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If you think someone is overdosing, call 911 immediately, give naloxone if it is available, and stay with the person. Naloxone temporarily blocks opioid effects and may restore breathing within two to three minutes. Do not wait to see whether it works before calling emergency services, and do not leave when the person wakes up: the overdose can return after naloxone wears off.
This guide answers the urgent question, “What does naloxone do, and how do I use it if someone is overdosing?” It follows U.S. federal public-health guidance. Always follow the instructions on the exact device in your hand and any directions from the 911 dispatcher.
What naloxone does
Naloxone is an opioid antagonist. It attaches to opioid receptors and temporarily blocks the effects of opioids that are suppressing a person’s breathing. When it works, breathing can improve within two to three minutes, according to the Centers for Disease Control and Prevention (CDC).
Opioids can slow the brain signals that control breathing. The immediate danger in an overdose is therefore not simply that a person is sleepy or appears intoxicated; it is that breathing becomes too slow, shallow or stops. Naloxone displaces opioids at their receptors for a time, giving breathing a chance to resume while emergency help is on the way.
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Naloxone is a temporary treatment, not a cure for the overdose. Its effect can wear off while opioids remain in the body. A person who seems better can become unresponsive and stop breathing again, which is why emergency medical evaluation and observation are still necessary.
What naloxone can and cannot reverse
- It can reverse the breathing suppression caused by opioids, including prescription opioids, heroin and illicitly manufactured fentanyl.
- It generally will not help a medical emergency unrelated to opioids. If another drug, alcohol, illness or injury is also involved, the person still needs emergency care.
- It is safe to give when an opioid overdose is suspected, even if opioids turn out not to be involved. FDA guidance says naloxone will not harm someone simply because the emergency had another cause, although it may not improve that cause.
Naloxone does not remove an opioid from the body, guarantee that the person is out of danger or replace oxygen, airway support and monitoring. It is one urgent action within a larger response.
CDC describes naloxone as “one important step when helping someone who is overdosing.” It is one part of a response that also includes calling 911, supporting breathing and remaining with the person.
How to recognize a possible opioid overdose
You do not need certainty before acting. If it is difficult to tell whether someone is heavily intoxicated, asleep or overdosing, CDC advises treating the situation as a possible overdose. A person who has taken several substances may not show a textbook set of signs, so look at responsiveness and breathing first.
| Possible sign | What you may observe |
|---|---|
| Unresponsiveness | The person cannot be awakened, does not answer or cannot respond normally. |
| Abnormal breathing | Breathing is slow, shallow, irregular or has stopped. |
| Choking or gurgling | Unusual snoring, gurgling or choking sounds may indicate a blocked airway or dangerously weak breathing. |
| Limpness | The body feels unusually slack or weak. |
| Color change | Lips or fingernails may look blue, gray or otherwise discolored. |
| Pinpoint pupils | The pupils look very small, although this sign may not appear in every overdose. |
Do not assume that a person who is still making noise is breathing adequately. Gurgling, snoring or gasping can be a sign of severely compromised breathing rather than ordinary sleep. Any combination of unresponsiveness and abnormal breathing should be treated as an emergency.
If you are unsure whether a person is breathing normally, watch the chest and face rather than relying only on sound. Tell the dispatcher exactly what you see: whether the person responds, whether the chest rises, and whether the breathing is slow, shallow, irregular or absent.
What to do when an overdose may be happening
Use this sequence as soon as you notice danger. It is written for a bystander; do not delay emergency help to perform a step beyond your training. If another person is present, divide the tasks so one person calls while another gives naloxone and watches breathing.
- Call 911 immediately. Tell the dispatcher that the person may have overdosed, give the location and describe whether the person is awake and breathing. Put the phone on speaker if that lets you help while talking. Do not hang up simply because the person begins to stir; the dispatcher can continue to guide you.
- Give naloxone if it is available. Use the product exactly as its label directs. The route and steps differ by device, so do not substitute instructions from a different product. If you have the package, keep it nearby for responders and to confirm which formulation was used.
- Try to keep the person awake and breathing. Speak loudly, call their name and gently stimulate them while preparing to help. Do not use dangerous methods such as striking, shaking violently or putting anything in the person’s mouth. Your goal is to notice changes and support safe breathing, not to force a fully alert response.
- Support the airway. If the person is unresponsive but breathing, place them on their side in the recovery position to help prevent choking. Watch the chest and face for continuing breaths. Recheck them frequently because a person can deteriorate after an initial improvement.
- Provide breathing support if needed. If breathing has stopped or is very weak, follow the dispatcher’s instructions. SAMHSA advises CPR in that situation, preferably by someone trained to perform it. Do not postpone naloxone or the 911 call while searching for training or equipment. If you are not trained, tell the dispatcher what you can observe and follow the instructions given.
- Reassess after two to three minutes. CDC says another dose may be needed if normal breathing has not returned. Give additional naloxone only as directed for the specific product, then continue monitoring. Do not assume that a person who moves or opens their eyes has adequate breathing.
