Overdose Emergency: How to Identify One and What to Do

emergency-1137137_1920 (1)If you have a loved one who struggles with an addiction, you probably worry that one day he will accidentally overdose (or “OD,” as some people refer to it). In a perfect world, that day will never come and your loved one will find recovery to overcome his problem. Unfortunately in the real world, the potential for an overdose looms no matter the substance, frequency of use, or even the amount taken at one time.

Finding someone who may have overdosed on a drug is a frightening, chaotic situation. It’s important to know ahead of time what the signs are and how to respond so that precious time isn’t lost when the situation arises. This guide will cover overdose signs for alcohol, heroin, cocaine, and opioid painkillers, as well as what to do in each circumstance. It’s important to act quickly if you even suspect an overdose, so don’t hesitate to call emergency services. Don’t worry that your loved one will be upset with you if he is using an illegal drug or is underage to legally drink and worries about consequences — the most important thing is to first save his life.



An overdose on alcohol is usually referred to as alcohol poisoning, which means a person has such high blood alcohol content (BAC) that it’s considered toxic. About 50,000 cases of alcohol poisoning are reported in the United States each year, and about one patient dies a week from it. Those at highest risk are college students, chronic alcoholics, anyone taking medication that could have a negative effect when mixed with alcohol, and even children who may consume alcohol out of curiosity.

It’s important to note that a person’s BAC can continue to rise for up to 40 minutes after they have stopped drinking, so alcohol poisoning may seemingly sneak up on someone who is heavily intoxicated. Symptoms include:

  • Confusion
  • Uncontrollable vomiting
  • Seizures or epileptic symptoms like convulsions and rigid spasms
  • Slow breathing (less than eight breaths per minute) or intermittent breathing (gaps of more than 10 seconds between breaths)
  • Abnormal skin condition: cold, clammy, pale, blue-tinged, and/or blotchy
  • Reduced body temperature or hypothermia
  • Passing out or becoming unconscious and an inability to be roused despite attempts to
  • verbally wake him, shake him, or pinch his skin

An easy way to remember alcohol poisoning danger signs is with the acronym MUST HELP:
Mental confusion
Snoring/gasping for air
Throwing up

Erratic breathing
Loss of consciousness
Paleness/Blueness of skin

Keep in mind that even someone who appears to be “sleeping it off” could slip into an unconscious state, putting him in life-threatening danger.

If your loved one is conscious and responsive after drinking heavily, stay with him and check often to make sure he stays that way. Do your best to keep him awake to lessen his chances of becoming unconscious. It’s best to keep him sitting upright, but if he insists on lying down he should stay on his side, not his back or stomach. A major hazard for someone with alcohol poisoning is a failing gag reflex — if he’s lying down and begins to vomit, he may have trouble turning over and could choke, especially if he’s unconscious. To reduce his risk, help him get into the Bacchus Maneuver position:

  • Raise the arm closest to you above his head to put him in a position where you can roll him closer to you.
  • Gently roll him toward you and guard his head from hitting the floor. His head should rest in front of, not on top of, his arm.
  • Tilt his head up to maintain an unobstructed airway.
  • Tuck his nearest hand under his cheek to maintain the angle and keep his face off the floor.
  • Stay with him and check him often for strong, steady breathing and heartbeat.

If he’s in the sun, move him inside or into the shade if you’re unable to get indoors. If it’s cold, move him to a warm location and give him a blanket. Don’t give him medication of any kind but help him drink water if he is able — don’t force the water down if he has trouble swallowing. Remember: if he has trouble drinking because his throat function and gag reflexes are off, he may be in serious danger.

Don’t touch him without letting him know what you’re doing and be mindful of what you say. Don’t lecture or ridicule him; not only will he be unreceptive in his condition, he will likely be less willing to let you help if he feels you’re judging him. Be firm but calm, and avoid expressing any feelings of anger or anxiety.

It isn’t necessary to see every symptom, and even if the classic signs aren’t there but you feel there is a significant risk, you should call emergency services for help. Provide as much information as possible to the response team, including what was consumed and when. If possible, bring any prescriptions he may have taken to show to the doctors.


There are a few ways a heroin overdose may occur: a new user may accidentally take a higher dose than intended, someone may unknowingly use an extremely pure batch and take more of the active ingredient than anticipated, or a long-term, regular user may develop a tolerance leading to such a high dose that the body becomes overwhelmed.

