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Opioid Overdose: Symptoms and Prevention

Opioids are a class of drugs used to treat pain.1 They include prescription pain relievers as well as illicit (illegal) forms typically used to get high, such as heroin, illicitly made fentanyl and fentanyl-like substitutes, and counterfeit prescription opioid pills.2 Regular opioid use can lead to opioid dependence, addiction, or a possibly deadly overdose.1,2,9 This article will help you better understand the risks and learn the signs and symptoms of overdose and how you can help someone who is overdosing.

What is Opioid Overdose?

An opioid overdose happens when a person takes too much of an opioid and their breathing significantly slows or stops.4 This can happen a number of ways, including:2,10

  • Taking opioids with other drugs, such as alcohol or benzodiazepines.
  • Taking a higher dose or using more often than your doctor told you.
  • Using someone else’s prescription for opioid painkillers.
  • Using illegal opioids, such as heroin, fentanyl, or counterfeit painkillers or sedatives.
  • Taking an opioid or non-opioid drug (or counterfeit pill) that is laced with fentanyl.
  • Accidentally, such as repeating a dose after forgetting you’ve already taken your opioid medicine.
  • Taking too much of an opioid in an attempt to harm oneself.

When your brain doesn’t get enough oxygen, this is called hypoxia, which can lead to permanent brain damage, coma, or even death.4 Brain cells break down quickly without oxygen and cells can die less than 5 minutes after breathing stops.12 Getting medical help right away, which typically includes giving the opioid antidote naloxone, can help restore a person’s breathing and may prevent death.1

Opioid Overdose Risk

Non-prescription (or non-medical) opioid users are already at increased risk of overdose, but additional risk factors include:2,20

  • History of overdose.
  • Recent release from prison.
  • Being male gender.
  • Injection drug use.
  • Polydrug use (using opioids in combination with other drugs), especially alcohol, benzodiazepines, sedatives, and cocaine.

Overdose risk factors in those who take prescription opioids, especially for chronic pain, are less understood and an area of much study. Risk factors may include:21

  • Using prescription opioids together with prescription benzodiazepines or antidepressants.
  • Taking prescription oxycodone or hydromorphone.
  • History of drug or alcohol use.
  • Certain medical issues, such as respiratory (lungs and breathing) illness, sleep apnea, or reduced kidney or liver function.

Having an opioid use disorder (OUD) also increases your overdose risk.17 Returning to opioid use following a period of abstinence (not using) is a big overdose risk factor for those with an opioid addiction.17 OUD treatment medicines can help reduce this risk. Studies show that buprenorphine and methadone both decrease the risk of overdose and overdose death.17

What Does an Opioid Overdose Look Like?

During an opioid overdose, breathing slows or stops.2 Other signs of an opioid overdose include:8,10,11

  • Loss of consciousness. People who lose consciousness will not respond to verbal or physical stimuli (such as being spoken to or touched) and they may not be able to wake up. If they appear they maybe awake, they may still be unable to speak.
  • Very small pupils.
  • Limp body with skin that feels clammy or wet to the touch.
  • Skin color changes. People with lighter skin may look blue or purple and people with darker skin may look grey or ashen.
  • Vomiting, gurgling, or choking sounds.
  • Irregular, slow, or stopped heartbeat.

If you think someone is having an overdose, call 911 right away. Then: 8,10,11

  • Give naloxone (Narcan, Kloxxado), if available.
  • Try to keep them awake and breathing. If they’re not awake, try to wake them by yelling their name and rubbing hard on their chest.
  • Place them on their side to keep them from choking on their own vomit.
  • Stay with them until medical help arrives.

Can You Reverse an Opioid Overdose?

Acting quickly is the key to reversing the possibly life-threatening slowed or stopped breathing caused by an opioid overdose.2 If you think someone might be overdosing, call 911 right away.8,10 They will be able to walk you through life-saving efforts you can try while you wait for help to arrive. You can also give naloxone if you have it.11,14

Naloxone (Narcan and Kloxxado) is a safe medicine that can help stop an opioid overdose.8,10 It comes in two forms: a nasal spray or injection.14,15 If given quickly enough, naloxone can help restore normal breathing in a person who is overdosing and temporarily prevent opioids from further effecting their breathing.14 Naloxone only works in the body for 30 to 90 minutes.14 So depending on the amount and type of opioid taken (and when it was last taken), overdose symptoms may return and a person may need more than one dose or other medical interventions.14,15

In many states, you can get naloxone without a doctor’s prescription from pharmacies, local health departments, and community naloxone distribution or harm reduction programs.14 All first responders are trained in how to identify an opioid overdose and give naloxone, and in many places, friends and family members can get this training as well.14 Recent national studies showed a 14% decrease in fatal opioid overdose among states that have naloxone access laws.15 To get and learn how to use naloxone, check the online Naloxone Finder.15

How Can I Prevent Overdose?

