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Opioid Overdose: Signs, Naloxone and What to Do

How to recognize an opioid overdose, give naloxone, and keep your loved one breathing until help arrives, plus how to have naloxone ready before you need it.

By Kyle, Recovery AdvocatorsUpdated October 1, 2026Fact-checked against primary sources · Awaiting clinical review

Naloxone (Narcan, RiVive) is a nasal spray that reverses an opioid overdose, and you can buy it at a pharmacy without a prescription. If you find someone you can’t wake who is breathing slowly or not at all, spray it right away and have a second dose in your hand.

How do I give naloxone (Narcan)?

What are the signs of an opioid overdose?

CDC lists these:1214

  • Can’t be woken up, or is falling asleep or losing consciousness
  • Slow, shallow or no breathing, or choking, gurgling or snoring sounds
  • Very small “pinpoint” pupils
  • Limp body
  • Blue or discolored skin, especially on the lips and fingernails

You don’t need to see every sign. If you can’t tell whether they’re high or overdosing, treat it as an overdose.14 Street pills can contain fentanyl without the person knowing; see fentanyl and counterfeit pills.

How does naloxone work?

It attaches to the brain’s opioid receptors and blocks the opioid for a short time, so breathing can restart.16 That can happen within 2 to 3 minutes.2 It works on heroin, fentanyl and prescription opioids, and it won’t harm someone who hasn’t taken opioids, whether they’re an infant or an older adult.23 So if you’re unsure, give it.

It does nothing for alcohol, benzodiazepines like Xanax or Valium, or stimulants like cocaine.410 When drugs are mixed, it still reverses the opioid part.16

Someone who uses opioids regularly may wake up in sudden withdrawal: sweaty, shaky, nauseated and irritable. CDC says this is uncomfortable but not life-threatening.1

What happens after they wake up?

Naloxone doesn’t last long, and the person can slip back into an overdose and need another dose.3 After a large amount of opioids, or a very strong or long-acting one, it may not be enough on its own.4 CDC advises staying with them until emergency help arrives, or for at least four hours, to make sure their breathing stays normal.5

If they wake up and want to leave

Try to keep them there so the paramedics can check them, even if they seem alert.3 Something like: “The Narcan can wear off before the drugs do. Please just let them look at you.” If they go anyway, ask them not to use again soon or alone, and send naloxone with them.

Why would they keep breathing but not wake up?

In April 2026, CDC warned that medetomidine, a veterinary sedative not approved for people, is increasingly mixed into the illegal fentanyl supply.10 Naloxone reverses the fentanyl but not the medetomidine, so a person can start breathing and still be very sleepy. Don’t keep spraying just to wake them. Keep them on their side and watch their breathing; if it slows again, give another dose.10

Where can we get naloxone today?

Pharmacies and some other stores sell the nasal spray without a prescription; if it isn’t on the shelf, ask the pharmacist.5 FDA approved Narcan (4 mg) for over-the-counter sale in March 2023, and RiVive (3 mg) and the first generic over-the-counter spray followed that July.67

Price depends on where you buy it and on your plan, so ask whether filling it through insurance costs less.2 Your local health department can tell you about programs that hand it out free or cheaply, and most syringe services programs have it.2 The SAMHSA National Helpline (1-800-662-4357) can also point you to local services.15

How should we store it?

Keep it in its box at room temperature, away from light, and follow the directions on the package.4 SAMHSA advises replacing it if it has been below 39°F or above 104°F, so don’t leave it in a hot or freezing car.16 Narcan 4 mg sprays made since January 2024 have a four-year shelf life, up from three, but older boxes go by the date printed on them.9

Our family's naloxone plan

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When is the risk highest?

The most dangerous times are a return to use after tolerance has dropped, such as after detox, rehab or jail; mixing opioids with alcohol, benzodiazepines or sleep medicines; and using alone, since nobody can give themselves naloxone.512 SAMHSA specifically names people just released from incarceration as people who should have it.16 Our page on what raises fentanyl overdose risk goes through each one. Opioids were involved in an estimated 44,564 of the 69,973 U.S. overdose deaths in 2025, by CDC provisional data that may change.11

If your loved one just came home from treatment, read the first 30 days after rehab; if they’ve started using again, see what to do after a relapse. Methadone and buprenorphine substantially lower the risk of dying from an overdose, CDC reports, so medication for opioid use disorder is worth raising.13

How do I talk to them about naloxone?

Tell them plainly that you’re keeping it because you want them alive. It doesn’t mean you approve of the using. If they’ve refused treatment, it also keeps the door open; see what you can still do when they say no.

What to say instead

Instead of

“If you’re going to keep using, that’s your problem.”

Try

“I’m not okay with the using, and I want you alive. I’m keeping naloxone in the kitchen.”

