If You Suspect an Opioid Overdose and the Person Is Unresponsive and Not Breathing: Give Naloxone and Start Rescue Breaths Immediately After Calling 9-1-1

The single most important action after you hang up with 9-1-1 is to give naloxone if you have it, then start rescue breathing — one breath every 5 seconds — and keep going until the person breathes on their own or help arrives. Calling 9-1-1 alone does not reverse an opioid overdose. The medication does, and so does oxygen going into their lungs. Everything else in this article supports those two actions, in that order, without delay.

Unresponsive and Not Breathing Means the Window Is Minutes, Not Hours

An opioid overdose kills by stopping breathing. Heroin, fentanyl, oxycodone, and prescription painkillers bind to receptors in the brainstem that control the urge to breathe, and when the dose is high enough, that drive shuts down. The heart keeps beating for a while after breathing stops, but oxygen in the blood drops fast, and brain damage can begin within roughly 4 to 6 minutes of complete oxygen deprivation. That is the clock you are racing.

The presentation is usually quiet. There is no dramatic clutching of the chest, no loud gasping in most cases. The person goes limp, their lips and fingertips may turn blue or gray, their breathing becomes slow and shallow or stops entirely, and they may make a snoring or gurgling sound as their airway partially collapses. Pinpoint pupils are common with opioid toxicity but are not required for you to act. If the person will not wake up and is not breathing normally, treat it as an opioid overdose and intervene.

This is where most bystander deaths happen. People call 9-1-1, then wait, assuming the dispatcher will talk them through everything or that paramedics will arrive in time. In many communities, emergency medical services take 7 to 12 minutes to reach a patient, and in rural areas that figure stretches considerably longer. You are the only person on scene who can act during those minutes.

A common and dangerous misjudgment is waiting for certainty. You do not need to know what the person took. Naloxone is safe to give to someone who is not actually experiencing an opioid overdose — it simply will not do much if opioids aren't involved. The Centers for Disease Control and Prevention has repeatedly emphasized that laypeople should give naloxone at the first sign of a suspected opioid overdose rather than waiting for confirmation. Suspicion plus unresponsiveness plus absent breathing is your trigger.

The Immediate Sequence After Dialing 9-1-1: Six Actions in Order

Once the call connects, the dispatcher will keep you on the line and may guide you. Follow their instructions if they conflict with anything here, because they know local protocol. If you have already hung up or are alone, work through these steps in this exact order. Do not skip ahead to CPR before you have given naloxone and delivered rescue breaths — for opioid overdose specifically, ventilation matters more than chest compressions, and the medication can restore breathing within 2 to 3 minutes.

1: Give naloxone right away if you have it. Nasal spray (Narcan, RiVive, or generic naloxone) goes into one nostril with the person lying on their back, head tilted back slightly. Insert the nozzle until your fingers touch the nose, press the plunger firmly all the way, and remove it. If you have an injectable kit, follow the package instructions for intramuscular injection into the thigh or upper arm. Note the time you gave it. 2: Check the airway and reposition the head. Tilt the head back and lift the chin to open the airway. Clear visible vomit or secretions from the mouth with a finger sweep only if you can see them; do not dig blindly. 3: Start rescue breathing immediately. Give one breath every 5 seconds — about 12 breaths per minute. Each breath should last about 1 second and make the chest rise. If the chest doesn't rise, reposition the head and try again. 4: Repeat naloxone every 2 to 3 minutes if there is no response. More than one dose is often needed, especially with high-potency synthetic opioids like fentanyl. Use a fresh nasal device each time if you have one; do not reuse a spent sprayer. 5: Add chest compressions if there is no pulse or you are unsure. If the person has no breathing and no signs of life after naloxone and rescue breaths, begin CPR at 100 to 120 compressions per minute, 2 inches deep on the center of the chest, with 2 rescue breaths after every 30 compressions. 6: Stay, monitor, and hand off to responders. Keep the person on their side once breathing returns to prevent choking on vomit, keep them warm, and tell EMS exactly what you gave and when. Naloxone wears off in 30 to 90 minutes, which is shorter than many opioids, so breathing can stop again before help fully stabilizes them.

The most common failure here is giving one dose of naloxone, seeing nothing happen in 30 seconds, and freezing. Nasal naloxone can take 2 to 3 minutes to take effect. If you gave a dose and the person is still not breathing, keep doing rescue breaths and prepare a second dose. Do not wait passively.

