• Signs of an Opioid Overdose

    A person experiencing signs of opioid overdose while another person administers naloxone nasal spray.

    Date Published: September 8, 2026

    Opioid overdoses can happen anywhere — at home, work or in your community. Often, the first people able to help are family, friends, coworkers or bystanders.

    Knowing the warning signs and acting quickly can save a life. You do not need to be a healthcare professional to help. With proper training, anyone can learn to spot an opioid overdose, respond safely and give care until advanced emergency help arrives.

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    What Is an Opioid Overdose?

    Opioids affect the brain and nervous system, especially the areas that control pain and breathing. In an overdose, breathing can slow or stop.

    Doctors may prescribe opioids to treat pain after an injury, surgery or certain illnesses. Some opioids, such as heroin, are illegal. Others, such as fentanyl, can be prescribed legally but may also be made and sold illegally.

    Examples of Opioids

    Prescription opioids, such as:

    • Codeine
    • Fentanyl
    • Hydrocodone
    • Morphine
    • Oxycodone

    Illegal opioids:

    • Heroin
    • Illegally made fentanyl

    Fentanyl may be prescribed by a doctor, but it can also be made and sold illegally, which increases the risk of overdose.

    Signs of an Opioid Overdose

    Common signs of an opioid overdose include breathing problems, trouble waking the person, changes in skin color, very small pupils and signs of opioid use nearby. If you think someone is overdosing, call 911 right away.

    Breathing Problems

    Breathing changes are often the first and most serious sign of an opioid overdose. The person may breathe slowly, shallowly or irregularly, or may stop breathing. Gasping, choking, snoring or gurgling sounds can also be signs that the person is not breathing normally.

    Changes in Responsiveness

    An opioid overdose can make a person very drowsy, confused or hard to wake. The person may not respond when you call their name, tap their shoulder or try to wake them.

    Possible signs include:

    • Extreme sleepiness or drowsiness
    • Confusion or unusual behavior
    • Trouble waking the person
    • No response to voice or touch
    • Loss of consciousness

    Changes in Appearance

    When oxygen levels drop, a person’s appearance can change. Possible signs include:

    • Blue, gray or pale skin
    • Blue or gray lips or fingernails
    • Pale, cool or clammy skin

    When Is an Opioid Overdose an Emergency?

    An opioid overdose is always a medical emergency. If you think someone is overdosing, do not wait to see if they improve. Call 911 immediately, even if you have naloxone.

    Seek emergency medical care immediately if the person has any of the signs described above.

    Every minute matters during an opioid overdose. Calling 911 and starting emergency care right away improves the person’s chance of survival.

    What Should You Do If You Suspect an Opioid Overdose?

    If you think someone is having an opioid overdose, act fast. These steps can help protect their life until emergency help arrives.

    Step 1: Ensure the Scene Is Safe

    Before you go to the person, check for anything that could be dangerous to you or others. If the area seems unsafe, stay back and call 911.

    Step 2: Check Responsiveness and Breathing

    If it is safe, try to wake the person by calling their name or gently tapping them. Check if they are breathing normally.

    • If the person is unresponsive and not breathing or only gasping, they are in cardiac arrest. Immediately begin CPR and use an AED if one is available. If there is naloxone nasal spray available, it should be administered as soon as possible without delaying CPR and AED use.
    • If the person is breathing slowly or irregularly or is not fully awake or is confused: Administer naloxone nasal spray.
    • If the person is awake and breathing normally: call 911 and monitor the person.

    Naloxone is most commonly available as a nasal spray designed for community use. It is easy to use and may be available for free through many public health programs, community organizations, pharmacies or harm reduction programs. The American Red Cross also offers an Opioid Overdose Kit with NARCAN® Nasal Spray for individuals who want to be prepared for an opioid overdose emergency.

    Step 3: Call 911

    Call 911 right away or ask someone nearby to call while you stay with the person. Tell the dispatcher you think it is an opioid overdose and follow their instructions.

    Step 4: Provide Additional Care

    Stay with the person until emergency help arrives and follow the directions of the 911 operator. Depending on their condition, you may need to:

    Learn How to Respond to an Opioid Overdose

    During an opioid overdose, every minute matters. Recognizing the signs, giving naloxone and knowing when to provide CPR or use an AED prompts you take lifesaving action while waiting for help to arrive.

