What Happens During an Opioid Overdose?

When someone takes too much of an opioid-whether it’s heroin, oxycodone, fentanyl, or even prescription painkillers-their breathing slows down or stops entirely. This isn’t just about feeling drowsy. The brain’s ability to control breathing gets shut down by the drug binding too tightly to opioid receptors. Without oxygen, brain damage can start in under three minutes. Death follows quickly if nothing is done.

Fentanyl is especially dangerous. It’s 50 to 100 times stronger than morphine. A dose as small as two grains of salt can kill. In 2022, fentanyl was involved in over 80% of the 107,622 opioid overdose deaths in the U.S. Many people don’t even know they’re taking it-fake pills made to look like oxycodone often contain fentanyl. That’s why overdoses can happen so suddenly, even to someone who’s used opioids before.

How Naloxone Works to Reverse an Overdose

Naloxone is the only medication proven to reverse an opioid overdose. It doesn’t cure addiction. It doesn’t get you high. It simply kicks opioids off the brain’s receptors and replaces them with itself. This restores breathing within 3 to 5 minutes. Think of it like a reset button for the brain’s breathing control center.

The FDA-approved versions are nasal spray (like Narcan) and injectable. The nasal spray is easier for non-medical people to use. You don’t need to be a doctor. You don’t need to find a vein. Just tilt the head back, insert the nozzle into one nostril, and press the plunger. That’s it.

Studies show it works in 85% of cases when used correctly. Even better, it’s incredibly safe. If someone doesn’t have opioids in their system, naloxone does nothing. You can’t accidentally overdose on naloxone. It won’t hurt someone who’s just drunk or on benzodiazepines. It only works on opioids.

Why One Dose Isn’t Always Enough

Here’s the catch: naloxone wears off faster than many opioids. Its effects last between 30 and 90 minutes. Fentanyl, carfentanil, and other synthetic opioids can stay in the body for hours. That means after naloxone wears off, the person can slip back into overdose. This is called re-narcotization.

The CDC says 40% of fentanyl overdoses require more than one dose of naloxone. That’s why it’s critical to give a second dose if the person doesn’t wake up after 3 to 5 minutes. Keep the spray handy. Keep watching them. Don’t assume one spray is enough.

Some newer formulations, like the 8 mg nasal spray approved in April 2024, are designed specifically for strong opioids like fentanyl. But even then, multiple doses may still be needed. Always be prepared for the possibility.

Recognizing the Signs of an Overdose

Not every unconscious person is having an opioid overdose. But these signs are strong indicators:

• Unresponsive to shaking or shouting
• Slow, shallow, or stopped breathing
• Blue or gray lips and fingernails
• Pinpoint pupils (very small dots in the center of the eyes)
• Gurgling or snoring sounds (like they’re drowning)

People often mistake overdoses for sleep. That’s deadly. If someone is unresponsive and breathing oddly, assume it’s an overdose. Don’t wait. Don’t check their phone. Don’t try to wake them up with ice water. Give naloxone and call 911 immediately.

Training programs show that 35% of the time is spent just teaching people how to tell the difference. Practice recognizing these signs. Watch videos. Role-play with a friend. The more familiar you are, the faster you’ll act when it matters.

How to Store Naloxone Properly

Naloxone doesn’t need refrigeration, but it does need protection. Keep it in a cool, dry place away from direct sunlight. Don’t leave it in your car’s glove box in summer-it can get hotter than 120°F. Heat and light can break down the medication.

Check the expiration date. Most nasal sprays last 18 to 24 months. If it’s expired, it’s better than nothing-but don’t rely on it. Replace it before it expires. Many community health centers give out free replacements.

Store it where you can find it fast. Not tucked in a drawer. Not buried in a backpack. Keep it with your keys, wallet, or in a small pouch clipped to your belt. If you’re someone who uses opioids, keep one on you. If you know someone who does, keep one in their room, their car, their work bag. Every location where they spend time is a potential emergency spot.

What to Do After Giving Naloxone

Calling 911 is non-negotiable. Naloxone is not a substitute for medical care. Even if the person wakes up, they still need to go to the hospital. Why? Because the overdose might have damaged their lungs or heart. Or they might slip back under.

After giving naloxone, place the person on their side in the recovery position. This keeps their airway open if they vomit. Vomiting is common after naloxone-it’s part of withdrawal. Don’t try to hold their head up. Just roll them gently onto their side, bend the top knee to keep them stable.

Stay with them. Monitor their breathing. If they stop breathing again, give another dose of naloxone. If you’re trained in CPR, be ready to start it.

Don’t leave them alone. Don’t let them walk it off. Don’t let them go back to using. The risk of another overdose is highest in the first hour after naloxone is given.

Who Should Have Naloxone?

Anyone who uses opioids-even just once in a while-should have naloxone. So should their friends, family, roommates, coworkers, and anyone who might be around them when they use.

People on long-term opioid pain medication. People in recovery. People who use heroin or fentanyl. People who take benzodiazepines with opioids (that combo increases overdose risk 10-fold). Even people who just take prescription painkillers for back pain.

In Australia, naloxone is available over the counter at pharmacies without a prescription. In the U.S., it’s free at many community centers, syringe programs, and libraries. You don’t need insurance. You don’t need to prove you’re at risk. Just ask for it.

Common Myths About Naloxone

• Myth: Giving naloxone encourages drug use. Truth: Studies show no increase in drug use after naloxone distribution. People who get naloxone are more likely to seek treatment.
• Myth: Naloxone is dangerous. Truth: It’s one of the safest medications ever made. It only works if opioids are present.
• Myth: You need training to use it. Truth: You don’t. The nasal spray is designed for anyone. But training helps you act faster and with more confidence.
• Myth: If they wake up, they’re fine. Truth: They’re not. They need medical care. Withdrawal can be brutal. They might try to use again right away.

Where to Get Naloxone

In Australia, you can walk into any pharmacy and ask for naloxone. Pharmacists are trained to show you how to use it. Many offer it for free through government programs. In Sydney, community health centers like The Bayside Clinic and the Sydney Medically Supervised Injecting Centre provide free kits.

In the U.S., you can buy Narcan nasal spray at CVS, Walgreens, Rite Aid, and other major pharmacies without a prescription. The price is around $45 to $60 with insurance, or $130 to $150 without. But many local health departments, needle exchanges, and nonprofits give it away for free. Search “free naloxone near me” online.

Don’t wait for a crisis. Get it now. Keep it with you. Teach one person how to use it. That one person could save your life-or someone else’s.

What Comes After Naloxone?

Naloxone is a rescue tool. It doesn’t fix the problem. It buys time. That time should be used to get help.

After a reversal, people often feel sick-nausea, shaking, anxiety, pain. That’s withdrawal. It’s terrifying. But it’s not life-threatening. What’s life-threatening is going back to using.

That’s why follow-up care matters. Treatment programs, peer support, counseling, and medication-assisted treatment (like methadone or buprenorphine) reduce the chance of another overdose by up to 50%. Naloxone doesn’t replace treatment. It makes treatment possible.

Every time naloxone is used, it’s a chance to connect someone to help. Don’t let that moment pass.