If you are using opioids, you do not have the luxury of not knowing what to do during an overdose event for yourself or someone you are using with. This highly common consequence of opioid addiction kills tens of thousands of people in the United States each year. The Centers for Disease Control and Prevention (CDC) estimated that in 2023, more than 3 out of 4 drug overdose deaths involved opioids. Whether it is heroin, fentanyl, counterfeit pills, or prescription painkillers, opioid overdose symptoms can sneak up fast and turn deadly in minutes as respiratory failure closes in. The sad truth is that many overdoses that result in death are preventable if someone nearby recognizes the early warning signs and acts quickly.
In this guide, we will walk through what opioid overdose symptoms actually look like in ways you can identify. You will learn the earliest clues that something is wrong, the classic signs of an overdose, and how to respond with naloxone, rescue breathing, and other stopgap techniques while you wait for emergency help. We will also talk about how to lower your risk and where to get real treatment for opioid use disorder, so this does not keep hanging over your head.
Quick Takeaways
- Opioid overdose symptoms usually build up, so early action can prevent death.
- The evident signs that something is wrong include pinpoint pupils, slowed or stopped breathing, and unresponsiveness.
- Weird snore like gurgling noise from someone who will not wake is often a sign of an overdose and not “deep sleep.”
- Use naloxone as soon as you suspect an overdose and repeat doses if needed.
- Always call emergency services and protect their breathing while you wait for help.
- You can lower overdose risk with harm reduction activities and evidence-based treatment.
Why Early Recognition of Opioid Overdose Symptoms Matters
Opioids can kill by quietly shutting down your breathing when you overdose. When you take too much for chronic pain, the batch is stronger than you expected, or you have mixed bad actors like alcohol or other drugs into he mix, your respiratory drive will slow in the brainstem. Breaths get shallow, slower, then stop. Without oxygen, brain cells start dying within minutes, and brain injury or death can happen fast.
Right now, opioids are involved in tens of thousands of overdose deaths in the United States each year. Even though recent data from 2024 overdose deaths have finally begun to fall, opioids still account for the majority of drug overdose deaths, and overdose levels are still well above the early 2010s, when the aptly-named opioid crisis began to accelerate thanks to increased access addicts were given to illicit drugs like heroin and synthetic opioids.
Learning how to spot an opioid overdose is critical for preventing opioid poisoning, as it might look more subtle than what you have seen on TV shows. You might not see someone wildly seizing or screaming. Instead, you see a person just nodding, breathing slowly, making weird snoring or choking sounds, or turning a little blue around the lips. Some people might assume the person is just really high and let them “sleep it off,” but that is precisely how people die.
Opioid Overdose Symptoms: What an Overdose Really Looks Like
Medical professionals recommend looking for three core opioid overdose symptoms that indicate you or a friend’s opioid misuse may lead to a fatal opioid overdose.
Pinpoint Pupils
The pupils become very small and “pinpoint.” In a dark room, they stay tiny rather than opening up as they normally would. You might need to gently open the person’s eyelid to see this. Pinpoint pupils that don’t respond to changes in light are one of the clearest signs of opioid intoxication.
Slow, Shallow, or Stopped Breathing
This is the most dangerous part where fatal overdoses often occur. Breathing and respiratory function may slow to less than eight breaths per minute, become irregular, or stop completely. You might hear strange gurgling, snoring, or choking sounds from someone who will not wake up. That is not them going to sleep; that is a major red flag for an opioid overdose. If someone isn’t breathing, they are dying, and you need to perform basic life support like chest compressions, laying them on their side to open airways, and rescue breaths to keep them alive until help arrives.
Unresponsiveness or Inability To Wake
The person will not respond when you call their name, shake them, or firmly rub your knuckles on their sternum (a widely accepted diagnostic check for consciousness and pain response). If they barely mumble, cannot stay awake, or instantly drift back out when you let go, treat it as a suspected opioid overdose and call 911 or emergency medical services immediately.
