 79,384 in 2024, but surviving an overdose raises the risk of another one, so follow-up care matters.
An overdose is a medical emergency, and minutes count. In 2024, 79,384 people in the United States died of a drug overdose, according to the CDC’s National Center for Health Statistics. That is a real drop from 105,007 deaths in 2023, but it is still a huge number of people. Knowing the signs and starting emergency steps quickly may help protect the person while emergency care is on the way.
Signs of an Opioid Overdose
The CDC’s overdose response guidance lists these signs:
- Unconsciousness or being unable to wake up
- Slow or shallow breathing, or trouble breathing, such as choking sounds or a gurgling or snoring noise from someone who cannot be woken
- Discolored skin, especially the lips or nails
- Small, constricted “pinpoint pupils” that do not react to light
NIDA’s naloxone DrugFacts adds vomiting, not being able to speak, a faint heartbeat, limp arms and legs, pale skin, and purple lips and fingernails. You do not need to see every sign. If someone has used opioids, or might have, and you cannot wake them or their breathing looks wrong, treat it as an overdose.
Snoring is worth calling out. People sometimes assume a person who is snoring is just sleeping it off. CDC specifically lists gurgling or snoring from someone who cannot be woken as a sign of overdose. Check on them.
What to Do, Step by Step
CDC’s response steps are short:
- Give naloxone if you have it, and call 911. If you do not have naloxone, call 911 right away. Tell the dispatcher the person is not breathing well or will not wake up.
- Try to keep the person awake and breathing, and follow the dispatcher’s instructions. Check whether they respond. SAMHSA’s Overdose Prevention and Response Toolkit says to provide rescue breaths if you can. Only do this if you are trained and able, or if the dispatcher walks you through it.
- Lay the person on their side to prevent choking if they vomit.
- Stay with the person until emergency help arrives.
If breathing does not come back, CDC’s naloxone page says to start with one dose and wait 2 to 3 minutes to see if normal breathing returns. SAMHSA’s toolkit says to wait 2 to 3 minutes before a second dose and keep giving doses every 2 to 3 minutes until the person starts breathing.
People freeze because they’re scared of doing it wrong. You don’t have to be perfect. If someone won’t wake up and their breathing looks off, give naloxone if you have it, call 911 and stay with them. Doing something fast matters more than doing it perfectly.
Donnita Smart, LCDC
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About Naloxone (Narcan)
NIDA describes naloxone as “a medicine that rapidly reverses an opioid overdose.” CDC explains that it works by blocking the effects of opioids, and that “naloxone will not harm someone if you give it to them and they are not overdosing on an opioid.” It only works on opioids. NIDA notes it will not reverse overdoses from drugs like cocaine or methamphetamine on their own.
A few things to know before you ever need it:
- You can buy it without a prescription. The FDA approved Narcan 4 mg nasal spray for over-the-counter use on March 29, 2023, the first naloxone product approved for use without a prescription. CDC says naloxone is available in all 50 states and over the counter.
- It wears off. NIDA says naloxone works for only 30 to 90 minutes, “but many opioids remain in the body longer than that.” Someone can stop breathing again after it wears off, which is why calling 911 and staying with them matters even if they wake up.
- Stronger opioids may need more than one dose. NIDA notes that some opioids are stronger and might require multiple doses.
- Withdrawal can hit fast. NIDA says people who are physically dependent on opioids may have withdrawal symptoms within minutes after getting naloxone. Expect them to feel sick, scared or upset. Stay with them, do not leave them alone, follow the dispatcher’s instructions and do not delay emergency care.
In Texas, the Department of State Health Services runs a naloxone distribution map to help people find free naloxone near them, supported by the state’s Texas Targeted Opioid Response program. If you or someone you live with uses opioids, including prescribed pain medication, it makes sense to keep naloxone at home and tell people where it is.
Fentanyl and Mixed Drugs
Much of today’s overdose risk comes from fentanyl and similar synthetic opioids. NCHS data show 47,735 overdose deaths involved synthetic opioids other than methadone in 2024. CDC warns that “sometimes other drugs, including cocaine and methamphetamine, are mixed with fentanyl,” so a person may be exposed to an opioid without realizing it when drugs are contaminated or mixed. Our posts on fentanyl and fentanyl test strips cover this in more detail.
