FAQ About Overdose

Written by Prevention Point Pittsburgh

How Can I Tell if Someone is Overdosing?

If someone has taken opiates or opioids (heroin, fentanyl, carfentanil, morphine, methadone, OxyContin, Opana, Vicodin, Percocet, codeine, or other pain medication), and their breathing becomes slow (less than 12 breaths per minute), or stops, they are likely overdosing. Common signs of opiate/opioid overdose may be: fingers and lips turning blue, no response when you shake them and call their name, body is limp, pulse is slow or they have no pulse. Their eyes may roll back. People die of opioid overdose if their breathing becomes so slow that it stops. If they stop breathing, after a few minutes, their heart will stop and their organs will shut down.

What Can I Do if Someone is Overdosing?

Check if they are breathing. If they ARE breathing, conscious, and can walk, it may help to get them up and moving, splash water on their face or use a cool wet cloth on their face. Keep checking their breathing, call 911.

If they are NOT breathing or breathing slow (less than 1 breath every 5 seconds), breathe for them. Roll them on their back, tilt their head back, remove anything in their mouth (food, gum, or vomit), take a deep breath, and make a seal with your mouth over theirs. Blow into their mouth, 2 breaths first, then 1 breath every 5 seconds until paramedics get there. Doing chest compressions can also help.

If you have naloxone (also called Narcan), give a few breaths (above), then injection or spray naloxone. Keep breathing for them until naloxone starts to work. If they aren’t breathing on their own in 3 minutes, give a second dose. Naloxone works on all opioids, including fentanyl, Acetyl fentanyl, Acrylfentanyl, Carfentanil, U-47700 and others. It can sometimes take more than 1 dose. Give one dose to start and breathe for them. It’s rare that someone needs more than 2 doses. Note: If someone also took benzos they may still be “out of it” or even unconscious, once the naloxone starts them breathing, but more naloxone won’t help as it doesn’t reverse the effects of benzos.

What About COVID-19?

Giving naloxone requires a brief period of being less than 6 feet from another person. This can be done safely as long as care is taken. Rescue breathing, even with a breathing mask and chest compressions, may carry a risk for COVID-19 transmission, however, when done correctly, this can save lives, especially if you don’t have naloxone. It is your decision whether to provide breathing. The most important intervention continues to be administering naloxone!

NALOXONE ONLY WORKS ON OPIOIDS, NOT METH OR COKE OR BENZOS.

What About Overdose From Speed or Cocaine?

Naloxone will not help an overdose from stimulants, like methamphetamine or cocaine. Symptoms of stimulant overdose can be shakes, sweating, rapid pulse, vomiting, foaming at the mouth, unable to talk or walk, pressure or tightness in the chest, seizures, unconsciousness, no breathing, no pulse. They need medical attention ASAP if they have symptoms of a heart attack, stroke or seizure. Fentanyl has been found in some meth and coke, so it’s a good idea to have naloxone on hand, even if you don’t use opioids.

What is Naloxone?

Naloxone is the generic name (brand names are Narcan and Evzio) for the safe, effective medication paramedics use when someone overdoses on opioids (Opioids include: heroin, morphine, fentanyl, carfentanil, U-47700, methadone, OxyContin, Vicodin, Percocet, Opana, Dilaudid, and other pain medications). Naloxone can re-start their breathing, if they get it soon enough.

How Does Naloxone Work?

Naloxone is injected into a muscle or sprayed into the nose (depending on type). It does not work if taken by mouth. It blocks the receptors in your brain to which opioids attach. It starts to work in 3-5 minutes and lasts 30-90 minutes. While you are waiting for it to work, keep breathing for the person who has overdosed.

How Do You Give Naloxone to Someone?

Naloxone can be injected into a muscle, using an IM needle 1 or 1 ½ inch long. Inject entire contents of bottle (1 cc) and wait 3-5 minutes while you continue breathing for them. Usually 1 cc is enough, but sometimes a second 1 cc dose is needed if they don’t wake up right away. Make sure you call 911 so the paramedics will be on their way in case there are other problems!

Nasal naloxone spray comes in a white box marked “Narcan Nasal Spray.” This type is stronger than IM naloxone so withdrawal symptoms may be more severe. Usually a second dose is not needed. When you push the button, all the contents spray, so make sure you have it in the person’s nose. You won’t see or hear the spray.

There is also an “auto-injector,” like an epi-pen, which you press against the person’s leg and push down for 5 seconds. This device talks to you and tells you how to use it. This is really easy to use, but this type is VERY strong (equivalent to FIVE doses of regular IM naloxone!) and the person who overdosed may more likely get sick from withdrawal.

