If you take one action after reading anything on this site, make it this one: get naloxone and put it somewhere the people in your household can find it. It costs little, it needs no prescription, and it is the only thing that reverses an opioid overdose while you wait for paramedics.
Why this matters even if nobody you know uses opioids
That sentence used to be a reasonable filter. It no longer is. Illicitly manufactured fentanyl has spread well beyond the opioid supply, and it now turns up in counterfeit pills sold as oxycodone, Xanax and Adderall, and in cocaine and methamphetamine.
The cruel arithmetic is that the people most likely to die are the ones with no opioid tolerance at all. A teenager who buys what they believe is a Xanax bar from a contact on social media has no tolerance whatsoever. A dose that a regular opioid user would survive can kill them.
So the question is not whether someone in your house uses opioids. It is whether anyone in your house, or anyone who visits it, might ever take a pill that did not come from a pharmacy.
Where to get it
- Any pharmacy, over the counter. Naloxone nasal spray was approved by the FDA for nonprescription sale, so you can buy it off the shelf or ask at the counter. You do not need to explain yourself and you do not need a doctor.
- Free through state and county programs. Many states run distribution programs that mail it or hand it out at no cost. California operates the Naloxone Distribution Project. Search your state health department plus naloxone.
- Harm reduction and syringe services programs, which distribute it free along with fentanyl test strips.
- Ask for two doses. Fentanyl overdoses frequently require more than one.
How to recognize an overdose
An opioid overdose kills by suppressing the drive to breathe. It is usually not instant, and there is often a window of many minutes in which intervention works.
- Unresponsive to shouting or to a firm rub on the breastbone
- Breathing very slow, shallow, gurgling, or stopped
- Pinpoint pupils
- Blue or grey lips, fingertips and face
- Limp body
- Snoring or choking sounds, which mean a blocked airway rather than sleep
That last one is worth emphasizing, because it is the sign people most often misread. Someone who has passed out and is snoring loudly and strangely is not sleeping it off.
What to do, in order
- Call 911. Most states have Good Samaritan laws that protect people who call for help at an overdose from certain drug possession charges. Say that someone is not breathing.
- Give naloxone. One spray into one nostril. There is no complicated technique and you cannot get the dose wrong.
- Support their breathing. Rescue breaths if you are trained. Chest compressions if there is no pulse.
- Wait two to three minutes, then give another dose if there is no response. Keep going until they breathe or help arrives. Stopping after one dose is the single most common bystander mistake.
- Stay with them. Naloxone wears off in roughly 30 to 90 minutes, which can be shorter than the drug it reversed. People can go back into overdose.
Two things to expect. Naloxone can put someone into abrupt withdrawal, and they may wake up sick, disoriented and angry. That is a survivable outcome and not a reason to hesitate. And if the supply contained xylazine, a veterinary sedative increasingly mixed into fentanyl, the person may stay sedated even after naloxone works, because naloxone does not reverse xylazine. Give it anyway, because the fentanyl is what stopped their breathing.
Three myths worth discarding
You cannot overdose by touching fentanyl. This fear has been amplified widely and toxicology does not support it. Fentanyl is not meaningfully absorbed through intact skin in the amounts encountered incidentally. Brush powder off and wash with soap and water. The myth does real harm, because it makes bystanders hesitate at the exact moment hesitation is fatal.
Keeping naloxone does not encourage drug use. There is no evidence for this, and research on harm reduction points the other way: people connected to these services are more likely to enter treatment, not less.
You cannot hurt someone by giving naloxone unnecessarily. If they were not overdosing on opioids, it does essentially nothing. There is no penalty for guessing wrong.
Have the conversation
Buying naloxone is the easy part. Telling the people you live with where it is, and showing them how to use it, is what makes it useful at three in the morning when you are not home. Put it somewhere obvious rather than hidden in a drawer, and treat the conversation the way you would treat pointing out the fire extinguisher.
If you are the person using, the same logic applies in reverse: tell someone. Never use alone. If you must, the Never Use Alone hotline at 1-800-484-3731 stays on the phone and dispatches help if you stop responding.
If you need help right now. Call 911 in an emergency. For a mental health crisis or suicidal thoughts, call or text 988 (veterans press 1). For free, confidential treatment referrals any hour of the day, call the SAMHSA National Helpline at 1-800-662-4357. To search licensed programs yourself, use FindTreatment.gov or our own treatment directory.
Alternative Addiction publishes reference information and a treatment directory. We are not a treatment provider and nothing here is medical advice, a diagnosis or a treatment plan. Never stop a prescribed medication without talking to a clinician. Withdrawal from alcohol, benzodiazepines and barbiturates can cause seizures and can be fatal without medical supervision.
