What it looks like. Unresponsive or barely rousable. Breathing very slow, shallow, or stopped. Lips and fingertips blue or grey. Pupils very small. Snoring or gurgling from an airway that is closing.
- Call the emergency number. Say they are not breathing properly.
- Airway and breathing come first. Open the airway; if they are not breathing normally, give rescue breaths if you are trained and willing, and start chest compressions if there is no normal breathing. In opioid overdose the problem is breathing, so breaths matter more here than in most arrests.
- Naloxone, where it is available and lawful for you to give it. It reverses the opioid effect and does nothing at all if the cause was something else. Follow the instructions on the device; a second dose may be needed.
- It wears off before the opioid does. Somebody who wakes up can stop breathing again in twenty minutes to an hour. Do not leave them, and do not let them refuse an ambulance on the strength of feeling fine.
- Recovery position if they are breathing normally and you must turn away, and keep checking.
They may wake confused, frightened or angry — naloxone precipitates immediate withdrawal. That is a predictable effect of the drug you have just given, not a reason to treat them as a threat.
Source. World Health Organization, Opioid overdose fact sheet, https://www.who.int/news-room/fact-sheets/detail/opioid-overdose ; European Resuscitation Council, Guidelines 2021, https://cprguidelines.eu/guidelines-2021
What this is not. Reading, not certification. Who may carry and administer naloxone is set by the law where you are.