How Can I Get Naloxone?

If you use opioids yourself, or are likely to witness an overdose, you can get injectable naloxone free of charge, at Prevention Point’s East Liberty Needle Exchange Site at 5913 Penn Ave, Pittsburgh any time between 12:00 and 2:30 pm on Sundays or at any of PPP’s van site (visit www.pppgh.org for details). The training on Overdose Prevention & Response and instruction on how to give naloxone takes 5- 10 minutes. You will be able to get injectable naloxone to take home with you. You can also get naloxone at any of our van syringe supply sites.

Where Else Can I Get Naloxone?

Pharmacies can sell naloxone (or bill your insurance) by standing order prescription (you don’t have to see a doctor). Ask your local pharmacist if they participate in the standing order.

The Allegheny County Jail now makes naloxone available to people on release from jail, if they request. Also, Pittsburgh City EMS will leave a naloxone kit when responding to an overdose. Some hospital emergency departments provide take home naloxone to someone who has overdosed. Some substance use treatment programs give out naloxone.

Service providers who want to have naloxone on hand can purchase naloxone at a pharmacy. Like a fire extinguisher, this is part of the cost of having a safe work site. For staff training, access one of the video trainings at: http://prescribetoprevent.org/ or Prevention Point’s website http://www.pppgh.org/ (under Overdose Prevention Project, Naloxone Access and Training).

If you can’t access naloxone through pharmacies, syringe exchange programs, or by other means, contact NEXT at https://www.naloxoneforall.org/ to get help with getting naloxone.

Is it Legal to Give Someone Naloxone?

YES! Pennsylvania Act 139 allows naloxone to be prescribed, directly or by standing order, to anyone who might witness, an opioid overdose. A person acting in good faith and with reasonable care, is immune from criminal prosecution, civil liability, professional licensing sanction or review.

I’ve Heard You Should Put Ice on Someone Who has Overdosed, is this True?

If someone is nodding, but can wake up, ice may help wake them. BUT it’s quicker to rub your knuckles HARD on their chest (sternum) bone, or pinch them on the earlobe, finger or inner arm. Ice wastes time and creates an unnecessary mess and won’t help someone who has stopped breathing.

What About Injecting Them With Salt Water?

You should never inject someone with salt water, speed, cocaine, bleach, milk or anything but naloxone. None of these things will help someone who is overdosing, some of them may hurt them, and they all are a waste of precious time.

How Long Does It Take Someone to Die From an Overdose?

If they stop breathing for as little as four minutes, they may have brain injury or death. Keep breathing for them, to keep them alive.

If I Have Naloxone, Do I Still Need to Do Rescue Breathing?

YES. It is important to get oxygen into their lungs ASAP. Sometimes they will start breathing on their own if you breathe for them for a few minutes or give chest compressions.

What If I Can’t Wait For the Paramedics to Get There?

If they aren’t breathing and are left alone they may die. Don’t assume that they will wake up on their own or that the paramedics will find them in time. If no one can stay with them, place them on their left side with their left arm and left leg out straight and right arm and leg bent, (rescue position). It is a little easier to breathe in this position and if they vomit it is less likely that they will choke than if they are on their stomach or back. Make sure ambulance is on their way, know where to find them, and can get to them easily. Tell the 911 dispatcher what they took if you know.

What Factors Can Increase the Risk of Overdose?

Anyone who uses opioids can overdose. Mixing different drugs together increases the risk. ESPECIALLY mixing opioids with alcohol and/or benzodiazepines (Xanax, Klonopin, Ativan, Valium and similar medications prescribed for anxiety). Not knowing the strength of drugs or medication increases risk. A lot of what is sold as heroin is Fentanyl or mixed with Fentanyl, MUCH stronger than heroin. You can’t always tell if Fentanyl is in the mix. Changes in tolerance, if you use opioids every day, but stop for even a few days and then start again, your risk increases because your tolerance is lower. Illness that affects your breathing, (like asthma, COPD, or emphysema) can also increase the risk of overdose.

Using Fentanyl Test Strips

You can get Fentanyl test strips at Prevention Point’s syringe exchange, to test for Fentanyl in other substances. Street drugs are unpredictable and mistakes happen, coke and fentanyl can often look similar. Use test strips to tell if your powder or rock is fentanyl.

For more information, contact: Prevention Point Pittsburgh 412-247-3404, www.pppgh.org or find them on Facebook. Get naloxone Sundays 12-2:30pm at PPP, 5913 Penn Ave in East Liberty, Pittsburgh.

You can also get naloxone on Tues, Wed, Thurs, or Friday at their van sites.