An overdose is a medical emergency that can involve opioids, stimulants, alcohol, benzodiazepines, or a combination of substances. Knowing how to respond in those first few minutes can make the difference between life and death. Whether you are a parent, friend, co-worker, or bystander, you do not need medical training to take meaningful action. You need to recognise the warning signs and know the steps to take while help is on the way.
This guide walks through how to spot the signs of an overdose and what to do when one is happening. The goal is to keep the person alive until emergency responders arrive.
Step 1: Recognise the Signs of an Overdose
The first step is knowing what an overdose looks like. Health Canada lists the following signs and symptoms of an opioid overdose:
- Unresponsiveness, or inability to be woken up even when shaken or shouted at
- Slow, weak, or absent breathing, sometimes accompanied by choking, gurgling, or snoring sounds
- Blue, purple, or grey lips or nails
- Very small (pinpoint) pupils
- Dizziness, confusion, or extreme drowsiness
- Difficulty walking, talking, or staying awake
- Cold, clammy skin
Health Canada also notes that other signs can be present that do not fit neatly into this list, including a stiff body or seizure-like movements, and advises giving naloxone even if you are in doubt, it will not cause harm and it can save a life.
If you suspect someone has overdosed, try to wake them. Start by calling the person’s name. If that does not work, vigorously grind your knuckles into the sternum (the breastbone in the centre of the chest), or rub your knuckles against their upper lip. If the person responds, check whether they can stay awake and keep breathing, and continue to monitor their breathing and alertness while keeping them as alert as possible. If they do not respond, it is time to act immediately.
Step 2: Call 9-1-1 for Help
An overdose needs immediate medical attention, so getting someone with medical expertise to the scene as fast as possible is essential. If no emergency medical services (EMS) or other trained personnel are already present, call 9-1-1 right away. You do not need to explain everything. Telling the dispatcher something like “Someone is unresponsive and not breathing, and I think it’s an overdose” is enough to get help moving. Be sure to give a specific address or a clear description of your location.
Once you have called, follow the dispatcher’s instructions. If appropriate, the 9-1-1 operator may walk you through starting CPR, based on your level of training.
If you are worried about getting into trouble for calling, the Good Samaritan Drug Overdose Act provides some legal protection. The federal Act, which became law on May 4, 2017, protects anyone who calls 9-1-1 or a local emergency number because of an overdose from charges for simple possession of a controlled substance, as well as from breaches of pre-trial release, probation orders, conditional sentences, or parole related to simple possession. The protection extends to anyone at the scene when help arrives, not only the person who made the call. The Act does not cover more serious offences such as outstanding warrants or drug trafficking, but the priority in that moment is saving a life, and making the call is always the right thing to do.
Step 3: Administer Naloxone
Naloxone is a medication that can temporarily reverse an opioid overdose, and Health Canada recommends giving it to anyone showing signs of an overdose or whenever one is suspected. It is available as a nasal spray or an injectable into a muscle, and it has been used by paramedics, firefighters, and community members across Canada to reverse opioid overdoses, including those involving fentanyl.
One important point: naloxone only works on opioids, but you do not need to be certain that opioids are involved before giving it. Health Canada is clear that you should administer naloxone even if you are in doubt, because it will not cause harm if the person is not overdosing on an opioid, and it can save their life if they are. Naloxone is safe for people of all ages.
Give one dose first, then wait 2 to 3 minutes to see whether the person starts breathing or responds. If there is no change, give a second dose, and continue giving a dose every 2 to 3 minutes until they start breathing or help arrives. Keep in mind that naloxone is only active in the body for 30 to 120 minutes, but the effects of most opioids last longer, so a person can slip back into an overdose even after they seem to have recovered. The goal is to restore breathing, not necessarily to fully wake the person up.
Be ready to comfort the person as they come around. Naloxone can trigger sudden withdrawal, which is unpleasant and may leave them agitated or confused. Staying calm and explaining what happened can help.
In Canada, take-home naloxone kits are available without a prescription at most pharmacies and local health authorities. If you do not have a kit on hand, this is a good time to get one.
Step 4: Support Breathing and Position the Person
Once naloxone has been given, the next priority is making sure the person can keep breathing. What you do depends on whether they are breathing on their own. If they are not breathing or their breathing is dangerously slow, start with rescue breathing. If they are already breathing on their own, move directly to the recovery position described below.
Rescue Breathing
Helping the person breathe is one of the most important things you can do, and it can be lifesaving on its own. During an overdose, breathing can slow or stop, so rescue breathing and chest compressions both help keep oxygen moving until help arrives or naloxone takes effect.
To perform rescue breathing on an adult:
- Make sure the airway is clear by checking that nothing inside the mouth or throat is blocking it
- Place one hand on the person’s chin and tilt the head back
- Pinch the nose closed, place your mouth over theirs to form a seal and give two slow breaths
- Watch for the chest, not the stomach, to rise
- Continue with one breath every 6 seconds
If the person has no pulse, chest compressions should be performed to keep blood flowing. To perform chest compressions on an adult:
- Lay the person on their back
- Press hard and fast on the centre of the chest
- Keep your arms straight and extended
If you are unsure how to do any of this, stay on the line and follow the 9-1-1 dispatcher’s instructions. They are trained to walk you through it step by step.
The Recovery Position
Once the person is breathing on their own again, or if they were breathing the whole time, roll them onto their side into the recovery position. The reason this matters comes down to the airway. An unconscious person loses the natural reflexes that normally protect their lungs, so anything in the mouth, whether saliva, vomit, or blood, can be inhaled and cause choking. Rolling them onto their side lets fluids drain away from the airway rather than pool in it. It also keeps body weight off the chest, making it easier to keep breathing.
To place an adult in the recovery position from lying flat on their back:
- Move the arm closest to you so it is raised in an L-shape, with the hand about level with their head, as if they were waving
- Using your hand nearest their head, take the hand on the far side of their body and bring it across to rest flat against their cheek on the side closest to you
- With your other hand, lift the outside of the far knee so the leg forms an upside-down V shape
- Pull that raised knee toward you to roll their whole lower body over, then rest the knee against the ground so they end up in a position that looks like a running pose
- Make sure the face is angled down toward the ground, with the neck extended slightly and the chin away from the chest so the airway stays open
Once the person is settled on their side, drape a blanket or jacket over them if cold or shock is a concern. Stay with them and watch their breathing closely the whole time. If breathing stops at any point, turn them onto their back right away and start CPR.
Step 5: Stay With the Person and Keep Monitoring
Once the person starts responding, the job is not over. Most people begin breathing again on their own within 2 to 3 minutes of receiving naloxone, but because naloxone wears off faster than many opioids, the overdose can return even after they seem to be doing better. Stay with them and keep a close watch on their breathing and alertness. Continue providing rescue breathing or compressions as needed while waiting for naloxone to take effect.
Most importantly, the person needs to get to an emergency department or other medical care as quickly as possible, even if they wake up after the first dose and say they feel fine. The risk has not fully passed just because they have come around, and only medical professionals can confirm they are truly in the clear.
Being Prepared Saves Lives
An overdose is frightening, but you do not need medical training to make a difference. Recognising the signs, calling 9-1-1, giving naloxone, supporting breathing, and staying with the person until help arrives are actions that matter enormously in those critical minutes. Keeping a naloxone kit on hand and knowing these steps ahead of time means you will be ready to act if you ever need to.
If you or someone you care about is struggling with substance use, an overdose can be a signal that it is time to reach out for support. A doctor, a counsellor, or a treatment or community program can help, and recovery is possible.