Other Physical Signs and Symptoms of Opioid Overdose
Beyond these first signs, other opioid overdose symptoms include:
- Pale, clammy, or cold skin
- Blue, purple, or gray lips and fingernails
- Very limp body and weak or slow pulse
- Vomiting or foaming at the mouth
- Seizures in some cases, especially with mixed drugs
For lighter-skinned people taking opioids, a lack of oxygen shows as blue lips or fingertips. For darker-skinned people, look closely at lips, gums, nail beds, and inside eyelids for a gray, purple, or ashy color. Regardless of the person, drastic changes from normal skin tone are a key indicator that something is wrong.
Early Warning Signs of Opioid Intoxication Before Collapse
Sometimes opioid overdose symptoms seem synonymous with other opioid effects that come with pain relief or “just being high. “Common early signs:
- Heavy nodding off mid-conversation
- Slurred speech and slow responses
- Scratching, itching, or flushed skin
- Walking unsteadily, dropping things, or zoning out
If you notice someone using more often, mixing opioids with other substances like alcohol or benzodiazepines, or needing higher doses to feel anything, their risk of overdose jumps. These are your opportunities to act early, not wait until they stop breathing.
How Fentanyl and Mixed Drugs Change Opioid Overdose Symptoms
Illicit fentanyl and its cousins can make opioid overdoses hit faster and harder than heroin or many prescription opioids. With fentanyl, someone can go from talking to fully unresponsive in a minute or two. Mixed use with alcohol, benzos, or illicit substances like cocaine can make it harder to prevent an overdose because stimulant crashes and sedatives can mask or worsen opioid overdose symptoms.
You may also need more than one naloxone dose when fentanyl or other synthetic opioids are involved, since the effects of naloxone are temporary (typically only 30 to 90 minutes). If you carry naloxone, keep multiple doses with you.
| Stage | What you might see | What to do |
|---|---|---|
| Early intoxication | Heavy nodding, slow talk, pupils small | Stay with them, check breathing often |
| Worsening signs | Loud snoring, gurgling, very slow breaths | Try to wake, call emergency services |
| Full overdose | No response, not breathing or gasping, blue lips | Call emergency services, give naloxone, and start rescue breathing mixed with chest compressions |
What To Do if You See Signs of Opioid Overdose
When you suspect an overdose, you do not need to be 100 percent sure. You just need to act with the best of your ability. The Substance Abuse and Mental Health Services Administration (SAMHSA) has an opioid overdose prevention toolkit you can use while waiting for emergency help to arrive. The essence of these steps involves:
- Checking response
- Call their name, shake them, and check if they are unconscious or unable to breathe.
- Rub your knuckles hard on their breastbone or upper lip. No response means it’s an emergency.
- Call emergency services
- In the US, call 911 and say you think it is an opioid overdose.
- Many areas have Good Samaritan laws that protect people who call for help.
- If multiple people are nearby, assign everyone a job to ensure things get done.
- Administer naloxone
- Give a dose right away if a person remains unresponsive, and give a second dose if they don’t respond within 2-3 minutes. Administer one spray per nostril, and don’t give up treatment after administering, thinking they will wake up on their own.
- Support breathing
- Keep monitoring
- As help is arriving, continue to note any changes in the person’s composure. SAMHSA recommends that anyone who has shown signs of overdose should be closely monitored for at least 4 hours after receiving naloxone to ensure the overdose doesn’t come back after the overdose reversal drug expires.
When and How To Administer Naloxone
Naloxone (Narcan) is a life-saving medication that temporarily blocks opioid receptors and can reverse an opioid overdose and its symptoms. It is now available in nasal sprays and injections, often without a prescription.
- Use naloxone on anyone with a suspected opioid overdose, even if you are not totally sure. Since naloxone has fewer health risks and rarer side effects than the overdose itself, err on the side of using it whenever possible.
- Follow the device instructions (most nasal sprays are one dose per nostril).
- If there is no improvement in 2 to 3 minutes, give another dose.
- Stay with the person, because naloxone can wear off while the opioids are still in their system, and overdose symptoms can return.
How To Perform Rescue Breathing Until Help Arrives
If someone is not breathing or is only gasping:
- Lay them on their back.
- Tilt the head back slightly, lift the chin.
- Pinch the nose closed.
- Give one slow breath into their mouth, watching for the chest rise.
