The Basics of Opiate Overdose Prevention and Reversal:
What Everyone Should Know to Save a Life!
A product of the Harm Reduction Coalition, www.harmreduction.org, with minor edits for use in
Ukraine. Reproduced with permission 2008.
What is an Overdose?
Overdose (OD) happens when a toxic amount of a drug, or combination of drugs overwhelms the
body. Shirka, Heroin and other downers affect the body’s central nervous system, which slows
breathing, blood pressure, and heart rate, and in turn reduces body temperature. In an opiate
overdose, the breathing slows to the point of respiratory arrest where the lack of oxygen to the brain
leads to the loss of consciousness, coma, or death. In a stimulant overdose drugs like baltushka,
methamphetamines, cocaine, and ecstasy raise the heart rate, blood pressure, and body temperature,
and speed up breathing. This can lead to a seizure, stroke, heart attack or death.
Anyone who uses drugs can overdose, from the first-time user to the veteran.
But overdoses don't have to be fatal!
Risk Factors and Prevention Tips
Mixing Drugs (poly-substance use)
Drugs taken together can interact in ways that increase their overall effect. Using drugs that have the
same effects on the body can be deadly. Such combinations include cocaine with other stimulants like
speed and ecstasy, or using alcohol with heroin and other downers. Many overdoses occur when
people mix opiates and/or alcohol with benzodiazepines such as Klonopin, Valium, and Xanax. Most
fatal overdoses are the result of poly-drug use.
Prevention: Use one drug at a time, or use less of each drug. Do your shirka first
and pace your drinking.
Tolerance (your body’s ability to process a certain amount of a drug)
Tolerance develops over time, so the amount of a drug a long-time user needs to feel the drug’s
effects is a lot greater than a newer user. Tolerance also wavers depending on several factors
including, weight, size, illness, stress, compromised immune system (from hepatitis or HIV for
example), and age. Your tolerance actually decreases over time, which is why there are more deaths
among older users. Most importantly, tolerance can decrease rapidly when someone has taken a
break from using a substance whether intentionally while in drug treatment or detox, or
unintentionally while in jail or the hospital. Research has also shown that tolerance is affected when a
person uses drugs in a new or unfamiliar environment, and therefore at a higher risk for overdose.
Prevention: Use less when you are sick or took a break from using. Do a tester shot,
or split your dope in half and wait.
Quality (how pure a drug is)
The content and purity of street drugs is always unpredictable. They are often “cut” with other drugs
or materials that can be dangerous. You can’t tell how pure your drugs are from looking at it, and
purity levels are always changing, which means you can do a shot that’s a lot stronger than what you
are used to and put yourself at risk of an overdose.
Prevention: Do a tester shot, release the tourniquet, and try to buy from the same
dealer so you have a better idea of what you’re getting.
UsingAlone
While using alone isn’t necessarily a cause of overdose, it increases the chance of fatally overdosing
because there is no one there to call for help or take care of you if you go out. Many fatal overdoses
have occurred behind closed or locked doors where the victims could not be found and no one was
there to intervene.
Prevention: FIX WITH A FRIEND! Develop an overdose plan with your friends or
partners, leave the door unlocked or slightly ajar, call someone you trust and have
them check on you, and if you do use alone and feel yourself going out, call for help.
How do you know if someone is really high or overdosing?
If someone is really high and using downers like heroin, alcohol, and pills…
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Muscles are slack and droopy
They might “nod out”
Speech may be slurred
Pupils will contract and appear small
They might be out of it, but they will respond to outside stimulus like loud noise or a push
Scratch a lot due to itchy skin
If someone is really high and using stimulants like speed, cocaine, or ecstasy…
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Pupils will be enlarged
Very alert and energetic, euphoric
They might be paranoid and agitated
Decreased appetite
If someone is overdosing their symptoms may look like
this…
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DEPRESSANTS
May be awake, but unable to
talk
Body is very limp
Face is very pale or clammy
Fingernails and lips turn blue
or purple
Breathing is very slow and
shallow, erratic, or has
stopped
Pulse (heartbeat) is slow,
erratic, or not there at all
Choking sounds, or a gurgling
noise
Vomiting
Loss of consciousness
Unresponsive to outside
stimulus
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STIMULANTS
Pressure, tightness or pain in
chest
Difficulty breathing
Headache, ringing in the ears,
dizziness
Foaming at the mouth
Profuse sweating, or failure to
sweat
Racing pulse
Grossly enlarged pupils
Muscle cramps
Inability to urinate
Nausea and vomiting
Shaking, or seizures
Loss of consciousness
Depressants and sedatives slow down your heart rate and breathing. A person who overdoses on a
depressant may pass out, stop breathing, or choke on their vomit—any of which can lead to death.
