by Caspian Whitlock - 13 Comments

Knowing the signs of a medication overdose can mean the difference between life and death. Every year, tens of thousands of people in the U.S. die from overdoses - many of them preventable if someone recognized the warning signs early enough. It’s not just about street drugs. Overdoses happen with prescription painkillers, sleep aids, anxiety meds, even common pain relievers like acetaminophen or ibuprofen when taken in too large a dose. You don’t need to be a doctor to spot the red flags. You just need to know what to look for.

What Happens When You Overdose?

An overdose isn’t just taking too much medicine. It’s when your body can’t process the substance, and your vital systems start shutting down. The brain, heart, and lungs are most at risk. With opioids like fentanyl or oxycodone, the main danger is breathing slowing down or stopping completely. With stimulants like cocaine or meth, your heart can race so fast it goes into dangerous rhythms. Alcohol or benzodiazepines can make you unconscious and unable to protect your airway. And when multiple drugs are mixed - which happens in over half of overdose deaths - symptoms become unpredictable and harder to treat.

Common Signs Across All Types of Overdose

No matter what drug is involved, some warning signs show up again and again. If you see even one of these, act fast:

  • Unresponsiveness - The person doesn’t wake up when you shake them or shout their name. This isn’t just sleeping. They’re not reacting to pain or sound.
  • Shallow or irregular breathing - Breaths are slow (less than 12 per minute), noisy, or stop for more than 10 seconds. You might hear gurgling or snoring sounds - that’s not sleep, that’s drowning on your own saliva.
  • Blue or gray lips and fingernails - This means your body isn’t getting enough oxygen. Cyanosis is a late sign, but it’s a clear emergency.
  • Pale, cold, clammy skin - Your body is going into shock. The blood is being pulled away from your skin to protect vital organs.
  • Vomiting while unconscious - This is especially dangerous with alcohol or depressants. If they’re passed out and throw up, they can choke.
  • Seizures - Uncontrolled shaking or jerking can happen with stimulants, alcohol withdrawal, or even some antidepressants in overdose.

If you see any of these, don’t wait. Call emergency services right away. Every minute counts.

Signs by Drug Type

Different drugs affect the body in different ways. Recognizing the pattern helps you respond faster.

Opioids: Fentanyl, Heroin, Oxycodone, Codeine

Opioids are the leading cause of overdose deaths. The classic trio - known as the “opioid triad” - is hard to miss:

  • Pinpoint pupils - Pupils shrink to the size of a pinhead, even in dim light. This is a dead giveaway.
  • Unconsciousness - They can’t be woken up, no matter how hard you try.
  • Slow or stopped breathing - Breaths are shallow, irregular, or absent. This is what kills.

Other signs: extreme drowsiness, snoring or gurgling sounds, cold and clammy skin. People who’ve stopped using opioids for a while - even just a week - are at higher risk. Their tolerance drops fast. A dose they used to handle can now kill them.

Stimulants: Cocaine, Methamphetamine, Adderall

Stimulant overdoses feel like your body is on fire. Symptoms include:

  • Extreme agitation or paranoia - They might be screaming, pacing, or acting violently.
  • Very high body temperature - Over 104°F (40°C). Skin feels hot and dry. This can cause organ failure.
  • Fast, irregular heartbeat - Pulse may be over 120 bpm. Chest pain is common.
  • Seizures - About one in three cocaine overdoses leads to convulsions.
  • High blood pressure - Systolic pressure above 180 mmHg can trigger a stroke or heart attack.

People often think stimulants are “safer” because they don’t cause breathing to stop. But the heart can fail just as quickly.

Depressants: Alcohol, Benzodiazepines, Barbiturates

These drugs slow everything down. The danger is slipping into deep unconsciousness without anyone noticing.

  • Slurred speech - Like they’re drunk, but worse.
  • Loss of coordination - Can’t walk straight, drop things, fall over.
  • Slow breathing - Less than 8 breaths per minute.
  • Vomiting while passed out - A major cause of death. If they’re unconscious and throw up, they can’t cough it out.
  • Low body temperature - Skin feels cold. This is especially dangerous with alcohol.

Alcohol poisoning is a form of overdose. If someone is passed out and you can’t wake them, don’t leave them alone. Don’t put them in the shower. Don’t let them “sleep it off.” Call 911.

Friends caring for an unconscious person on a couch, one giving rescue breaths as rain falls outside the window.

Polysubstance Overdose: The Hidden Killer

More than half of all overdose deaths in 2022 involved more than one drug. Fentanyl is often mixed into cocaine, meth, or counterfeit pills that look like oxycodone or Xanax. These pills can be 50 to 100 times stronger than morphine. Someone might take one thinking it’s a regular pain pill - and overdose within minutes.

When multiple drugs are involved, symptoms overlap and confuse. Someone might have pinpoint pupils (opioid) but also a racing heart and high fever (stimulant). This makes it harder to guess what to do - but the response is still the same: call for help immediately.

