Someone’s not breathing right. Their skin is blue. They’re slumped over, unresponsive. You check their pulse-weak or gone. You think: overdose. Your heart races. You want to help, but you’re scared you’ll do it wrong. You’re not alone. Most people freeze in these moments-not because they’re cold-hearted, but because they’ve never been shown exactly what to do. And time is slipping away. Brain damage can start in as little as four minutes without oxygen. But here’s the truth: you don’t need to be a doctor. You just need to know five simple, life-saving steps-and do them fast.

Call 911 First, Then Act

The very first thing you do? Call emergency services. Not after you check their breathing. Not after you find the naloxone. Right now. Say clearly: “Someone has overdosed. They’re not breathing.” Give your location. Stay on the line. Dispatchers are trained to talk you through what to do while help is coming. Don’t assume someone else called. Don’t wait to see if they “wake up.” People don’t just snap out of an overdose. And if you delay calling, you delay everything else. Studies show that EMS arrival cuts death risk by 35%. Every second counts.

Check Breathing-Not Just Consciousness

Don’t shake them or yell “Hey!” That wastes time. Instead, gently tap their shoulder and shout, “Are you okay?” If there’s no response, check their breathing immediately. Look at their chest. Listen at their nose and mouth. Feel for air on your cheek. You have 10 seconds. If they’re not breathing-or if they’re gasping, snoring, or making weird, irregular sounds-that’s not normal sleep. That’s respiratory failure. This is the most common cause of death in overdoses, especially with opioids like heroin, fentanyl, or prescription painkillers. Gasping is not breathing. It’s a sign the brain is shutting down. Act like they’re not breathing at all.

Give Rescue Breaths-No Mouth-to-Mouth Needed

If they’re not breathing, start rescue breathing. Tilt their head back slightly by lifting their chin. Pinch their nose shut. Seal your mouth over theirs. Give one slow breath-about one second long-until you see their chest rise. Don’t blow hard. Don’t overinflate. You’re not trying to fill their lungs like a balloon. You’re just giving them enough air to keep oxygen flowing to their brain. Then take your mouth away. Let their chest fall. Wait five to six seconds. Then give another breath. Keep going: one breath every five to six seconds. That’s 10 to 12 breaths a minute. If you get tired, switch with someone else. Rescue breathing alone can keep someone alive for 15 to 30 minutes. Many opioid overdoses don’t need chest compressions-just breathing support. The heart often keeps beating until the brain is starved of oxygen. Keep breathing for them until help arrives.

Use Naloxone If You Have It

If you have naloxone-whether it’s a nasal spray like Narcan or an auto-injector-use it now. Naloxone reverses opioid overdoses. It won’t work on alcohol, benzodiazepines, or stimulants like cocaine or meth. But if there’s any chance opioids are involved-which is likely, since they cause nearly 75% of overdose deaths-you give it anyway. The 2023 SAMHSA guidelines say: “Naloxone first for any suspected opioid involvement.” For nasal spray: lay them flat. Insert the nozzle into one nostril. Press the plunger firmly for 2-3 seconds. Don’t pull it out until you’re done. If they don’t respond in 3-5 minutes, give a second dose in the other nostril. Naloxone wears off faster than some drugs. Fentanyl can come back after the naloxone wears off. That’s why you still need to keep giving rescue breaths and wait for EMS-even if they wake up. They might slip back under.

Put Them in the Recovery Position If They’re Breathing

If they’re breathing on their own but unconscious, don’t leave them on their back. They could choke on their tongue or vomit. Roll them onto their left side. This is called the recovery position. Here’s how: kneel beside them. Straighten their legs. Bend their far leg at the knee. Place their far arm under their head. Gently roll them toward you, keeping their head, neck, and spine aligned. Once on their side, make sure their top leg is bent at 90 degrees to keep them stable. Tilt their head back slightly so their airway stays open. Check their breathing every two to three minutes. Keep them warm with a coat or blanket. Don’t give them water, coffee, or food. Don’t try to make them walk. Don’t put them in a cold shower-that can trigger heart problems, especially with stimulants.

Know the Differences: Opioids vs. Stimulants vs. Alcohol

Not all overdoses look the same. Knowing the difference can save a life.

• Opioids (heroin, fentanyl, oxycodone): Skin is pale or bluish. Lips and nails turn blue. Breathing is slow, shallow, or stops. Pupils may be tiny-but not always. Fentanyl overdoses often don’t show pinpoint pupils. Naloxone works here.
• Stimulants (cocaine, meth, MDMA): Skin is hot, flushed, sweaty. Pulse is fast. Body temperature rises dangerously-over 40°C (104°F). They may seize. Do NOT cool them with ice baths. That can cause heart rhythm problems. Instead, move them to a cool place. Loosen clothes. Use damp cloths on their neck, armpits, and groin. Call 911 immediately. Naloxone does nothing here.
• Alcohol: Vomiting is common. They may be unconscious but breathing. Risk of choking is high. Keep them on their side. Watch for vomiting. Don’t let them sleep it off. Alcohol depresses breathing even more. If they’re not waking up, treat it like an opioid overdose-start rescue breathing and call 911.

Polysubstance overdoses-where someone takes more than one drug-are now the norm. In 73% of cases, multiple substances are involved. So if you’re unsure? Assume opioids are part of it. Give naloxone. Start breathing. Call 911. Better safe than sorry.

What Not to Do

There are myths that kill. Don’t:

• Put them in a cold shower or ice bath-can cause cardiac arrest.
• Slap them, shake them, or try to “wake them up”-wastes precious time.
• Give them coffee, food, or water-they could choke.
• Leave them alone-even if they seem okay after naloxone.
• Wait to see if they “get better on their own”-they won’t.

And don’t assume you’re not qualified. You don’t need a certificate to save a life. In 2023, over 3.2 million Americans were trained in overdose response. Many of them were parents, teachers, baristas, and neighbors. You’re not too late. You’re not too inexperienced. You’re the person who’s there right now. That’s enough.

After Help Arrives

When paramedics get there, tell them what you did: “I gave two doses of naloxone,” or “I was doing rescue breathing for eight minutes.” Give them any empty bottles, pills, or drug paraphernalia you found. That helps them treat the person better. Don’t feel guilty. Don’t feel like you failed if they don’t wake up. You did everything right. You gave them a chance. And that’s what matters.

Overdose survival isn’t about luck. It’s about action. Communities with trained bystanders reversed over 12,500 overdoses between 2021 and 2023-with a 98.7% survival rate to hospital discharge. That’s not magic. That’s people knowing what to do. You can be one of them.

If you’re in the UK, naloxone is available for free from pharmacies, needle exchange programs, and some community health centres. Ask for it. Keep it in your bag or car. You never know when you’ll need it. And if you’re ever unsure what to do-call 999. They’ll guide you through it.