A drug overdose happens when a person takes more of a substance, or a combination of substances, than their body can safely process. It can affect anyone who uses drugs or medications, whether the use is occasional, ongoing, or accidental, and it can escalate within minutes. Knowing the warning signs and how to respond can save a life.
Overdose deaths remain a serious public health concern in the United States, and the Centers for Disease Control and Prevention and SAMHSA emphasize that many are preventable when people recognize the signs early and act quickly. This page explains what an overdose can look like across different drug classes, how to respond to a suspected opioid overdose using naloxone, and the basic rescue steps that keep a person as safe as possible until help arrives.
The single most important message is this. When an overdose is suspected, do not wait to be certain. Treat it as an emergency and get help immediately.
Overdose Signs by Drug Class
Different substances affect the body in different ways, so overdose can look different depending on what was taken. Many overdoses also involve more than one substance at once, which can make signs harder to read. When in doubt, treat any of the following as an emergency.
| Drug class | Common overdose signs |
|---|---|
| Opioids (heroin, fentanyl, prescription pain medication) | Slow, shallow, or stopped breathing, pinpoint pupils, blue or gray lips and fingertips, limp body, gurgling or choking sounds, unresponsiveness. |
| Stimulants (cocaine, methamphetamine) | Chest pain, racing or irregular heartbeat, very high body temperature, agitation, confusion, seizures, and risk of stroke or cardiac emergency. |
| Depressants including benzodiazepines | Extreme drowsiness, confusion, slurred speech, weak or slow breathing, and unresponsiveness, with greatly increased danger when combined with alcohol or opioids. |
| Alcohol (alcohol poisoning) | Confusion, vomiting, seizures, slow or irregular breathing, low body temperature, pale or bluish skin, and inability to stay awake or wake up. |
Responding to an Opioid Overdose and Using Naloxone
Naloxone is a medication that can rapidly reverse an opioid overdose by restoring breathing. It is available as a nasal spray and, according to SAMHSA, is safe, easy to use, and available without a prescription in many pharmacies and community programs. Naloxone only works on opioids, but because opioids are so often involved and because it is not harmful if opioids are not present, giving it during a suspected overdose is a reasonable step.
- Call 911 first, or have another person call while aid is given.
- If opioids may be involved and naloxone is available, give a dose according to the package instructions.
- Naloxone can wear off before the opioids do, so a person can slip back into overdose. A second dose may be needed, and emergency care is still essential.
- After giving naloxone, place the person in the recovery position and monitor their breathing until help arrives.
- The person may wake confused or in withdrawal. Stay calm, keep them safe, and encourage them to wait for paramedics.
Basic Rescue Steps and the Recovery Position
While waiting for emergency responders, a few simple actions can help keep a person alive. Medical training is not needed to make a difference, and the dispatcher on the phone can guide a bystander through each step.
- Try to wake the person by calling their name and firmly rubbing knuckles on their breastbone.
- Check whether they are breathing. If breathing has stopped, a trained bystander can begin rescue breaths or CPR as directed by the 911 dispatcher.
- If they are breathing but unconscious, place them in the recovery position: roll them onto their side, with the lower arm extended and the top knee bent to keep them stable, and tilt the head slightly back so the airway stays open. This helps prevent choking if they vomit.
- Do not leave the person alone, and do not put them in a cold shower or try to make them vomit.
- Stay until help arrives, and share any information about what was taken.
Why Overdose Risk Has Been Rising
Overdose is not a sign of weakness or a moral failing. It is a physiological event, and several factors that have little to do with how much a person intends to take can push the body past what it can safely handle. Understanding these factors helps families and communities respond with clarity rather than blame, and it helps explain why the risk today is different from what it was a decade ago.
The Centers for Disease Control and Prevention and NIDA point to a small number of drivers behind the rise in overdose deaths. The drug supply itself has changed and become far less predictable. Many people use more than one substance at a time, which multiplies the strain on breathing and the heart. And a person's tolerance can drop quickly after any break from use, so a dose that once felt routine can become dangerous. None of these factors requires a person to be using more than before. Often the amount stays the same while the risk quietly climbs.
- An unpredictable supply. Substances bought outside a pharmacy can vary widely in strength and content from one batch to the next, so a person cannot reliably judge a safe amount.
- Polysubstance use. Combining substances, especially any two that slow breathing, raises the danger sharply because their effects stack on top of one another.
- Lowered tolerance. After detox, incarceration, hospitalization, or any period without use, the body adjusts, and a previously familiar amount can overwhelm it.