What to Do If You Suspect an Overdose

There’s no time to panic. Follow these steps:

  1. Call emergency services - In Australia, dial 000. In the U.S., dial 911. Don’t wait. Don’t text. Call.
  2. Check breathing - If they’re not breathing or breathing very slowly, start rescue breathing if you know how. Tilt their head back, pinch the nose, give one breath every 5 seconds.
  3. Give naloxone if you have it - Naloxone (Narcan) reverses opioid overdoses. It comes as a nasal spray. Spray one dose into one nostril. If they don’t respond in 2-3 minutes, give a second dose. It’s safe to give even if you’re not sure it’s an opioid overdose.
  4. Keep them on their side - This is called the recovery position. It keeps their airway open if they vomit.
  5. Stay with them - Even if they wake up, they can crash again. Don’t leave them alone until help arrives.

Never try to make them vomit. Never put them in a cold shower. Never let them “sleep it off.” These are myths that kill.

A child's hand reaching for a pill on a counter surrounded by medicine bottles, with spirit birds rising in the background.

Prevention: Tools That Save Lives

You can reduce the risk - even if someone you know uses drugs.

  • Fentanyl test strips - These cost less than a dollar. Dip them in a solution of crushed pills or dissolved powder. If they turn positive, the drug contains fentanyl. That doesn’t mean don’t use it - it means use less, or have naloxone ready.
  • Naloxone kits - Keep one at home, in your car, or with friends who use opioids. They’re now available over the counter in pharmacies without a prescription. Most cost $40-$50.
  • Don’t use alone - Most fatal overdoses happen when people are alone. If you use, have someone with you who knows how to respond.
  • Know your tolerance - If you’ve been away from a drug for even a few days, your body forgets how to handle it. Start with a tiny amount.

There’s no shame in carrying naloxone. It’s not enabling - it’s saving lives. In states with “Good Samaritan” laws, people who call for help during an overdose can’t be arrested for drug possession. That law exists because it works. In places where it’s in place, 911 calls for overdoses jumped by 27%.

When to Get Help Beyond the Emergency

Surviving an overdose doesn’t mean the problem is over. Many people need treatment afterward. If you or someone you know has overdosed, reach out to a professional. The National Helpline (1-800-662-HELP) offers free, confidential support 24/7. They can connect you to local treatment programs, counseling, or recovery groups. Recovery isn’t about quitting forever overnight. It’s about getting the support you need to stay alive.

Can you overdose on over-the-counter medications?

Yes. Common pain relievers like acetaminophen (Tylenol) can cause liver failure if you take more than 4,000 mg in a day. Ibuprofen overdoses can lead to kidney damage, stomach bleeding, or seizures. Always follow label instructions - and never mix multiple products that contain the same active ingredient.

Is naloxone safe to use if I’m not sure it’s an opioid overdose?

Yes. Naloxone only works on opioids. If the person didn’t take opioids, it won’t hurt them. It won’t wake them up if they overdosed on alcohol or stimulants, but it also won’t make things worse. If someone is unresponsive and you suspect an overdose, give naloxone - it’s better to be safe.

How long does naloxone last, and can the overdose come back?

Naloxone lasts 30 to 90 minutes. Many opioids, especially fentanyl, last much longer. So even if the person wakes up after naloxone, they can slip back into overdose once the naloxone wears off. That’s why you must call emergency services - even if they seem fine. They need medical monitoring.

Can fentanyl be detected in drugs before using them?

Yes. Fentanyl test strips are inexpensive, easy to use, and detect fentanyl in powders or dissolved pills with over 97% accuracy. They’re available online, at harm reduction centers, and some pharmacies. Testing your drugs doesn’t guarantee safety - but it gives you critical information to reduce risk.

Why are younger adults more at risk for overdose now?

Most overdose deaths now involve synthetic opioids like fentanyl, which are often mixed into other drugs without the user’s knowledge. Younger adults are more likely to use drugs obtained illegally, where contamination is common. Also, many have never used opioids before and don’t know their tolerance. A single pill can be deadly.

What should I do if I find someone unresponsive but I’m afraid to call 911?

Call anyway. In most places, laws protect people who call for help during an overdose. Even if drugs are present, you won’t be arrested for seeking help. The goal is to save lives - not punish people for being sick. If you’re scared, dial 911 and say, “I’m calling for a medical emergency. I’m not using drugs.” The dispatcher will guide you.

Final Thoughts

Overdose doesn’t always look like a movie scene. It’s often quiet. Someone slumps in a chair. Their breathing gets slow. Their skin turns gray. If you’ve ever thought, “It won’t happen to me,” or “They’ll wake up soon,” you’re not alone. But those thoughts cost lives. The tools to prevent death are here - naloxone, test strips, education, and the courage to act. You don’t need to fix someone’s addiction to save their life. You just need to recognize the signs - and call for help.