by Caspian Whitlock - 11 Comments

Someone you know is unconscious. Their breathing is slow, shallow, or gone. Their lips are blue. You’re scared. You think: overdose. But you don’t know what to do next. You’re not a doctor. You don’t have a medical degree. You just want to help before it’s too late.

Here’s the truth: you don’t need to be an expert. You just need to act-fast and right. In the 4 to 6 minutes before emergency crews arrive, your actions can mean the difference between life and death. Studies show bystander intervention can cut overdose deaths by up to half. You don’t need to fix everything. You just need to keep their body alive until help gets there.

Step 1: Check for responsiveness and breathing

Don’t shake them or yell too loud. That wastes time. Instead, tap their shoulder firmly and shout, "Are you okay?" If there’s no response, immediately check their breathing. Look at their chest. Listen at their mouth. Feel for air on your cheek.

Gasping, snoring, or irregular breaths aren’t normal breathing. They’re signs of severe oxygen deprivation. This is not sleep. This is overdose. If they’re not breathing normally-or not at all-you have to act now.

Step 2: Call for emergency help

Call 000 (Australia) or 911 (US) immediately. Don’t wait to find naloxone. Don’t try to wake them longer. Don’t assume they’ll "sleep it off." The single most important thing you can do is get professional help on the way. Emergency services reduce overdose mortality by 35% compared to waiting for spontaneous recovery.

While you’re on the phone, stay calm. Tell them: "Someone is unresponsive and not breathing normally. I suspect an overdose." Give your location clearly. If you’re in a building, say the floor and unit number. If you’re outside, describe nearby landmarks. Stay on the line. The dispatcher might guide you through next steps.

Step 3: Give rescue breathing if they’re not breathing

If they’re unconscious but still have a pulse, you don’t need chest compressions. You need to keep oxygen flowing. Rescue breathing is your most powerful tool.

Place them on their back. Tilt their head back gently by lifting their chin. Pinch their nose shut. Seal your mouth over theirs. Give one slow breath-about one second long-until you see their chest rise. Don’t blow too hard. Don’t inflate their stomach. That can cause vomiting.

Then, take a breath yourself. Give another breath every 5 to 6 seconds. That’s about 10 to 12 breaths per minute. Keep going. Even if you’re tired. Even if you’re scared. Keep breathing for them. Most opioid overdoses don’t cause heart failure right away. They cause breathing to stop. You’re keeping their brain alive.

Step 4: Use naloxone if you have it-and you suspect opioids

Naloxone reverses opioid overdoses. That includes heroin, fentanyl, oxycodone, morphine. It does nothing for alcohol, benzodiazepines, cocaine, or MDMA. If you don’t know what they took, give it anyway. SAMHSA’s 2023 guidelines say: "Naloxone first for any suspected opioid involvement."

Most naloxone kits today are nasal sprays. Remove the cap. Insert the nozzle into one nostril. Press the plunger firmly for 2 to 3 seconds. Don’t spray it into both nostrils. One is enough. If they don’t respond after 2 to 3 minutes, give another dose in the other nostril.

Even if they wake up after the first dose, don’t stop. Naloxone wears off in 30 to 90 minutes. Opioids can stay in their system longer. They could slip back into overdose. Keep monitoring them. Keep giving rescue breathing if needed. And keep waiting for EMS.

A rescuer speaking to a glowing dispatcher figure while administering breaths to an unconscious person indoors.

Step 5: Put them in the recovery position if they’re breathing

If they’re breathing on their own but still unconscious, roll them onto their left side. This is the recovery position. It keeps their airway open and stops them from choking if they vomit.

Here’s how: Kneel beside them. Straighten their legs. Bend their nearest arm at 90 degrees, palm up. Place their far arm across their chest. Bend their far leg at the knee, foot flat on the ground. Gently roll them toward you, using their bent leg as a pivot. Tilt their head back slightly to keep the airway clear. Their top arm should be under their head. Their bottom arm should be out to the side.

Check their breathing every 2 to 3 minutes. Watch for changes. If they stop breathing, go back to rescue breathing immediately.

What NOT to do

Don’t put them in a cold shower or ice bath. That’s a myth. It can trigger dangerous heart rhythms, especially with stimulant overdoses.

Don’t try to make them walk. Don’t give them coffee or food. Don’t slap them. Don’t inject anything except naloxone if you’re trained and it’s available.

Don’t assume they’re just "sleeping." Overdose looks like deep sleep. But their breathing is too slow. Their skin is too pale. Their lips are blue. That’s not rest. That’s a medical emergency.

Special cases: stimulants and alcohol

If you think it’s cocaine, meth, or MDMA (ecstasy), the priority shifts. These drugs raise body temperature dangerously. You need to cool them down. Move them to a cool area. Remove excess clothing. Wet their skin with cool water. Use a fan. Don’t use ice packs directly on the skin-that can cause shock.

For alcohol overdose, the biggest risk is choking. Their gag reflex is shut down. Keep them on their side. Watch for vomiting. If they vomit, roll them onto their side immediately and clear their mouth with your fingers if needed. Don’t give them water. Too much fluid can cause dangerous electrolyte imbalances.

An unconscious person placed in recovery position on a grassy hill at twilight with a naloxone spray nearby.

Why this works: the science behind the steps

Opioid overdoses kill by stopping breathing. The brain needs oxygen. After 4 minutes without it, brain cells start dying. Rescue breathing keeps oxygen flowing. Naloxone blocks the opioids from binding to brain receptors, letting breathing restart. It’s not magic. It’s physiology.

Studies from the New England Journal of Medicine show that when bystanders give rescue breathing and naloxone together, survival rates jump to 98.7%. In communities where people only got naloxone without training, survival was only 87.3%. Training matters. Knowing the steps matters.

And here’s something most people don’t know: naloxone is safe. You can’t overdose on it. If they didn’t take opioids, it won’t hurt them. Giving it is never the wrong choice.

What happens after EMS arrives

Paramedics will give oxygen, start IV fluids, and monitor heart and brain function. They might give more naloxone. They’ll take them to the hospital. Even if they wake up, they need medical evaluation. Overdose can cause internal damage that doesn’t show up right away.

And yes-they might be angry. They might deny they took anything. They might refuse help. That’s normal. Your job isn’t to judge. Your job was to save their life. That’s enough.

Be ready next time

Keep a naloxone kit at home if you or someone you know uses opioids. They’re free or low-cost in many places-pharmacies, community centers, health clinics. In Australia, you can get them without a prescription. In the US, they’re now available over-the-counter in most states.

Take a free 45-minute online course from the American Red Cross or your local health department. Practice the recovery position with a friend. Learn how to recognize the signs. This isn’t about being a hero. It’s about being prepared.

Someone you care about could need you tomorrow. Don’t wait until then to learn what to do. The time to act is now. Because when it happens, you won’t have time to look it up on your phone. You’ll have to remember. And you will.