How to Respond to a Suspected Overdose While Waiting for Help

• by Melinda Hawthorne
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When someone overdoses, every second counts. It’s not a movie scene with dramatic music and a hero rushing in. It’s quiet. Maybe they’re slumped in a chair, not breathing right. Their skin might be pale or blue. Their lips are slow to move. You think, Are they just asleep? But something’s off. And you’re alone with them, waiting for help to arrive.

Most people don’t know what to do next. They panic. They shake the person. They try to wake them up with cold water. Or worse-they wait. They think, Maybe they’ll wake up on their own. But here’s the hard truth: if someone stops breathing for more than four minutes, brain damage can start. And in an overdose, that window is often shorter.

You don’t need to be a doctor. You don’t need fancy equipment. You just need to know five things-and do them in order. This isn’t theory. These steps are backed by the CDC, SAMHSA, and the American Red Cross. They’ve saved thousands of lives. And they can save this one.

Step 1: Call 911 Immediately

Before you do anything else, call emergency services. Don’t wait. Don’t think, I’ll call after I give them naloxone. Don’t assume someone else already did. Pick up your phone. Dial 911. Say clearly: “I think someone is overdosing. They’re not breathing.” Give your location. Stay on the line.

Why is this so critical? Because EMS arrival cuts death risk by 35%, according to a 2022 JAMA study. Even if you have naloxone, you still need paramedics. Naloxone wears off in 30 to 90 minutes. Opioids like fentanyl can stay in the system for hours. The person can stop breathing again after you think they’re fine. Only trained responders can monitor them long enough to prevent that.

And yes-call even if you’re scared. Even if you think they’ll get in trouble. Good Samaritan laws in 49 U.S. states protect people who call for help during an overdose. Your call could be the reason they live.

Step 2: Check Breathing and Position Them

Once you’ve called, check the person. Are they breathing? Not just moving. Not just snoring. Are their chest and belly rising and falling regularly? If they’re breathing but unconscious, place them in the recovery position.

To do this:

1. Kneel beside them.
2. Extend their arm closest to you straight out.
3. Place their other arm across their chest, hand near the shoulder.
4. Bend their far leg at the knee, foot flat on the ground.
5. Roll them gently toward you, using the bent leg as a pivot.
6. Tilt their head back slightly so the airway stays open.

This keeps their tongue from blocking their throat and lets any vomit drain out. Don’t leave them flat on their back. That’s how people choke.

If they’re not breathing-or only gasping-start rescue breathing right away. Gasping is not normal breathing. It’s a sign their body is shutting down.

Step 3: Give Rescue Breaths

For opioid overdoses, breathing support alone can keep someone alive until help arrives. You don’t always need naloxone.

How to do it:

1. Pinch their nose shut.
2. Open their mouth and tilt their head back.
3. Take a normal breath-not a deep one-and seal your lips over theirs.
4. Blow gently for about one second until you see their chest rise.
5. Remove your mouth and let their chest fall.
6. Repeat every 5 to 6 seconds. That’s 10 to 12 breaths per minute.

Don’t blow too hard. You don’t want air going into their stomach. That causes vomiting, which can choke them. Watch for chest rise. That’s your only indicator it’s working.

Most people give up after 30 seconds. Don’t. Keep going. Fatigue is real. But every breath you give is oxygen they’re not getting on their own. The brain needs that oxygen. Keep going until help arrives-or they start breathing on their own.

Step 4: Administer Naloxone If Available and Suspected Opioid Overdose

Naloxone reverses opioid overdoses. It won’t help with alcohol, benzodiazepines, cocaine, or methamphetamine. But if you suspect opioids-especially since fentanyl is in so many pills now-use it.