Why Rescue Breaths Outrank Chest Compressions in an Opioid Overdose

Standard CPR training drills "30 compressions, 2 breaths" into everyone's head, and that instinct is not wrong — but for an opioid overdose it can cost you the thing that matters most. The problem in opioid poisoning is that the brain has stopped telling the body to breathe. Oxygen is still circulating in the blood; there's simply no fresh air coming in. Restoring ventilation fixes the core problem.

The math behind this is worth understanding. A person has roughly 4 to 6 minutes of usable oxygen stored in their blood and lungs after breathing stops before brain injury begins. Chest compressions move that existing blood around, but they do not add oxygen. Rescue breaths do. That is why harm-reduction organizations and many EMS protocols prioritize "rescue breathing first" for suspected opioid overdose with a pulse: you ventilate, you give naloxone, and compressions come in when the heart stops or you cannot detect a pulse.

In practice, you can check for a pulse at the carotid artery in the neck for no more than 10 seconds. If you feel one, focus on breaths. If you don't feel one, or you're not confident, start full CPR with compressions — you will not hurt someone by doing CPR, and compressions plus breaths cover both possibilities. The American Heart Association's basic life support guidance treats lay rescuer uncertainty as a reason to act, not a reason to wait.

One detail people miss: mouth-to-mouth carries real infection risk and makes some bystanders hesitate. Barrier devices, pocket masks, and bag-valve masks are the reason many naloxone kits include a face shield. If you have a barrier, use it. If you don't, rescue breaths are still recommended for a person who is not breathing, because the alternative is certain death. The CDC and AHA both hold that the benefit outweighs the risk for lay rescuers in this scenario.

Dosing Naloxone: What One Spray Actually Delivers and Why You May Need Three

Naloxone products differ meaningfully in what a single dose contains, and knowing the numbers helps you decide when to redose. The table below reflects standard formulations; always read the label on the product in your hands, because manufacturers revise packaging.

The gap between 3 mg and 4 mg matters less than the number of doses you're prepared to give. Illicitly manufactured fentanyl and its analogs can be far more potent than heroin, and reports from harm-reduction programs in multiple U.S. states describe situations requiring 2, 3, or more naloxone doses to restore breathing, particularly when carfentanil or high-concentration fentanyl is involved. Public health agencies now routinely advise carrying at least two doses.

There's a tradeoff worth naming honestly. High-dose or repeated naloxone can trigger acute withdrawal — agitation, vomiting, and sometimes combative behavior — as opioid receptors are abruptly cleared. That is uncomfortable and occasionally dangerous, but it is never a reason to withhold naloxone from someone who is not breathing. Life first. Withdrawal management comes after the person is ventilating and help is on the way.

Storage and expiration are the quiet failure points. Naloxone is temperature-sensitive; leaving a kit in a hot car or a freezing garage can degrade it, and nasal devices have expiration dates typically 2 to 3 years out. Check the date on your kit twice a year and replace it. A kit you never checked is a kit you can't count on.

The Three-Minute Rule and the Redose Decision That Saves Lives

The practical rule that harm-reduction trainers repeat is simple: give a dose, do rescue breaths for 2 to 3 minutes, and if there's no improvement, give another dose. That rhythm keeps you from either underdosing in fear or overdoing it in panic. It also fits how the medication actually behaves in the body.

Start your mental timer when the first spray goes in. During those first 2 to 3 minutes, you are not idle — you are giving breaths at 12 per minute, which means roughly 5 or 6 breaths before you reassess. That's also roughly the point at which naloxone's effect peaks in most people. If breathing has returned, stop the cycle and switch to monitoring. If nothing has changed, the second dose goes in.

Signs of success are usually obvious. The person may gasp, cough, groan, or suddenly sit up. Color returns to lips and face. Breathing deepens. Some people wake up confused or frightened, and a calm voice and explanation of what happened helps. Do not let them stand up and walk away immediately; naloxone's effect is shorter than many opioids, and re-sedation within 30 to 90 minutes is a well-documented risk.

If breathing returns but the person remains unconscious, keep giving rescue breaths and place them in the recovery position — on their side, with the lower arm forward and the head tilted back — so vomit drains and the airway stays open. Stay with them, keep the naloxone kit out, and re-dose if breathing slows again before EMS arrives. The one mistake to avoid in this phase is leaving.

What Actually Kills Bystanders: Delays, Denial, and the Fear of Getting in Trouble

The overwhelming majority of fatal opioid overdoses that occur with someone else present involve a delay rather than a lack of knowledge. People wait to "make sure." They worry about calling police. They fear legal consequences, or they fear they'll be blamed. Every one of those hesitations is a physical risk to a person who isn't breathing.