Chest compressions along with breaths is the best way to perform rescue breathing with proper training, especially if there is no pulse. Rescue breathing buys time by keeping oxygen moving while naloxone starts reversing the overdose.
What Not To Do in a Drug Overdose/Opioid Use Emergency
As is often the case, common myths arise about medical conditions like overdose. These do not work:
- Putting them in a cold shower or bath
- Slapping them in the face or throwing water on them
- Walking them around or trying to “wake them up with coffee”
- Leaving them alone to sleep it off
None of these will fix opioid overdose symptoms. They only waste time and increase the risk of brain injury or death. Call for medical help, administer naloxone, and support their breathing instead.
Preventing Future Opioid Overdoses, Opioid Use Disorder, and Finding Help
Once you understand opioid overdose symptoms, the next step is preventing them in the first place. Those with substance use disorders, either from illegal opioids or from prescription medications, have increasing difficulty controlling their dose and fighting against withdrawal symptoms. During a relapse, you are at a much higher risk of an overdose from the drug’s pharmacological effects, which is one of the insidious ways that the drug stops those with opioid dependence from trying to escape from its pull.
Who Is at Higher Risk of Opioid Overdoses?
You are at higher risk if you:
- Recently left detox, jail, or rehab (your tolerance is lower)
- Mix opioids with alcohol, benzos, or other sedatives
- Use alone where no one can see overdose symptoms
- Use drugs from new dealers or counterfeit pills
- Have existing lung, heart, or sleep breathing problems
Simple Ways To Reduce Overdose Risk
Even if you can’t prevent overdose in all situations, there are some steps you can take to reduce the harm when using and lower your risk of overdose:
- Never use alone. If you must, use a phone or virtual spotting service.
- Test a small amount first, especially with new batches or pills.
- Avoid mixing opioids with alcohol or benzos.
- Keep naloxone where you actually use it, not hidden in a drawer or out of reach.
These harm reduction steps do not replace treatment or prevent opioid overdose. Still, they can keep you alive long enough to get into a recovery program or for emergency medical technicians to perform opioid overdose treatments.
FAQs About Opioid Overdose Response and Symptoms
How to tell if someone is overdosing?
When someone is high, they may be sleepy but can still wake up and respond. With an opioid overdose, they will not wake up, their pupils are pinpoint, and their breathing is slow, shallow, or stopped. If you cannot wake them or their breathing sounds like choking or gasping, treat it as a suspected overdose and act fast.
Why can an opioid overdose cause death so quickly?
Opioids slow the part of the brain that controls breathing. In an overdose, breaths become so slow or shallow that oxygen cannot reach the brain and other organs. Within minutes, cells start dying, leading to brain damage, coma, or death. That is why recognizing opioid overdose symptoms and giving naloxone quickly is so critical.
What does an opioid overdose look like on fentanyl compared with heroin?
With fentanyl, opioid overdose symptoms often appear faster and can be more severe. A person may suddenly slump over, stop responding, and breathe only a couple of times a minute or not at all. Because fentanyl is so strong, multiple naloxone doses are often needed, and overdose can return after temporary improvement, so ongoing monitoring is essential.
Can someone overdose on prescription opioids taken as directed?
If you use prescription opioid medications exactly as prescribed and do not combine them with other depressants, the risk of overdose is lower, but it is never zero. Health conditions like sleep apnea, lung disease, or accidental extra doses can trigger opioid overdose symptoms even with prescription drugs. Always follow your healthcare provider’s directions and talk openly about any side effects or extra use.
Remaining Vigilant for Opioid Overdose
Opioid overdose does not always present as a dramatic scene where you immediately know the stakes. More often, it looks like a friend who “seems really out of it,” a loved one who will not wake up, or a stranger making strange snoring sounds on a couch. When you understand opioid overdose symptoms and trust your instincts, you turn from a bystander into someone who can save a life.
If overdose has been a close call for you, take that as a signal, not a sentence to wallow in your own isolation. Reach out to our admissions team at New Chapter Recovery. We employ evidence-based treatments to help you get off opioids with our flexible outpatient treatment program, and provide a complete selection of outpatient care options for New Jersey communities. You are not alone, and you are not beyond help. Every breath you take now is another chance to choose a different path for your future.