A user may show symptoms a few short minutes after taking the dose, or he may have a delayed response before which he can hold a conversation and perform other tasks. Heroin overdose symptoms include:

  • Difficulty breathing — shallow breaths, slow and difficult breathing, or a complete cessation of respiratory function
  • A drop in blood pressure
  • Decreased heart rate and weak pulse
  • Dry mouth and tongue discoloration, usually displayed in white patches
  • Extremely small pupils, sometimes as small as the head of a pin (“pinpoint pupils”)
  • Bluish-tinged nails and lips
  • Stomach and intestinal spasms and cramps or constipation
  • Confusion and delirium
  • Drowsiness
  • Muscle spasms
  • Loss of consciousness and an inability to be woken up

woman-918981_1920If you suspect a possible heroin overdose, seek emergency help immediately. Keep your loved one conscious and upright, or if he’s unable to sit up, then in the Bacchus Maneuver position. Do not make him throw up unless instructed to by emergency personnel after you’ve provided them as much information as possible on his condition. Don’t put potential legal ramifications before his safety; get him life-saving help as quickly as possible.


Cocaine overdose can be an especially great risk because a user can’t be certain of the quality or potency of the substance he’s using. In a particularly strong dose, even just a small amount can cause extremely dangerous side effects like heart arrhythmia, elevated blood pressure, or even sudden death. Left untreated, a cocaine overdose can lead to serious damage in the heart, kidneys, liver, and other organs, and can cause extreme secondary effects including heart attack and stroke.

Symptoms of this kind of overdose are often difficult for an outsider to identify, so if you know your loved one has been using, it’s important to keep an eye out and communicate with him about how he’s feeling. Warning signs may include:

  • Elevated heart rate, increased blood pressure, and/or high body temperature
  • Increased or rapid breathing
  • Headache
  • Intense nausea or vomiting
  • Dilated pupils
  • Hyperstimulation or irritability
  • Psychotic episodes including panic, paranoia or euphoria, or behaving in an erratic manner
  • Feeling like his heart is beating in his head or like his head may explode
  • Feeling like his heart will beat out of his chest
  • Feeling dehydrated, as if he can’t get enough to drink

Time is a crucial factor in treating a cocaine overdose. A quick response can be the difference between life and death, not to mention debilitating damage to the body. Seek help at the first warning signs of overdose or if you believe your loved one is in danger of one. In addition to the physical effects on the body, major psychological and behavioral changes can put both the user and others at risk. Overdose victims often sustain injury as a result of confused, aggressive behavior, so it’s vital to seek help to protect both your loved one and yourself. If he begins to act unstable or violent — even if he’s only making threats — lock yourself and anyone else somewhere out of his reach and call for help immediately.

Opioid Painkillers

Opioid painkillers are extremely powerful, so even someone with a prescription is susceptible to overdose. It can occur from taking too much of one, mixing it with other drugs or alcohol, or abusing the opioid and taking it without a doctor’s prescription or for longer than advised. Two groups are especially susceptible to overdose: elderly patients who forget they’ve already taken their dose and take another in error, and those with metabolic disorders. Changes in metabolism can affect the way the medication is absorbed, so close monitoring by a doctor is crucial for safe administering.

There are a few kinds of warning signs to look out for. The first are signs of overmedication, which may lead to an overdose. These symptoms may include:

  • Extreme sleepiness or drowsiness
  • Mental confusion
  • Unintelligible speech
  • Slowed breathing, especially if combined with shallow breaths
  • Pinpoint pupils
  • Reduced heartbeat
  • Weakened blood pressure
  • Difficulty waking from sleep

In addition to signs of overmedication, the signs of opioid overdose may include:

  • Loss of color in the face
  • Clammy, cold skin
  • Limp body
  • Bluish tint on lips and fingernails
  • Vomiting
  • Inability to speak
  • Slowed breathing
  • Slowed heart rate

Because opioids slow down respiratory function and breathing, someone in the midst of an overdose may also show signs of extreme respiratory distress. Sometimes referred to as the “death rattle,” it will be a labored, gurgling exhale of breath. It has a very distinct sound and means that the person will need resuscitation immediately. If you hear it, stay with him, call for help, and be prepared to administer CPR.


No matter the person, circumstances, or location, if you believe someone could be overdosing on any kind of drug, call for emergency help immediately. Gather as much information as you can about what he has taken, when and how he took it, and any prescriptions he may be on as well as basic information like age, weight, and height in order to give emergency responders as much help as possible. Do not leave him alone if he is unconscious, and stay very close if he’s awake as long as he isn’t displaying violent behavior. With quick, decisive action, you may be able to save your loved one before an overdose takes his life.