- Stay until emergency responders take over. Explain what you observed, what you gave, when you gave it and whether any other substances may have been involved. Give responders the device packaging if it is available. Continue following the dispatcher’s directions until help arrives.
Why the 911 call cannot wait
Naloxone can improve breathing quickly, but it does not remove opioids from the body or treat other medical problems. Emergency responders can provide airway support, oxygen, monitoring and further treatment if the person worsens or needs additional doses.
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Calling first also matters when you are not sure what happened. A person who appears to have overdosed may have a head injury, another poisoning, a medical illness or more than one substance in their system. Naloxone is safe to try when opioid overdose is suspected, but only emergency professionals can assess the full situation.
Using the naloxone device you have
There is no single universal technique for every naloxone product. Read the label before an emergency if you can, and follow the printed or spoken directions for the exact formulation available. Device packaging may explain how to position the product, deliver the dose and determine whether a repeat dose is permitted.
Nasal products
An over-the-counter nasal spray is designed for use in the nose without a needle. Use the labeled dose and administration steps, then watch for a response. Do not assume that a different nasal product has the same priming, packaging or repeat-dose instructions. Keep the spray available while waiting because another dose may be needed if normal breathing does not return after two to three minutes.
Other formulations
Some settings may have injectable or other forms. Their preparation and administration requirements are product-specific. If you have not been trained to use that form, ask the 911 dispatcher for instructions while another bystander calls and watches the person. Never improvise a dose, route or schedule. If the only product available is unfamiliar, tell the dispatcher its name or describe the package.
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CDC’s general interval is two to three minutes to see whether normal breathing returns. If it does not, or if it improves and then becomes abnormal again, follow the product label and dispatcher instructions for another dose. More than one dose may be required when potent or long-acting opioids are involved. Continue to watch breathing after every dose; a temporary response is not the same as recovery.
What to expect after naloxone
Breathing may improve before the person is fully alert
The first goal is adequate breathing, not a complete return to normal behavior. Keep watching the person even if they open their eyes or speak. A sudden return to consciousness does not prove that the opioid danger has ended. They may remain confused, weak or sleepy, and those symptoms should be reported to responders rather than dismissed as ordinary fatigue.
Withdrawal can be sudden and uncomfortable
In a person who is physically dependent on opioids, naloxone can precipitate withdrawal. CDC’s caregiver information lists possible nausea, vomiting, sweating, shaking, restlessness and a fast heart rate. These reactions can be distressing, but they are not a reason to withhold naloxone when an overdose is suspected. Keep the person safe, explain that help is coming and report the symptoms to responders.
Do not try to counter withdrawal with another substance, food or drink. Naloxone has already served its emergency purpose of opposing opioid-related breathing suppression; the next priority is monitoring and professional evaluation.
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If opioids were not involved
Naloxone will not cause opioid withdrawal in someone who has no opioid dependence, and FDA says it will not harm a person merely because the emergency was misidentified. It may not improve poisoning or illness caused by non-opioid substances, so the 911 evaluation remains essential. A lack of response to naloxone is a reason to continue emergency care, not evidence that the situation is safe.
Why improvement does not end the emergency
Naloxone’s action is temporary. The opioid may last longer than the medication, and breathing can become dangerously slow again after an initial recovery. The person may also have suffered low oxygen, an injury, aspiration or a second poisoning. Do not let them “sleep it off,” drive themselves away or stay alone after receiving naloxone.
Keep the person on their side if they are not fully alert, continue checking breathing and follow the dispatcher’s directions. Do not give food, drink or additional medicines unless a medical professional tells you to do so. If breathing becomes abnormal again, tell the dispatcher immediately and give another dose only when the product directions and timing indicate it is appropriate.
Information to give emergency responders
While waiting, gather facts without delaying care. Be ready to say when you found the person, what you observed before and after naloxone, how many doses were given and the times they were given. If you know of prescription opioids, heroin, fentanyl or other drugs, alcohol, illness or injury, tell responders. If you do not know, say that plainly; guessing can mislead treatment.
Keep the person in sight and do not send them away to find identification, medication or a ride. The device package, remaining doses and any information from people who were present can help responders understand what happened.
Access, storage and readiness
FDA reports that some naloxone products are available over the counter. CDC says naloxone is available in all 50 states, but local stock, dispensing rules and community programs vary. A pharmacist or local public-health program can explain what is available in your area. Availability does not mean every store carries every formulation, so check locally rather than relying on a particular retailer or brand.
For preparedness, obtain a product you can identify and learn its labeled steps before an emergency. Keep the instructions with the device and check the package periodically for damage or expiration. If you receive a different formulation later, read that product’s directions rather than relying on memory from an earlier device. Consider keeping the device where family members, friends or coworkers can find it quickly, while following the package’s storage directions.
Training can make it easier to recognize abnormal breathing, use the device and follow dispatcher instructions under stress. Training is helpful, but lack of prior training should not stop a bystander from calling 911 and giving naloxone according to the label when an overdose is suspected.