Almost every U.S. state has a Good Samaritan law that provides some protection from arrest or prosecution for drug possession or paraphernalia when someone calls 9-1-1 for a suspected overdose. The protections vary in scope by state, and some cover only certain offenses or only the caller, so confirm your state's statute through a legal aid office or state health department if you want specifics. The general direction is clear: the law is designed so that calling for help is not the thing that gets you charged.

Fentanyl has created a second layer of fear: bystanders worried that touching someone or giving rescue breaths will expose them to fatal doses. There is no documented case of a bystander dying from simply touching fentanyl, but occupational exposure in first responders has caused symptoms, and public health agencies including the CDC have published guidance on the very low but nonzero risk from incidental contact. A barrier device for breaths and gloves for any contact with powders are sensible precautions. They are not a reason to do nothing.

Denial is the quietest killer. "They're just asleep." "They were fine ten minutes ago." "I don't want to embarrass them." If a person cannot be woken by loud speech and a firm shoulder shake, and their breathing is slow, irregular, or absent, that is the moment. The cost of a false alarm is a startled person and a wasted dose of naloxone. The cost of waiting is measured in minutes of oxygen debt.

What Not to Do: Slapping, Ice, Milk, and Other Delays

A cluster of folk remedies shows up at almost every overdose scene, and each one costs time. Slapping or shaking a person who is unresponsive but still breathing does not reverse opioid respiratory depression and can injure them. Putting ice in the mouth, in the crotch, or down the pants does nothing to restore breathing and risks choking. Forcing milk or water down an unconscious person's throat causes aspiration and airway obstruction. These interventions feel like action, which is precisely why they are dangerous.

Inducing vomiting is another trap. An unconscious person cannot protect their airway, and vomit in the lungs after an overdose is a common cause of death even when naloxone is later given. Never give anything by mouth to someone who is not awake and swallowing. If they vomit on their own, turn them to their side and clear the mouth.

Injecting anything other than naloxone, "walking them around," or putting them in a cold shower are all cited in public health guidance as ineffective at best and harmful at worst. Stimulants like cocaine or methamphetamine do not reverse opioid-induced respiratory depression, and combining them with an opioid overdose adds cardiac strain. There is no substitute for naloxone and oxygen.

A subtler error is stopping too soon. Someone who is breathing again is not necessarily out of danger. Naloxone's half-life is shorter than that of many opioids, including methadone and long-acting prescription formulations, so re-sedation is expected rather than exceptional. Stay with the person until EMS has assessed them, and if you must leave before they arrive, make sure someone else is there and tell the dispatcher where the person is and what has been given.

Preparation: The Kit, the Plan, and Who to Train Before the Emergency

The time to prepare is not when someone is blue on the floor. Naloxone is now available over the counter in the United States — the FDA approved Narcan nasal spray for nonprescription sale in March 2023, and RiVive followed — with retail prices typically around $45 for a two-pack of Narcan, though pharmacy and state program pricing varies widely. Many states distribute free kits through health departments and syringe service programs, and most insurance plans and Medicaid cover prescribed naloxone with little or no copay. Confirm current pricing at your pharmacy, because it changes.

A workable kit is small. Two doses of naloxone, a barrier mask or face shield, gloves, and a one-page card with the steps and the local overdose hotline number. Keep one at home, one in the car, and one in whatever bag goes to work or to the places you or your household use substances. Tell the people you live with where it is. A kit nobody can find is a kit that doesn't exist.

Training takes about 15 minutes. Most state health departments, pharmacy chains, and community harm-reduction groups offer free in-person or online sessions that cover naloxone administration, rescue breathing, and the recovery position. Emergency dispatchers in most jurisdictions will talk a caller through all of it in real time if you tell them "I think this is an overdose and they're not breathing." Say those words early in the call, because they change the protocol the dispatcher follows.

Know your local resources before you need them. Crisis lines like 988 in the United States handle substance-related emergencies and can connect callers to same-day treatment; many states operate 24-hour overdose response lines. If the person is a minor, if there are other people at risk, or if you're uncertain what was taken, say so on the 9-1-1 call. Telling the dispatcher "they may have taken fentanyl" does not get you in trouble under Good Samaritan protections, and it changes what the responding crew brings.

What Recovery Looks Like in the First 90 Minutes

Once breathing returns, the emergency isn't over — it has changed character. The person may be confused, nauseated, sweating, or combative. They may have a headache, and some people describe a sudden return of pain that the opioid had been masking. Speak calmly, explain that they overdosed and that naloxone was given, and keep them on their side. Do not let them refuse transport to a hospital; re-sedation is the main reason to have a medical professional watch them for a few hours.