    The American Red Cross First Aid for Opioid Overdoses Online Course teaches you how to recognize the signs of an opioid overdose, assess breathing and responsiveness, administer naloxone products and understand when CPR may be needed.

    This self-paced online course takes about 55 minutes to complete and provides practical skills and guidance to help you respond with confidence during an opioid overdose emergency.

    Download the Free Red Cross First Aid App

    The free First Aid mobile app by the American Red Cross puts expert advice for emergencies like opioid overdoses in the palm of your hand — from the latest First Aid and CPR techniques to the nearest hospital location. Stay up to date on your lifesaving skills.

    Download the American Red Cross First Aid mobile app on the Apple App Store.
    Get the American Red Cross First Aid mobile app on Google Play.

    Or text: "GETFIRST" to 90999

    Frequently Asked Questions About Opioid Overdose Signs

    What are the first signs of an opioid overdose?

    Breathing Problems

    Breathing changes are often the first and most serious sign of an opioid overdose. The person may breathe slowly, shallowly or irregularly, or may stop breathing. Gasping, choking, snoring or gurgling sounds can also be signs that the person is not breathing normally.

    Changes in Responsiveness

    An opioid overdose can make a person very drowsy, confused or hard to wake. The person may not respond when you call their name, tap their shoulder or try to wake them.

    Why are opioid overdoses so time-sensitive?

    Opioid emergencies are especially time sensitive because opioids can suppress the brain's drive to breathe. And without enough oxygen, permanent brain injury or death can occur within minutes. So immediate action is critical.

    The first few minutes before EMS arrives can determine whether that person survives and how well they recover. Calling 911, giving naloxone and supporting breathing can keep oxygen reaching the patient's brain until professional help arrives.

    What does opioid overdose breathing look like?

    Breathing changes are often the first and most serious sign of an opioid overdose. The person may breathe slowly, shallowly or irregularly, or may stop breathing. Gasping, choking, snoring or gurgling sounds can also be signs that the person is not breathing normally.

    What are some common misconceptions about opioid overdoses?

    One common misconception is that opioid overdoses only happen to people who are using illegal drugs. Yes, it can happen in those who use illegal drugs, but overdoses can also involve prescription medications and accidental exposures, including accidental exposures in children.

    Another misconception is that the use of naloxone ends the emergency. Naloxone is temporary. Additional doses may be needed and the person still needs emergency medical evaluation because breathing problems can return.

    What is naloxone?

    Naloxone is a medicine used in suspected opioid overdose emergencies. It can temporarily reverse the effects of opioids and help a person breathe more normally until emergency medical help arrives. Naloxone is most commonly available as a nasal spray designed to be easy for the public to use. It may be available for free through public health programs, community organizations, pharmacies or harm reduction programs.

    Even if naloxone seems to work, the person still needs emergency medical care. Always call 911 and stay with the person until help arrives.

    Should I call 911 if I have naloxone?

    Naloxone does not replace emergency medical care. Always call 911 if you think someone is overdosing. If Naloxone is available give it as soon as possible after calling 911.

    Can someone overdose on prescription opioids?

    Prescription opioids, including codeine, hydrocodone, morphine and oxycodone, can cause an overdose. The risk is higher when a person takes more than prescribed, mixes opioids with alcohol or certain medicines, or uses illegally made opioids.

    Can opioid overdoses cause cardiac arrest?

    An opioid overdose can slow or stop a person’s breathing, which keeps oxygen from reaching the brain and other vital organs. Without quick treatment, this can cause cardiac arrest and become life-threatening.

    Is CPR necessary during an opioid overdose?

    An opioid overdose can slow or stop a person’s breathing. If breathing stops, their heart will also stop, which can cause cardiac arrest. If this happens, start CPR and follow the 911 dispatcher’s instructions. If an AED is available and the person shows signs of cardiac arrest, use it right away and follow the device’s prompts.

    About the Expert

    This article incorporates guidance from Nathan Charlton, MD, an emergency medicine physician, medical toxicologist and addiction medicine specialist at the University of Virginia. Dr. Charlton has nearly 20 years of experience caring for patients experiencing opioid-related emergencies and those treated with naloxone. He is also Vice Chair of the American Red Cross Scientific Advisory Council, a group of experts that evaluates scientific evidence and provides guidance on first aid, CPR and emergency care recommendations for the American Red Cross.

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