Learn how to:
- Identify the signs of opioid overdose and stimulant overdose.
- Respond and help someone during an overdose.
- Use naloxone to reverse an opioid overdose.
- Prevent loved ones from experiencing an overdose.
- Find treatment resources for adults, teens/youth, and parents.
- Find additional resources.
Opioid Overdose Recognition and Response
Examples of opioids: fentanyl, heroin, morphine, prescription opioids such as oxycodone, hydrocodone, Vicodin (hydrocodone-acetaminophen), Percocet (oxycodone-acetaminophen), methadone, codeine
Signs and Symptoms of Opioid Overdose
Call 911 immediately if a person exhibits any of the following opioid overdose symptoms:
- Unresponsive and can’t wake up: even when you call their name or shake them firmly.
- The person is not breathing or is not breathing normally: one breath every 3-5 seconds.
- Blue, purple or gray color in skin, lips, or fingernails
- Cold or clammy skin
Steps for Opioid Overdose Response
- Call 911. If the person is unresponsive, not breathing, or turning blue or gray, call 911 for emergency medical help.
- Tell the operator your exact location.
- Say you are with a person who is not breathing. You do not have to say anything about substances or medicines at the scene.
- Tell the operator you are going to give the person naloxone.
- Follow any additional instructions you get from the operator.
- Give Naloxone. Give them one dose of naloxone every 2-3 minutes until their breathing returns to normal (normal = one breath every 3-5 seconds)
- Watch and learn how to respond to an opioid overdose and administer naloxone (nasal spray and intramuscular injection).
- It is safe to give naloxone to someone, even if you aren’t sure they took opioids.
Give rescue breaths. After giving the first dose of naloxone, lay the person flat on the ground, tilt their chin upwards to open the airway, and provide one rescue breath every 5 seconds.
- Make sure you see the person’s chest rise and fall when giving rescue breaths.
- Chest compressions are not needed as long as the person has a pulse. If the person does not have a pulse, start chest compressions and use an automated external defibrillator (AED).
- If you cannot give rescue breaths, start chest compressions immediately to move air into the lungs and stimulate blood flow.
- To perform chest compressions:
- Place your hands on the center of the chest (on the sternum between the nipples) with one hand on top of the other.
- Position your body directly over your hands and center your weight over them.
- Press down firmly at least 2 inches deep, into the chest.
- Let the chest rise completely after each compression.
- Press down on the chest at a rate of 100-120 per minute.
- To perform chest compressions:
- Stay with the person until emergency help arrives. When the person wakes up from the overdose, they may not feel well and can potentially be confused. They should get medical attention and not take any more substances.
- Naloxone wears off within 30-90 minutes. It is possible for the person to go back into the overdose once the naloxone wears off.
- It is important to call 911. If that is not possible, stay with the person in case the naloxone wears off and additional doses are needed.
Naloxone (also known by the brand name Narcan) is a medication that can reverse opioid overdoses by blocking the effects of opioids and restoring breathing in minutes. This includes overdoses caused by fentanyl.
- Naloxone is available as an injection or a nasal spray and is easy to use.
- Anyone can administer naloxone – you do not need any special training.
- You cannot hurt someone by giving them naloxone if they don’t need it.
- Naloxone is safe to give to everyone, including children and pets.
Where to find naloxone:
- Find naloxone near you.
- Naloxone is covered by Medicaid in Washington State.
- Anyone in Washington State can receive naloxone from a pharmacy without a prescription by using the Statewide Standing Order to Dispense Naloxone. Visit DOH's Resources for Pharmacies webpage to learn more about the standing order and naloxone in pharmacies.
- People living in Washington State can request free naloxone by mail. The mail order program is meant for people who can’t easily go to a community organization or a pharmacy to get a kit.
- For more information, please visit DOH's Naloxone Instructions webpage.
Psychostimulant Overdose Recognition and Response
Examples of psychostimulants: methamphetamine (meth), cocaine, crack cocaine (crack), prescription amphetamines such as dextroamphetamine (Adderall) and methylphenidate (Ritalin).
The information listed below comes from the CDC’s Stimulant Guide.
Signs and Symptoms of Psychostimulant Overdose
Methamphetamine or cocaine overdose, sometimes referred to as “overamping,” can include symptoms like heat stroke, heart attacks, strokes, or stopped breathing.
Signs that a person may need immediate medical attention include (but are not limited to) the symptoms listed below. Always call 911 if someone:
- Loses consciousness.
- Stops breathing or can’t breathe effectively.
- Has a high body temperature.
- Has a seizure that lasts longer than 5 minutes.
- Has difficulty breathing after experiencing a seizure.
- Has multiple seizures in a row.
- Is known to have experienced a seizure for the first time. See below for more information about seizures.
- Shows any sign of a stroke, including:
- Numbness in the face, arms, or legs
- Sudden and severe headaches
- Blurred vision, or
- Sudden loss of coordination
- Shows any sign of a heart attack or cardiac arrest, including:
- Pain, pressure, or squeezing sensations in the center of the chest.
- Discomfort in the neck, arms, jaw, back, or stomach, and
- Shortness of breath, lightheadedness, nausea, fatigue, or cold sweats.
- Has injuries that require medical attention.
Considerations for Psychostimulant Overdose Response
- Naloxone will not work to reverse a stimulant overdose, but it is safe to give someone naloxone if you’re unsure if they took opioids. If in doubt, give naloxone.
- While you wait for emergency medical help to arrive, you can:
- Help the person remain hydrated and cool them down using a wet washcloth, fans, ice packs, etc.
- Monitor the person who is overheating and assess for worsening symptoms.
- If the person stops breathing, give rescue breaths. See rescue breath instructions above.
- If the person loses their pulse (no heartbeat), give chest compressions. See chest compression instructions above.
