Opioid Overdose: Risks, Warning Signs and How to Respond

Opioids, sometimes called narcotics, include strong prescription pain relievers such as oxycodone, hydrocodone, fentanyl and tramadol, as well as the illegal drug heroin. Providers may prescribe them for pain after a major injury or surgery, for severe pain from conditions such as cancer, and sometimes for chronic pain. Taken briefly and as prescribed, they are generally safe, but anyone taking opioids is at risk of opioid use disorder and overdose, especially if the drugs are misused — taking more or more often than prescribed, using them to get high, or taking someone else's.

What an overdose is

Opioids act on the part of the brain that controls breathing. High doses can slow or stop breathing, sometimes fatally.

What causes one

An overdose can happen when someone:

• takes an opioid to get high;
• takes an extra dose, or doses too often, by accident or on purpose;
• mixes an opioid with other medicines, illegal drugs or alcohol — combinations with certain anti-anxiety medicines such as Xanax or Valium can be fatal; or
• takes opioids prescribed for someone else.

Children are especially at risk of accidental overdose from medicine not meant for them. People receiving medications for opioid use disorder (MOUD) are also at some risk, because many of those medicines are controlled substances that can be misused.

Who is at higher risk

Anyone who takes an opioid can overdose, but the risk is higher for people who take illegal opioids, take more than prescribed, combine opioids with other medicines or alcohol, have conditions such as sleep apnea or reduced kidney or liver function, or are over 65.

Signs of an overdose

• very small pupils;
• falling asleep or losing consciousness;
• slow, shallow breathing;
• choking or gurgling sounds;
• vomiting;
• a limp body;
• pale, blue or cold skin;
• a faint heartbeat; and
• purple lips and fingernails.

What to do

1. Call 911 immediately.
2. Give naloxone if it is available. Naloxone is a safe medicine that can quickly reverse an opioid overdose by blocking the opioids' effects. It comes as a nasal spray or as an injection into a muscle, under the skin or into a vein. Read the instructions and check the expiration date. It will not harm someone overdosing on other drugs, so use it if you think someone is overdosing.
3. Try to keep the person awake and breathing, and lay them on their side to prevent choking.
4. Stay with them until emergency workers arrive.

Prevention

If you take opioid pain medicine:

• take it exactly as prescribed — never more at once or more often;
• never mix it with alcohol, sleeping pills or illegal drugs;
• store it where children and pets cannot reach it; a lockbox also keeps others in the home from taking it;
• get rid of unused medicine promptly; and
• teach family and friends how to respond to an overdose.

People at higher risk should get naloxone, which is sold at pharmacies, and carry it everywhere.

Sources

• MedlinePlus, U.S. National Library of Medicine, "Opioid Overdose": https://medlineplus.gov/opioidoverdose.html