Stimulant Overdose Looks Different
Overdoses involving cocaine or methamphetamine may involve different signs from opioid overdoses, though symptoms can overlap, especially when substances are mixed. CDC’s stimulant guide lists serious signs that need medical attention, including:
- Rapid breathing, fast heart rate or irregular heartbeat
- Overheating or heavy sweating
- High blood pressure
- Chest pain or tightness
- Panic or extreme anxiety, confusion, hallucinations or psychosis
- Tremor, dizziness, nausea or vomiting
CDC says naloxone does not treat a stimulant overdose, but “no harms will be caused by the naloxone if opioids are not involved.” This matters more than ever. According to CDC, nearly 60,000 overdose deaths in 2023 involved cocaine or other stimulants, and fentanyl contamination puts people who use stimulants at risk of opioid overdose too. If you are not sure what someone took, call 911 and give naloxone anyway. Our post on what cocaine does to your heart explains the cardiac risks.
Calling 911 in Texas
Fear of getting in trouble keeps some people from calling for help. A 2021 report from the U.S. Government Accountability Office found that 47 states and D.C. had both Good Samaritan and naloxone access laws, which protect people from certain criminal penalties when they call 911 for an overdose. At the time, the GAO listed Texas as one of the states without a Good Samaritan law for overdoses.
That changed later in 2021. Texas added a limited protection to Health and Safety Code Section 481.115, effective September 1, 2021. It is a defense to prosecution for possessing a small amount of certain drugs, not full immunity, and it only applies under specific conditions, such as being the first person to call for help, staying on the scene and cooperating with responders. It also has exceptions. Our post on the Texas Good Samaritan law walks through the details. The statute is fact-specific and may not apply in every situation. This is general information, not legal advice, so talk with a qualified Texas attorney about any specific case. The most important thing is still to call.
After the Overdose
Surviving an overdose is not the end of the danger. A study of 17,568 Massachusetts adults who survived an opioid overdose, published in the Annals of Internal Medicine, opens by noting that “opioid overdose survivors have an increased risk for death,” and CDC lists a history of overdose as a risk factor for another one.
In that observational study, methadone and buprenorphine treatment were associated with lower opioid overdose mortality during follow-up. According to the NIH summary, compared with people who did not receive medication, people receiving methadone had a 59 percent lower risk of opioid overdose death and people receiving buprenorphine had a 38 percent lower risk over 12 months of follow-up. The study also found that only a minority of survivors got these medications. Whether a medication fits is a decision for the person and a prescriber. Our post on Suboxone vs. methadone explains the differences, and life after fentanyl detox covers why the weeks after stopping are risky.
The days after an overdose are a window. People are often shaken and more open to talking about help than they were the week before. If you love someone who just survived one, don’t wait for things to calm down. Sit with them, tell them you’re scared for them, and help them make the call.
Donnita Smart, LCDC
When to Reach Out for Help
If someone has stopped breathing, cannot be woken or may have overdosed, call 911, give naloxone if available, and stay with the person until help arrives. Do not wait to see if they sleep it off.
Outside of an emergency, it is time to talk with a professional if:
- You or someone you love has had an overdose or a close call
- You have found pills, powders or paraphernalia and are worried about fentanyl
- Someone is using more, using alone or mixing substances
- Someone has tried to cut back or stop and has not been able to
If you or someone you know is in emotional crisis, call or text 988. If anyone is in immediate danger or cannot stay safe, call 911 or go to an emergency department. Alcohol and sedative withdrawal can be dangerous, so do not stop suddenly after heavy regular use without medical advice.
Talking With a Professional
If someone you care about has survived an overdose, or you are worried one is coming, a conversation with a treatment provider is a good next step. Have a rough idea of what they use, how often and any past overdoses or treatment. The admissions team at Discovery Point Retreat can explain what an assessment involves. Ask which services are currently available and whether outside care might also be needed. A primary care doctor, pharmacist or local health department can also help, including with getting naloxone.