Instead of

“Don’t you dare overdose in this house.”

Try

“If anything ever happens, I’ll give you naloxone. Where do you keep yours?”

Instead of

“Promise me you’ll never use again.”

Try

“Please don’t use alone. If you do use, tell someone where you are.”

Frequently asked questions

Do I need training to use naloxone?

No. FDA approved the over-the-counter spray after data showed people can use it correctly without a health professional.56 If you want to be ready for rescue breathing, a CPR class teaches it.

Can calling for help get anyone arrested?

CDC says most states have Good Samaritan laws that protect people who are overdosing, and the people helping them, from arrest, charges or both.514 What they cover varies by state, so they don’t protect against everything.

What is nalmefene?

A second overdose reversal medication. It comes as a nasal spray and as an auto-injector (Zurnai, for ages 12 and up), and both need a prescription.817 Ask a doctor whether it makes sense for your family.

Your next step

Get naloxone today: where to find it
Medication that lowers overdose risk →They won't get help: what you can still do →

Sources

  1. CDC — Fact Sheet: Family and Caregivers, How and When to Use Naloxone for an Opioid Overdose (April 2024). cdc.gov/overdose-prevention/media/pdfs/2024/04/Naloxone-Fact-Sheet_Fam… — accessed Oct 2026
  2. CDC — 5 Things to Know About Naloxone (May 2, 2024). cdc.gov/overdose-prevention/reversing-overdose/about-naloxone.html — accessed Oct 2026
  3. FDA — Access to Naloxone Can Save a Life During an Opioid Overdose (Consumer Update, content current as of June 2026). fda.gov/consumers/consumer-updates/access-naloxone-can-save-life-durin… — accessed Oct 2026
  4. CDC, National Institute for Occupational Safety and Health — Using Naloxone to Reverse Opioid Overdose in the Workplace: Information for Employers and Workers (DHHS NIOSH Pub. 2019-101, 2019). cdc.gov/niosh/docs/2019-101/pdfs/2019-101.pdf — accessed Oct 2026
  5. CDC — Lifesaving Naloxone (June 11, 2025). cdc.gov/stop-overdose/caring/naloxone.html — accessed Oct 2026
  6. FDA — FDA Approves First Over-the-Counter Naloxone Nasal Spray (March 2023). fda.gov/news-events/press-announcements/fda-approves-first-over-counte… — accessed Oct 2026
  7. FDA — FDA Approves Second Over-the-Counter Naloxone Nasal Spray Product (July 28, 2023). fda.gov/news-events/press-announcements/fda-approves-second-over-count… — accessed Oct 2026
  8. FDA — Information about Naloxone and Nalmefene. fda.gov/drugs/postmarket-drug-safety-information-patients-and-provider… — accessed Oct 2026
  9. FDA — FDA Announces Shelf-Life Extension for Naloxone Nasal Spray (January 17, 2024). fda.gov/drugs/drug-alerts-and-statements/fda-announces-shelf-life-exte… — accessed Oct 2026
  10. CDC Health Alert Network — Medetomidine in the U.S. Illegal Fentanyl Supply Increasing Risk for Overdose and Severe Withdrawal Syndrome, HAN-00527 (April 2, 2026). cdc.gov/han/php/notices/han00527.html — accessed Oct 2026
  11. CDC National Center for Health Statistics — U.S. Overdose Deaths Decrease for Third Consecutive Year in 2025 (May 13, 2026). cdc.gov/nchs/pressroom/releases/20260513.html — accessed Oct 2026
  12. CDC — About Prescription Opioids (June 2025). cdc.gov/overdose-prevention/about/prescription-opioids.html — accessed Oct 2026
  13. CDC, MMWR — Treatment for Opioid Use Disorder: Population Estimates, United States, 2022 (June 27, 2024). cdc.gov/mmwr/volumes/73/wr/mm7325a1.htm — accessed Oct 2026
  14. CDC — Signs of Opioid Misuse, Opioid Use Disorder, and Overdose. cdc.gov/overdose-resources/pdf/Signs-of-Opioid-Misuse-Opioid-Use-Order… — accessed Oct 2026
  15. SAMHSA — National Helpline. samhsa.gov/find-help/helplines/national-helpline — accessed Oct 2026
  16. SAMHSA — Opioid Overdose Reversal Medications (OORM). samhsa.gov/substance-use/treatment/overdose-prevention/opioid-overdose… — accessed Oct 2026
  17. FDA — FDA Approves First Nalmefene Hydrochloride Auto-Injector to Reverse Opioid Overdose (Zurnai, August 7, 2024). fda.gov/news-events/press-announcements/fda-approves-first-nalmefene-h… — accessed Oct 2026

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