Opioid Overdose

An opioid overdose happens when opioids overwhelm the part of your brain that controls breathing. This can slow or stop breathing. It may lead to death if not treated in time.

An overdose can occur if you take too much of an opioid or mix it with other addictive substances. Any opioid, either prescription or nonprescription, can lead to an overdose. The amount that’s “too much” varies based on your tolerance and the strength of the opioid. That can make it hard to know what’s safe and what’s not. So, it’s important to follow prescribing instructions closely or avoid substances when you might not know what the dosage is.

An overdose is a medical emergency. While this is a frightening event, knowing what to do can save a life. An emergency opioid overdose reversal medication may treat the condition if given quickly. But medical care is still needed after emergency treatment to check for complications.

Signs of opioid overdose

Signs and symptoms of an opioid overdose include:

• Weakness or limp limbs
• Pale, blue or purple lips and fingernails
• Cold and clammy skin
• Slowed or stopped heartbeat and breathing
• Snoring or gurgling sounds coming from the mouth
• Tiny pupils (black center of eye)
• Unresponsive (can’t wake up)
• Vomiting

Act quickly if you notice these signs. If you carry an emergency opioid overdose reversal medication, administer it immediately. Then, contact 911 or your local emergency services number.

Opioid overdose causes

Taking opioids in a way your body isn’t used to can lead to an overdose. Common examples include:

• Accidentally taking an opioid (like an extra dose)
• Mixing substances that contain at least one opioid and another substance
• Taking more than your body’s tolerance of an opioid
• Using opioids that were prescribed to another person

Risk factors of opioid overdose

Anyone who uses opioids could potentially experience an overdose. An overdose can happen if this is your first time using an opioid or if you’ve taken one frequently.

Your risk increases if you:

• Are over the age of 65
• Have opioid use disorder
• Take opioids by injection
• Take large doses of opioids
• Return to opioid use after stopping for a period of time
• Have certain medical conditions that may affect breathing or your body’s tolerance of opioids, like sleep apnea, HIV, lung disease or liver disease
• Use a combination of opioids and sedatives, like benzodiazepines
• Use a combination of opioids and stimulants, like amphetamines and methamphetamine

Research shows that if you had one overdose, you’re at an increased risk of having another in your lifetime.

It can be hard to know what you’re getting when using nonmedical opioids. Because they’re not regulated, their strength can vary. They might be mixed with other drugs like heroin, fentanyl or carfentanil (an extremely potent drug used to sedate large animals). These unknown ingredients increase your risk of overdose and death. Also, pills that are given to you or bought from a friend may look like a safer drug, but might contain lethal doses of nonmedical opioids, including fentanyl.

What happens to your body in an opioid overdose?

Opioids bind to receptors in your brain. These receptors are supposed to send signals to the rest of your body to tell it to keep breathing. Opioids interrupt these signals. This causes your breathing to slow and eventually stop (respiratory failure). Your body needs oxygen to survive. Within minutes of not receiving enough oxygen, your brain cells begin to die.

Treating an overdose as soon as possible prevents death and other serious complications like severe disability or brain damage.

How doctors diagnose opioid overdose

First responders or healthcare providers look for signs of an overdose and rely on information from friends and loved ones. As you’re likely unconscious while experiencing an overdose, they’ll assess the scene and look for clues or substances near you.

If first responders suspect an overdose, they’ll administer naloxone. This is an emergency medication that treats opioid overdoses. If your symptoms improve with this medication, it confirms that you had an overdose.

In a hospital setting, providers may order drug tests to make a diagnosis. They’ll also perform other tests to assess your health and look for other signs, symptoms or medical conditions that may need treatment.

How is opioid overdose treated?

Naloxone (Narcan®) and nalmefene are the primary emergency treatments for an overdose. These medications:

• Rapidly reverse or block opioid effects
• Restore normal breathing within two to five minutes
• Come as a nasal spray or an injection

Naloxone only works for about 30 to 90 minutes. But overdose effects can return once it wears off. You may need to give an additional dose of the emergency opioid overdose reversal medication as you wait for emergency services to arrive.

Nalmefene is only used in healthcare settings outside the U.S.

Once at the hospital, providers may also perform additional treatments, like intubation, to help you breathe.

Can opioid overdose be prevented?

Here are some ways to lower the risk of overdose:

• Avoid mixing opioids with other substances.
• Carry naloxone if you or a loved one uses opioids.
• Have someone with you, whenever possible, if you use opioids.
• Store medications safely in your home, out of reach of children or others.
• Teach family and friends how to respond to an overdose.

If you or a loved one is at risk of overdose, reach out for help. There are medical resources available so you can get the care you need.

What should I do if I think someone is experiencing an opioid overdose?

If you think someone is having an overdose:

• Call 911 or your local emergency services number immediately.
• Administer naloxone, if you have it.
• Try to keep them awake and breathing by rubbing their chest with your knuckles (sternum rub).
• Lay the person on their side to prevent choking.
• Stay with them until help arrives.