Signs of opioid overdose:

• Slow or stopped breathing
• Unresponsive to shaking or shouting
• Blue or gray lips and fingertips
• Pinpoint pupils (but not always-fentanyl overdoses often have normal-sized pupils)

If you have naloxone:

1. Follow the instructions on the kit.
2. For nasal spray: Tilt their head back, insert the nozzle into one nostril, and press firmly for 2-3 seconds.
3. Give a second dose in the other nostril if the first doesn’t work after 2-3 minutes.
4. Even if they wake up, keep monitoring. They can relapse into overdose once naloxone wears off.

Don’t wait for perfect signs. If you think it’s an opioid overdose, give naloxone. It’s safe. It won’t hurt someone who hasn’t taken opioids. And it can bring someone back from the edge.

Step 5: Stay With Them Until Help Arrives

Don’t leave. Don’t assume they’re fine after naloxone. Don’t let them walk around. Don’t let them go back to using.

Monitor their breathing every 2-3 minutes. Use the AVPU scale to check their level of alertness:

• A - Alert: awake and aware
• V - Responds to voice
• P - Responds to pain (like a sternum rub)
• U - Unresponsive

If they go from V to U, start rescue breathing again. If they stop breathing, begin CPR: 30 chest compressions followed by 2 breaths. Push hard and fast-about 2 inches deep, 100-120 times per minute. You don’t need to be perfect. Just keep going.

For stimulant overdoses (like cocaine or meth), don’t use naloxone. Don’t give them cold showers or ice packs. That can trigger dangerous heart rhythms. Instead, keep them cool and calm. Loosen tight clothes. Move them to a quiet, cool space. Offer small sips of water if they’re awake and alert-but no more than 250ml per hour. Too much water can cause dangerous low sodium levels.

For alcohol overdose, the biggest risk is choking. Keep them on their side. Watch for vomiting. Don’t let them lie flat.

What Not to Do

There are myths everywhere. Don’t:

• Shake or slap them to wake them up-this delays real help
• Give them coffee, cold showers, or ice baths-these can make things worse
• Try to make them vomit-this increases choking risk
• Wait to see if they “sleep it off”-many overdose deaths happen because someone was mistaken for just sleeping
• Leave them alone-even if they seem fine

These myths come from old advice or movies. Real life doesn’t work that way. Overdose is silent. It doesn’t scream. It doesn’t always look dramatic. But it kills fast.

Real Stories, Real Results

In Bristol, a man named David used naloxone on his friend after finding him blue and still. He called 911 first. He gave rescue breaths while waiting. His friend survived. David didn’t have training-he just watched a 10-minute video online. That’s all it took.

According to the CDC’s Community Access to Naloxone project, communities with full training reversed over 12,500 overdoses between 2021 and 2023. Survival rates were 98.7%-compared to 87.3% in places where people only had naloxone but no training.

The difference? Knowing how to position someone. Knowing how to breathe for them. Knowing to stay.

What to Do After

When EMS arrives, tell them everything: what the person took, when, how much, what you did, when you gave naloxone, how they responded. Write it down if you can. This helps them treat the person correctly.

Afterward, don’t blame yourself. Don’t assume you should have done more. You did what you could. That’s more than most people would have done.

If you’re struggling with guilt or fear, reach out. There are support lines. There are peer groups. You’re not alone.

And if you haven’t already-get trained. Learn the recovery position. Practice rescue breathing. Keep naloxone in your bag, your car, your home. It’s free in many places through local health clinics or pharmacies. You don’t need a prescription anymore.

Because the next time someone overdoses, it might be someone you love. Or it might be you.

Next Steps: Be Ready for Next Time

Don’t wait for the next emergency to learn this. Practice the recovery position on a pillow. Watch a 10-minute video from the American Red Cross or SAMHSA. Ask your local pharmacy if they offer free naloxone. Keep a kit in your car or bag. Talk to friends about it.

Overdose isn’t rare. In the UK alone, over 4,000 people died from drug overdoses in 2022. Most happened in homes. Most happened with someone nearby. But most people didn’t know what to do.

You can change that. You don’t need to be brave. You just need to act. And you don’t have to be perfect. You just have to start.