Opioid overdose

This page provides information on how to identify if someone is experiencing opioid overdose, how to respond, and additional information on naloxone and fentanyl test strips.

Opioid overdose signs

  • Respiratory depression: Slow, irregular, or stopped breathing is one of the most critical signs. The person may have difficulty breathing or may not be breathing at all.
  • Unconsciousness or unresponsiveness: The person may be unresponsive to stimuli, including verbal commands or physical touch. They might be difficult to wake up or completely unconscious.
  • Bluish or gray skin: A blue-gray tint, especially around the lips or fingertips can indicate a lack of oxygen, which is a result of respiratory depression.
  • Slow or irregular heartbeat: The heart rate may be slow or irregular, which can be a sign of reduced oxygen levels in the blood.
  • Pinpoint pupils: Opioid overdose often causes constricted pupils, which appear as very small, pinpoint-sized pupils.
  • Choking or gurgling sounds: The person might make unusual choking or gurgling noises due to difficulty breathing or airway obstruction.
  • Cold, clammy skin: The skin may become cool and sweaty, indicating a lack of oxygen and poor circulation.

What to do if someone is overdosing

  • Call 911 immediately.
  • Administer naloxone via the instructions.
  • Lay the person on their side in The Recovery Position to prevent choking.
  • If there is no improvement, administer a second dose 2-5 minutes after the first.
  • Stay with the person until emergency assistance arrives.

*Most states have laws that may protect a person who is overdosing or the person who called for help from legal trouble. Washington state has the Good Samaritian law that does this.

What is naloxone (brand name Narcan)?

Naloxone is a medication designed to reverse an opioid overdose. Opioids slow down the activity of the central nervous system. This can dangerously slow or stop breathing which may lead to death. Naloxone displaces the opioids from the opioid receptors in the brain which allows the person who is experiencing an opioid overdose to begin breathing normally.

Naloxone/Narcan do NOT impact alcohol poisoning. It doesn’t harm a person to use Narcan if one is unsure what substances have caused the overdose, but it is only effective for opioid based substances. Alcohol overdose info here.

What are fentanyl test strips (FTS)?

Fentanyl is a synthetic opioid that is up to 50 times stronger than heroin and 100 times stronger than morphine. Fentanyl is a major contributor to fatal and nonfatal overdoses in Washington and the United States.

Fentanyl test strips (FTS) are a harm reduction strategy designed to reduce the negative consequences of drug use, including the risk of fatal and nonfatal overdose. Anyone can purchase and use FTS to test for the presence of fentanyl in a drug. For additional info, see the Fentanyl Testing to Prevent Overdose fact sheet.

Naloxone and fentanyl test strip education workshop

This 30-minute workshop covers what an opioid is, common side effects, types of opioids, and signs of opioid overdose. This workshop is available for free in person at the University of Washington in Seattle and via Zoom for all UW campus locations.

Schedule a naloxone and fentanyl test strip education workshop

Where can I pick up Narcan & fentanyl test strips at the UW?

UW community members can pick up Narcan and FTS (for free) at the following locations:

UW Seattle

UW Bothell

UW Bothell locations may include the HaWRC, library vending machine, and Campus Safety

UW Tacoma

Complete the UW Tacoma Narcan access form to access free Narcan on campus

Mail order and access outside of the UW

You can have Narcan nasal spray mailed to you anywhere in Washington state at no cost thanks to People’s Harm Reduction Alliance.

Use this state-based locator to find a pharmacy, clinic, health department, or community based organization in your area that provides naloxone distribution. We suggest calling ahead to confirm inventory and in the case of pharmacy access, request information about co-pay.

Naloxone/Narcan online training video

Frequently asked questions (FAQs):

Can the person overdose again if I’ve just given them naloxone?

Naloxone temporarily knocks the opioids out of the opioid receptors in the brain, this will trigger normal breathing. However, depending on how much opioids the person has in their system, they could experience a second potentially fatal overdose because the naloxone wears off in about 30-90 minutes. For this reason, we recommend the individual seek medical attention to ensure they are in the company of someone with additional naloxone in case a second overdose occurs. It’s also important for the person experiencing an overdose not to take any more drugs or alcohol within (at least) a three hour period. If you are unable to seek medical assistance, and can not stay with the person yourself, ensure they are in the company of an individual who is aware of the situation and has more naloxone.

Can someone be given too much naloxone?

It is not possible to give so much naloxone so as to harm a person. However, if a person is dependent on opioids (including people without substance use disorders, but on chronic pain medication) or has a habit, the more naloxone they get, the more uncomfortable they will be because of withdrawal symptoms. Vomiting is a possibility. Be sure they don’t aspirate (inhale) the vomit by putting them in the recovery position if they’re unconscious. If the person gets too much naloxone, try to explain to them that their withdrawal symptoms will begin to fade in a half hour or so.

Does naloxone work on fentanyl?

Yes. Sometimes it may take more doses, but studies show that a person experiencing an overdose involving fentanyl will usually ‘come to’ after 1 or 2 doses. Chest rigidity has been seen in some fentanyl-related overdoses and this causes the individual to stop breathing immediately. Naloxone reverses this too. The presence of fentanyl in street drugs makes it more important than ever to recognize and treat a suspected overdose immediately.

Other resources

House Bill 2112

In 2024, the Washington State Legislature passed House Bill 2112 to ensure that all institutions of higher education are providing education and access to nalaxone and fentanyl test strips (FTS) to address the growing public health impact of opioids. UW LiveWell provides the educational training piece for the University of Washington, while other campus partners fulfill the distribution of the actual products of naloxone and FTS.