The chemical reason is straightforward. Naloxone is cleared from the body in roughly 30 to 90 minutes, depending on the route and the person. Many opioids, especially long-acting ones like methadone or extended-release oxycodone, remain active far longer. When the naloxone leaves, the opioid effect can return, and breathing can slow again with no warning. Hospital observation for at least a few hours is standard, and some patients need repeated naloxone or a continuous infusion.

There's a broader recovery point worth making for families. Surviving an overdose is the beginning of a treatment conversation, not the end of it. The period right after a nonfatal overdose is one of the highest-risk windows for another, because tolerance has dropped and the same dose that once felt normal can now be lethal. Connecting the person to treatment, prescribing naloxone to household members, and having a plan for who calls whom is the practical work after the crisis.

If you are the one who responded, you may feel shaky afterward. That's normal, and it's worth mentioning to your own doctor or a crisis line if it lingers. Bystanders who intervene often carry a specific kind of quiet stress, and there's no requirement that you carry it alone. The person you helped may not remember it. You will.

FAQ

Can you give naloxone to someone who isn't actually overdosing on opioids?

Yes, and you should. Naloxone only blocks opioid receptors, so it has no meaningful effect on someone whose problem is not opioid-related — the worst case is a wasted dose. The CDC explicitly recommends erring toward giving it when someone is unresponsive and not breathing, because waiting for certainty is how people die. There is no evidence that naloxone harms someone who has not taken opioids.

How long does nasal naloxone take to work, and what if nothing happens?

Nasal naloxone typically begins working within 2 to 3 minutes, sometimes slightly faster. If there is no response after that window, give a second dose — high-potency fentanyl often requires more than one. Keep giving rescue breaths the entire time and call out the time of each dose so EMS knows what has been given. Continued absence of breathing after 2 to 3 doses should trigger CPR.

Is touching someone who overdosed on fentanyl dangerous?

Incidental skin contact with fentanyl is not known to cause overdose, and no bystander death from casual contact has been documented. The risk rises with powders or patches and with prolonged handling, so wear gloves if available and avoid rubbing your eyes or face. A barrier mask for rescue breaths removes the mouth-to-mouth concern. The CDC's guidance on fentanyl exposure supports responding rather than avoiding.

Do I still need to do rescue breathing if I've given naloxone?

Yes — naloxone and rescue breaths work together, not as substitutes. Naloxone takes minutes to restore the breathing drive, and during that time the person's brain is still deprived of oxygen. Delivering one breath every 5 seconds maintains oxygenation until the medication works and remains essential if additional doses are needed. Stopping breaths to wait for the drug is one of the most common bystander errors.

What if the person starts breathing and then stops again before EMS arrives?

Give another dose of naloxone and resume rescue breathing at 12 per minute. Re-sedation is common because naloxone clears the body in 30 to 90 minutes while the opioid may still be active for hours, especially with long-acting formulations. Put the person on their side, keep monitoring, and tell EMS how many doses you've given and when. Never leave them alone after breathing returns.

Does calling 9-1-1 for an overdose ever get the caller arrested?

Most U.S. states have Good Samaritan laws that limit criminal liability for drug possession when someone calls for medical help during an overdose, though the protection's scope varies by state and does not cover every offense. The laws exist precisely so fear of arrest doesn't delay help. If you want details for your state, check the statute or ask a legal aid organization; general guidance from public health departments is to call first and sort out legal questions later.

How much does naloxone cost, and where can you get it free?

Over-the-counter Narcan generally retails around $45 for a two-pack, but exact shelf prices vary by pharmacy, and insurance or Medicaid often reduces the cost of a prescribed version. Many state health departments and syringe service programs distribute free kits, and some community organizations offer mail-order naloxone at no charge. Check your state health department's overdose prevention page or ask your pharmacist. Prices change, so confirm rather than assume.

Can someone who overdosed refuse to go to the hospital?

They can, but persuade them not to. The first 30 to 90 minutes after naloxone are when re-sedation is most likely, and hospital staff can monitor breathing and re-dose if needed. If the person is a minor or is confused and lacks capacity to decide, EMS and hospital staff follow their own protocols. If they refuse and leave, give their household at least two naloxone kits and a written plan for what to do next time.

This article is general educational information about emergency response to a suspected opioid overdose and is not a diagnosis, treatment plan, or individualized medical instruction. Emergency protocols, naloxone formulations, Good Samaritan statutes, and local services vary by jurisdiction and change over time; verify specifics with your local emergency medical service, state health department, or a qualified clinician. If someone is unresponsive or not breathing, or if you are at risk of self-harm, contact your local emergency number or crisis service immediately.