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Common mistakes to avoid
- Waiting for proof: You do not need to know the substance with certainty before calling 911 and giving naloxone when the signs suggest an overdose.
- Waiting for naloxone to work before calling: The call should happen immediately; the medication and the call are parallel actions.
- Leaving after the person wakes: Breathing can fail again, and responders need the history of what happened.
- Withholding naloxone because of withdrawal: Withdrawal is uncomfortable, but untreated respiratory depression can be fatal.
- Using a remembered dose for a different product: Device instructions vary. Use the label for the product in hand.
- Assuming naloxone treats every poisoning: It targets opioid effects. A person can remain critically ill from alcohol, stimulants, sedatives, illness or injury even after naloxone is given.
- Attempting procedures beyond your training: Follow the dispatcher. Do not delay the call or naloxone while trying to perform an unfamiliar intervention.
- Stopping observation too soon: A person who is talking can still relapse into dangerous breathing. Keep watching until emergency responders take over.
- Arguing about blame or consent during the crisis: Focus on breathing, the 911 call and accurate information for responders. The emergency takes priority over questions about how the substances were obtained or used.
A practical bystander checklist
In an emergency, use this short version:
- Recognize unresponsiveness or dangerously abnormal breathing.
- Call 911 and state that an overdose may be occurring.
- Give the available naloxone according to its label.
- Keep the person awake and breathing when possible; place an unresponsive breathing person on their side.
- If breathing has stopped or is very weak, follow dispatcher instructions for CPR or other trained support.
- After two to three minutes, give another dose if normal breathing has not returned and the product directions allow it.
- Stay with the person and hand responders the device packaging and all information about substances or timing.
Questions people often have
Should I give naloxone if I am not sure opioids were taken?
Yes, when the person has signs of a possible overdose. Naloxone is safe if opioids were not involved, although it will not reverse a non-opioid emergency. Call 911 even when you are uncertain, because another illness, injury or substance may require urgent treatment.
What if the person refuses help after waking up?
Explain that naloxone can wear off and breathing can fail again. Keep 911 involved and tell responders what the person received and how they responded; do not leave someone who has recently been unresponsive to manage the risk alone. Let emergency professionals address the refusal and assess whether the person is safe.
Can naloxone be used in children?
FDA says naloxone can be used across ages when an opioid overdose is suspected. Use the available product according to its label and obtain emergency help immediately. Do not delay because you are unsure whether the person is a child, teenager or adult.
How quickly should naloxone work?
CDC says it may restore normal breathing within two to three minutes. If normal breathing has not returned after that interval, follow the product directions and dispatcher guidance about another dose. Continue emergency care even if the first dose appears successful.
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No. More than one dose may be needed, particularly when potent or long-acting opioids are involved. The label for the product in hand and the person’s breathing determine what to do next; never create your own dosing schedule.
What if the person is breathing but will not wake up?
Treat that as an emergency. Call 911, give naloxone if an opioid overdose is possible, place the person on their side if they are breathing, and keep checking for changes. Unresponsiveness can reflect overdose or another critical condition.
Should I wait to see whether naloxone works before calling?
No. Call 911 first or have another person call immediately. Naloxone is temporary and cannot provide the airway support, oxygen or evaluation that emergency responders can provide.
Where can I find naloxone before an emergency?
Some products are sold over the counter, and CDC says naloxone is available in all 50 states. Ask a pharmacist or local public-health program about current local options, instructions and availability. Do not delay an overdose response while trying to purchase a product.
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Frequently Asked Questions
What does naloxone do?
Naloxone temporarily blocks opioid effects and may restore breathing suppressed by an opioid overdose. Its effect can wear off, so it does not replace 911 care.
When should I give naloxone?
Give it when an opioid overdose is suspected, especially with unresponsiveness and slow, shallow, irregular or stopped breathing. Call 911 immediately and follow the product label.
When should another dose be given?
CDC advises waiting two to three minutes to see whether normal breathing returns. If it does not, or becomes abnormal again, follow the exact product label and dispatcher instructions.
Is naloxone safe if opioids were not involved?
Yes. FDA says it will not harm someone simply because the emergency had another cause, although it will not reverse a non-opioid illness or poisoning.
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What withdrawal symptoms can naloxone cause?
In someone physically dependent on opioids, it may cause sudden withdrawal, including nausea, vomiting, sweating, shaking, restlessness and a fast heart rate. This discomfort is not a reason to withhold naloxone during a suspected overdose.
Why must I stay after the person wakes up?
Naloxone is temporary, and breathing can become dangerously slow again while opioids remain in the body. Stay until emergency responders take over.
The Bottom Line
Call 911, give naloxone if an opioid overdose is possible, follow the exact device instructions, and stay with the person. Recheck breathing after two to three minutes and give another labeled dose if needed. Even if the person improves, emergency medical care is still necessary.
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