Sometimes you can hear a person’s raspy breathing and know they’re having problems. If they’ve
stopped breathing, you may not know it, but if they begin to turn blue, they may be very close to
dying and need immediate attention—rescue breathing or CPR. The most important thing is to act
right away and don’t hesitate to call for help! If the person is still conscious, walk them around, keep
them awake, and monitor their breathing. If they pass out and become unresponsive get medical
assistance!
If the person is unconscious, try to wake them up by calling their name, or yelling something that
would normally startle them. If they do not respond try waking them with pain stimulus by pinching
their ear, under their arm, or rubbing their sternum with your knuckles. Be sure to check their
breathing. Put your face over theirs and feel for air against your cheek while watching to see if their
chest rises and falls. If they are not breathing, put the person in the recovery position and go call an
ambulance.
Tips on calling for medical help
Many of us are afraid to call for an ambulance when someone we know overdoses. You may have had
a bad experience with paramedics, or heard stories about people being arrested when the police
came. But if you don't know how to do rescue breathing and/or CPR (or don't want to), and you don't
have naloxone, calling an ambulance may be the only way to save the person's life. Here are a few
tips for calling:
When calling the ambulance…
Quiet down the scene.
Speak calmly and clearly. The more things appear to be under control the less likely the cops will
be sent.
Tell the dispatcher that the victim is unconscious and not breathing or turning blue.
Tell them exactly where you and the victim are, the address and room number. If you are outside,
give them the nearest street intersection and a landmark, as much information as possible to
help them get to you.
You do not have to tell the dispatcher…
Your name (give them an alias if they ask)
That it’s an overdose
Or that drugs are involved
Once the paramedics arrive, tell them as much as you know about what drugs the person
was using. For many of you, hiding your stuff before anyone comes (especially anything that might
have residue like cookers, cottons, empty bags, etc.) is standard practice. Be calm and respectful, let
them do their job. If the cops come too, remain calm, don’t have an attitude and be as honest as you
can without getting yourself into trouble.
If you're afraid of the cops, absolutely cannot stay and no one else is around…
You can still call an ambulance! If you're on the street or in a park, calling from a pay phone is
pretty anonymous.
Try to get a passerby to help before you leave.
If you are inside a building and you can do it without hurting your friend, take them into the street,
or the building doorway. The easier it is for the paramedics to get to them, the better.
(Remember to put them in the recovery position!)
If you can’t move your friend, you can stay until you hear the sirens get really close, then leave.
Just make sure paramedics can get to them: leave the door open or put a note up, etc.
(Again, remember to put them in the recovery position before you leave!)
If you have naloxone…
1. Can you get to it? If you have to leave the victim, remember to put them in the
recovery position.
2. Draw the naloxone up into the syringe.1cc of 0.4mg/mL naloxone can be enough, but
you can always draw up more and administer 1cc first, evaluate and then give them
another dose.
3. Naloxone can be administered into the muscle, so you don’t have to find a vein. The
best places to inject are in the arm (deltoid), thigh (quadriceps), or butt (gluteus).
4. If you have an alcohol swab, clean the area, if not administer the shot anyway at a 90°
angle.
5. Begin rescue breathing.
*Naloxone should kick in pretty quickly, but it could take a few minutes for the victim to come out
of it. If they don’t wake up and resume breathing within a few minutes, give them a second dose.
*In the meantime, it’s important that you breathe for them.
Rescue breathing
After you’ve called an ambulance and/or administered naloxone, start rescue breathing. Turn the
person over onto his/her back, tilt their head back gently to open the airway. Check their mouth to
make sure nothing is blocking their throat. Pinch their nose and give 2 slow breaths. Each breath
should last 1 ½ to 2 seconds and you should see their chest rise and fall. Wait 5 seconds and give 1
slow breath. Continue to give them 1 slow breath every 5 seconds until the paramedics
arrive. If someone else is with you, take turns breathing until help arrives. Remember: rescue
breathing is very important and can determine whether someone lives or dies. It only takes a few
minutes without oxygen for permanent brain damage to occur.
If your friend wakes up and starts breathing again, stay with them and monitor their
breathing. They can still slip back into an overdose!
What NOT to do if someone
overdoses
Do Not put the person in an ice cold bath, it could put them into shock, or they could drown. If they
are still breathing, you can put them under a cool shower to wake them, but stay with them and keep
the water away from their nose and mouth.
Do Not inject them with salt water or milk, it won’t revive them and in the time it takes to find a vein
you could be rescue breathing or trying to wake them up.
Do Not inject someone overdosing on heroin with speed or cocaine. It’s not a good use of time and
can make them worse. It’s one more drug their body has to deal with.
Now that you know the basics, talk to your friends or partner so you both know what to do
if you or someone you care about overdoses. Come up with a plan that you can realistically
use in the event of an overdose.