FAQ
Should I give naloxone or call 911 first?
Both, as fast as you can. CDC says to give naloxone if available and call 911. If someone else is there, one person can call while the other gives naloxone.
Can naloxone hurt someone who is not overdosing?
No. CDC says naloxone will not harm someone who is not overdosing on an opioid, and it causes no harm if opioids are not involved.
Do I need a prescription for Narcan?
No. The FDA approved Narcan nasal spray for over-the-counter use in 2023. In Texas, the DSHS map can help you find free naloxone.
Why call 911 if the person wakes up?
Naloxone lasts 30 to 90 minutes, and many opioids last longer. The person can stop breathing again and still needs medical care.
Does naloxone work on a cocaine or meth overdose?
Not on its own. But stimulants are sometimes mixed with fentanyl, so give naloxone anyway if opioids could be involved, and call 911.
Will I get in trouble for calling 911 in Texas?
Texas has a limited legal defense for people who call for help during an overdose, with conditions and exceptions. See our Texas Good Samaritan law post for details. Calling is always the right move when a life is at risk.
References
- Centers for Disease Control and Prevention (CDC). What to Do If You Think Someone Is Overdosing. Stop Overdose. Accessed October 2026. cdc.gov
- CDC. About Naloxone. Accessed October 2026. cdc.gov
- National Institute on Drug Abuse (NIDA). Naloxone DrugFacts. Accessed October 2026. nida.nih.gov
- U.S. Food and Drug Administration (FDA). FDA Approves First Over-the-Counter Naloxone Nasal Spray. March 29, 2023. Accessed October 2026. fda.gov
- Substance Abuse and Mental Health Services Administration (SAMHSA). Overdose Prevention and Response Toolkit (PEP23-03-00-001). Accessed October 2026. library.samhsa.gov
- CDC, National Center for Health Statistics. Drug Overdose Deaths in the United States, 2023 to 2024 (NCHS Data Brief No. 549). Accessed October 2026. cdc.gov
- CDC. A Stimulant Guide. Accessed October 2026. cdc.gov
- CDC. Stimulant Overdose. Accessed October 2026. cdc.gov
- Texas Department of State Health Services (DSHS). Naloxone Distribution Interactive Map. Accessed October 2026. healthdata.dshs.texas.gov
- U.S. Government Accountability Office (GAO). Drug Misuse: Most States Have Good Samaritan Laws and Research Indicates They May Have Positive Effects (GAO-21-248). March 2021. Accessed October 2026. gao.gov
- Texas Legislature. Health and Safety Code, Chapter 481, Section 481.115. Accessed October 2026. statutes.capitol.texas.gov
- Larochelle MR, et al. Medication for Opioid Use Disorder After Nonfatal Opioid Overdose and Association With Mortality: A Cohort Study. Annals of Internal Medicine. 2018. PubMed. Accessed October 2026. pubmed.ncbi.nlm.nih.gov
- National Institutes of Health (NIH). Methadone and buprenorphine reduce risk of death after opioid overdose. News release, June 19, 2018. Accessed October 2026. nih.gov
- SAMHSA. National Helpline. Accessed October 2026. samhsa.gov
Related Reading
- Addiction Treatment
- Fentanyl in the Drug Supply: What Every Texan Needs to Know
- International Overdose Awareness Day: Recognizing the Signs and Finding Help in North Texas
- How to Tell If Someone Is Abusing Opioids
- Opioid Detox
Resources
- 988 Lifeline. Call or text 988, or chat at 988lifeline.org. Free, confidential support 24/7.
- SAMHSA National Helpline. Call 1-800-662-HELP (4357) or visit the SAMHSA National Helpline page for free, confidential referrals to local treatment.
- 911. For any medical emergency, including a suspected overdose, call 911 immediately. If naloxone is available for a suspected opioid overdose, give it according to the package instructions while waiting for help.
This article is general education and is not medical or legal advice.
If you or someone you love is ready to talk, call Discovery Point Retreat at (855) 245-7133 to speak with our admissions team.