Addiction treatment and expanding naloxone access can help reduce the risk of opioid overdose.2,16 Medicines for opioid use disorder, specifically methadone and buprenorphine, can greatly lower risk of opioid overdose and overdose death.2,17,18

Other strategies to prevent opioid overdose include:2

  • Never mixing opioids with alcohol or other drugs.
  • Taking prescription opioids exactly as your doctor told you to. Be careful not to take more of it or more often than told.
  • Properly storing and disposing of medicines.
  • Asking for naloxone when you or someone in your family is prescribed opioids and teaching your family and friends how to spot and respond to an overdose, including how to use naloxone.

How Can I Find OUD Treatment Near Me?

If you think you or a family member has a problem with opioids, talk to your doctor. They can help you find a treatment program that will help you leave your addiction behind.

American Addiction Centers (AAC) is a leading provider of detox and addiction treatment, with centers across the United States. If you or a loved one is struggling with an opioid use disorder, AAC is here to help you start your recovery. Call our free and confidential hotline at any time, day or night.


  1. World Health Organization. (2021, August 4). Opioid overdose.
  2. Substance Abuse and Mental Health Services Administration. (2018). SAMHSA opioid overdose prevention toolkit.
  3. National Institute on Drug Abuse. (2021, March 11). Opioid overdose crisis.
  4. National Institute on Drug Abuse. (2021, June 1). Prescription opioids drugfacts.
  5. Centers for Disease Control and Prevention. (2020, December). Drug overdose deaths in the United States, 1999-2019.
  6. National Academy of Medicine. (2020, October 26). The American opioid epidemic in special populations: Five examples.
  7. Schuler, M. S., Dick, A. W., & Stein, B. D. (2019, June 7). Sexual minority disparities in opioid misuse, perceived heroin risk and heroin access among a national sample of US adults. Drug and Alcohol Dependence, 201, 78–84.
  8. Centers for Disease Control and Prevention. (n.d.). Preventing an opioid overdose.
  9. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
  10. S. National Library of Medicine. (2021, June 3). Opioid overdose.
  11. National Harm Reduction Coalition. (2020, August 28). Training guide: Opioid overdose basics.
  12. S. National Library of Medicine. (2021, July 2). Cerebral hypoxia.
  13. West, B. & Varacallo, M. (2020, September 20). Good Samaritan laws. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
  14. National Institute on Drug Abuse. (2021, June 1). Naloxone drugfacts.
  15. National Institute on Drug Abuse. (2017, March 30). Naloxone for opioid overdose: Life-saving science.
  16. Centers for Disease Control and Prevention. (2018). Evidence-based strategies for preventing opioid overdose: What’s working in the United States.
  17. Substance Abuse and Mental Health Services Administration. (2021). Tip 63: Medications for opioid use disorder.
  18. National Institute on Drug Abuse. (2018, January). Principles of drug addiction treatment: A research-based guide.
  19. The Commonwealth Fund. (2021, August 13). The drug overdose toll in 2020 and near-term actions for addressing it.
  20. Webster, L. R. (2017). Risk factors for opioid-use disorder and overdose. Anesthesia & Analgesia, 125(5), 1741–1748.
  21. Dilokthornsakul, P., Moore, G. Campbell, J. D., Lodge, R., Traugott, C., Zerzan, J. … & Page, R. L. (2016).Risk factors of prescription opioid overdose among Colorado Medicaid beneficiaries. The Journal of Pain 17(4), 436–443.
  22. Gladden, R. M., O’Donnell, J., Mattson, C. L., & Seth, P. (2019). Changes in opioid-involved overdose deaths by opioid type and presence of benzodiazepines, cocaine, and methamphetamine – 25 states, July-December 2017 to January-June 2018. Morbidity and Mortality Weekly Report, 68(34), 737–744.
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