Information about seizures:
- Call 911 if:
- The seizure does not resolve within 5 minutes
- The person experiences multiple seizures in a row
- The person never had a seizure before
- The person has difficulty breathing or waking up after the seizure.
- Remain calm and help the person in distress. Talk to them calmly to let them know what you are doing.
- Help the person lie down safely without falling or hitting their head, if possible.
- Remove nearby objects, including eyeglasses, to reduce the risk of injury from sudden involuntary movements.
- Do not put anything in their mouth or between their teeth.
- Do not try to restrain the person’s movements.
- Call 911 if:
- The same protections from the Good Samaritan Law apply to you when responding to a psychostimulant or any overdose situation.
- If you seek medical assistance in a drug-related overdose, you cannot be prosecuted for drug possession.
- The overdose victim is also protected from drug possession charges.
- Anyone in WA State who might have or witness an opioid overdose is allowed to carry and administer naloxone
- Additional information about psychostimulant overdose and response can be found at Methamphetamine Overdose / Overamping.
What Can You Do to Help Prevent Overdose?
- Lead with Empathy: Substance use disorder is complex and requires care, connection, and community for recovery. Leading with empathy means working to set aside fear, confusion, frustration, or anger toward a person who is experiencing substance use disorder. Empathy can encourage people to carry naloxone, seek resources for support, and connect with loved ones and peers to aid in their recovery.
- Be Prepared: Learn the Signs of Overdose and Carry Naloxone: Recent research has shown that access to naloxone does not increase young people’s likelihood to use opioids like fentanyl. In fact, the research showed that teens that had access to naloxone were less likely to use opioids.
- Talk to Your Loved Ones About Substance Use Disorder: With more fentanyl in the drug supply, opioid overdose and deaths have risen dramatically in recent years. Having regular, open, non-judgmental, and compassionate conversations with your loved ones – even if you don’t know if they are using – can help:
- Encourage people experiencing substance use disorder to seek help.
- Encourage young people to ask questions and learn about potential risks associated with substance use.
- Reduce community stigma around substance use disorder.
- Assume any pills, liquids, or powdered substances you did not get directly from a pharmacy or dispensary may contain fentanyl.
- Talk to your doctor about how to correctly take opioid prescriptions and about non-opioid medications for pain management, if you would like an alternative.
- WA State DOH’s Safe Medication Return program lets people dispose of household prescriptions and over-the-counter medications (including medications for household pets).
- Take Back Your Meds Program
- Drop boxes are located throughout Washington at participating retail pharmacies, hospital, and clinic pharmacies and law enforcement offices.
- Most prescription and over-the-counter medicines are accepted, unless specified.
Treatment, Recovery, and Support Resources
Resources for Community Members and People Using Substances
- Washington Recovery Help Line
- Provides support and treatment options to anyone experiencing substance use, gambling addiction, and/or mental health challenges.
- Their helpline is available 24/7 at 1-866-789-1511
- Medications for Opioid Use Disorder (MOUD) Locator
- Learn About Treatment
- 988 Suicide & Crisis Lifeline
- Call, text, or chat 988 to be connected to the Suicide & Crisis Lifeline. It is confidential, free, and available 24/7/365.
- Dial 988 and press 4 for ‘Native and Strong Lifeline’ serving American Indian and Alaska Native people.
- Dial 988 and press 1 for Veterans services
- All 988 services are available in Spanish.
- Crisis Connections
- Tends to the emotional and physical needs of individuals across Washington.
- Immediate help is available 24 hours a day by calling the adult crisis line: (866) 427-4747.
- Never Use Alone
- Provides a life-saving, judgement-free point of contact for people who use drugs alone.
- Crisis line operators will stay on the phone with you while you use your substance and will notify emergency services in the event that you become unresponsive.
- Call (800) 484-3731 for this free service.
- Washington Tribal Opioid Solutions Treatment Resources
- Find it Toolkit: Substance Use Resources in Washington State
Resources for Youth and Parents/Caregivers
- Teen Link
- A confidential crisis line specifically for teens.
- Teen volunteers answer calls and are trained to talk with you about whatever you’re facing. No issue is too big or too small.
- Call (866) 833-6546 to talk to someone today.
- Teen/Young Adult Treatment
- Youth Overdose Education
- Talking to Teens About Fentanyl: Youth Discussion Guide: Talking to Teens About Fentanyl
- Understanding and Supporting Adolescents with an Opioid Use Disorder
- The Healing of the Canoe
- Tribal youth substance use prevention tools/education for clinicians, treatment organizations, and community members
- DOH Prevent Overdose WA Campaign
- WA Friends For Life Campaign
- WA State Health Care Authority’s Starts with One Campaign
- Designed to inform and educate young adults, their parents, and older adults about the dangers of prescription substance misuse and the importance of safe storage, use, and disposal.
- WA Tribal Opioid Solutions and WA HCA “For Our Lives” Campaign: For Native Lives
- Media campaign intended to support educational efforts around opioid misuse prevention and treatment for native communities in Washington State.
- Public Health Seattle/King County’s "Talk Even If" campaign
- Aims to motivate parents and caregivers to talk to their teens (14-17) about the risk of fentanyl and harm reduction measures to help reduce teen overdose deaths in King County.
- Benton/Franklin Health District’s “Carry a Second Chance” Naloxone Campaign
- University of Washington, Addictions, Drug & Alcohol Institute (ADAI) handout: What’s Up With Fentanyl
- This handout is available for download, but if interested in bulk printing, please visit the ADAI Clearinghouse, University of Washington.
- Syringe Service Program Directory
- National Harm Reduction’s Toolkit for Communities of Faith Facing Overdose
- Supporting Parents and Infants Affected by Substance Use
- DOH’s Drug User Health information