The opioid crisis remains one of the deadliest public health emergencies in modern American history. In the US, there were over 105,000 drug overdoses in 2023, with nearly 80,000 of those involving opioids [1].
Recognizing the signs of opioid poisoning and knowing how to act in an emergency can literally mean the difference between life and death. Opioids depress the respiratory system and an overdose can escalate from mild symptoms to life-threatening danger in minutes.
Educating yourself and your community about how to spot an overdose and when to use lifesaving interventions like naloxone (Narcan) is an essential step in preventing more tragedies and saving lives.
What Are Opioids?
Opioids are a class of drugs that act on specific receptors in the brain and body to reduce pain. They work by blocking pain signals and can also produce feelings of relaxation or euphoria. Doctors prescribe certain opioids to treat moderate to severe pain, such as after surgery, injury, or for cancer-related pain.
While they can be very effective for pain control when used properly, opioids also slow breathing and heart rate, which is why they can be dangerous if misused or taken in high amounts.
Opioids include both legally prescribed medications and illegal drugs.
Prescription opioids are regulated and meant to be used under medical supervision, but they still carry risks of dependence, addiction, and overdose. Illicit opioids, such as heroin or illegally manufactured fentanyl, are especially dangerous because their strength can vary widely, and they are often mixed with other substances. Both legal and illegal opioids can lead to opioid poisoning or overdose, particularly when taken in large amounts or combined with alcohol or other sedating drugs.
Common Types of Opioids
Prescription Opioids:
- Oxycodone (OxyContin, Percocet)
- Hydrocodone (Vicodin)
- Morphine
- Codeine
- Tramadol
- Hydromorphine (Dilaudid)
- Methadone (also prescribed for opioid use disorder treatment)
Illicit opioids:
- Heroin
- Fentanyl
- Fentanyl analogs (e.g, carfentanil)
- Nitazines
What Is Opioid Poisoning?
Opioid poisoning is the medical term for toxic effects caused by opioids in the body. It’s often caused by ingesting too much or high doses of opioids or mixing opioids with dangerous combinations such as alcohol or benzodiazepines.
Opioid poisonings also affect children through accidental ingestion and exposure. Poison control centers reported more than 12,000 calls a year about children and teens exposed to opioids, with nearly 60% of those cases involving children aged 5 or younger [2].
One of the most effective ways to protect children is to keep all opioid and other prescription medications securely stored, ideally in a locked cabinet or container that is out of reach and sight. Surveys show that nearly 70% of opioid prescriptions in homes with children are not safely stored, making them accessible to curious kids or even teens who might misuse them [3].
Is Opioid Poisoning An Overdose?
Opioid overdoses occur when someone takes too much of an opioid (either accidentally or intentionally). All opioid overdoses are opioid poisonings. However, not all opioid poisonings are overdoses. Opioid poisonings can sometimes include situations such as medication errors, children accidentally ingesting opioids, or dangerous drug interactions.
Signs of Opioid Poisoning
Opioids slow down several systems in the body and can quickly become fatal [4].
- Pinpoint Pupils: Pupils become extremely small and don’t respond normally to light.
- Shallow Breathing: Slow or reduced breathing, often less than 8 breaths per minute.
- Unresponsiveness: Inability to wake up or respond to external stimuli (e.g., shaking, shouting).
- “Death Rattle”: Gurgling, snoring, or abnormal choking sounds.
- Low Oxygen: Bluish or gray lips or fingernails, darkened nail beds.
- Changes in Skin: Cold, clammy skin may also feel sweaty.
How To Use Narcan and Prevent Overdoses
Narcan® is a brand name for naloxone, a fast-acting medication that can reverse the effects of an opioid overdose. Opioids slow or stop breathing by attaching to specific receptors in the brain. Naloxone works by quickly binding to the same receptors and blocking opioids, restoring normal breathing within minutes [5].
It is safe nd easy to use, and has no effect if opioids are not present. Because opioid overdoses primarily become fatal due to respiratory failure, administering Narcan can be the step that prevents brain injury or death while waiting for emergency medical help. Here is how to use it:
Step 1: Remove the device from the packaging.
Take the Narcan® nasal spray out of the box and peel back the package to open it. Do not open it until you are ready to use it. Do not test or prime the spray.
Step 2: Position the device correctly.
Hold the nasal spray with your thumb on the bottom of the plunger and your index and middle fingers on either side of the nozzle.
Step 3: Position the person.
Lay the person on their back. Gently tilt their head back and support their neck with your hand.
Step 4: Insert the nozzle.
Place the tip of the nozzle into one nostril until your fingers are against the bottom of their nose.
Step 5: Administer the dose.
Press the plunger firmly to release the full dose of Narcan into the nostril.
Step 6: Wait and observe.
Watch for a response. If the person does not wake up, breathe normally, or respond within 2 to 3 minutes, proceed to the next step.
Step 7: Give a second dose if needed.
Use a new Narcan nasal spray and administer it into the other nostril.
Step 8: Call 911 and monitor.
Call emergency services immediately if you haven’t already. Stay with the person, monitor their breathing and level of consciousness, and provide rescue breathing if needed until help arrives.
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Sources
[1] Regina, A. et al. 2025. Opioid Toxicity. StatsPearl.
[2] CDC. 2025. Understanding the Opioid Overdose Epidemic.
[3] CHOP. 2023. CHOP Researchers Find Rate of Fatal Opioid Poisonings Among Children More Than Doubled Over 13-Year Span.
[4] John Hopkins. 2017. Majority of Opioid Medications Not Safely Stored in Homes With Children, Survey Finds.
[5] NY Department of Health. How To Use Narcan Nasal Spray for An Overdose.