- Using alone. When no one else is present, there is no one to call for help or give naloxone, which turns a survivable event into a fatal one.
Fentanyl and the Changing Drug Supply
Illicitly manufactured fentanyl is a synthetic opioid that is far more potent than heroin, and it has reshaped the risk landscape across the country, including in New Mexico. According to the CDC and DEA, fentanyl is now frequently mixed into other drugs, including counterfeit pills made to look like prescription medication, and into stimulants such as cocaine and methamphetamine. A person may have no way of knowing that fentanyl is present, and because it is active in very small amounts, even a slight miscalculation can be life threatening.
This is why overdoses now happen to people who believe they are taking something else entirely. Someone who has never knowingly used an opioid can still experience an opioid overdose if the substance they took was contaminated. It is also why naloxone matters so broadly. Because fentanyl is an opioid, naloxone can reverse a fentanyl overdose, though more than one dose is sometimes needed given fentanyl's potency.
Fentanyl test strips as a harm reduction tool
Fentanyl test strips are an inexpensive way to check whether a drug contains fentanyl before it is used. Public health agencies, including SAMHSA, describe them as a practical harm reduction measure that can prompt a person to use less, use with someone nearby, or not use at all. Test strips do not make any drug safe, and they cannot measure exactly how much fentanyl is present, but they add a layer of information where there would otherwise be none. Many community and public health programs distribute them at low or no cost.
Why a small amount matters so much
The danger with fentanyl comes from its potency rather than any single behavior. Because it is effective at doses far smaller than other opioids, contamination that is invisible to the eye can be enough to slow or stop breathing. Treating any suspected opioid exposure as a possible fentanyl exposure, and keeping naloxone within reach, reflects the reality of today's supply rather than an overreaction to it.
Lowered Tolerance and the Risk After a Break From Use
One of the most misunderstood aspects of overdose is that risk can actually rise after a person stops using for a while. When someone uses a substance regularly, the body adapts and builds tolerance, meaning it takes more of the substance to produce the same effect. When use stops, whether through detox, a hospital stay, time in custody, or a personal decision to pause, that tolerance fades, sometimes within days.
If a person then returns to a previous amount, the body may no longer be able to handle it. NIDA identifies this loss of tolerance as a leading reason overdoses cluster around the first days and weeks after a period of abstinence. This is a clinical fact, not a reason to avoid stopping. It is precisely why the days after detox are a time for close support rather than isolation, and why a structured step-down into ongoing care matters so much.
Recognizing this pattern reframes how families understand a return to use. A recurrence of use after a period away is a medical event that calls for a rapid, compassionate response, including having naloxone available and re-engaging with treatment. It is not evidence that recovery is impossible.
How Treatment Reduces the Risk of Overdose
Responding to an overdose in the moment saves a life. Connecting to treatment afterward is what changes the odds going forward. Evidence gathered by NIDA and SAMHSA is consistent on this point: sustained treatment for a substance use disorder, and medication for opioid use disorder in particular, substantially lowers the risk of a future overdose. The goal is not simply to survive one crisis but to build the medical care, stability, and support that make the next one far less likely.
Ascend Recovery Center in Albuquerque offers a full continuum of care under one roof, so a person does not have to navigate the fragile days after an overdose alone. Care can begin with medically supervised detox and continue through residential and outpatient levels, with the clinical team coordinating each step based on the person's individual progress. Ascend is accredited by the Joint Commission and maintains 24/7 LPN nursing on site for detox and residential care, with 18 beds available.
Medically supervised detox
For many people, safer footing begins with medical detox. At Ascend, detox is supported by 24/7 LPN nursing, and clients are assessed with recognized withdrawal scales, using CIWA for alcohol withdrawal and COWS for opioid withdrawal, so care can be adjusted to what the body is actually experiencing. A medical provider sees detox clients within hours of admission. Managing withdrawal in a monitored setting is far safer than attempting it alone, and it removes one of the situations in which people are most likely to return to use with a lowered tolerance.
Medication-assisted treatment for opioid use disorder
Medication-assisted treatment, or MAT, combines medications with counseling and is recognized by NIDA and SAMHSA as one of the most effective ways to reduce overdose risk for opioid use disorder. Ascend's approach uses Suboxone, Sublocade, and Naltrexone or Vivitrol, paired with clinical support. Ascend does not offer methadone; methadone is not in its formulary, and the team refers people who need it to a federally licensed opioid treatment program. These medications work by stabilizing brain chemistry, easing cravings, and, in the case of Vivitrol, blocking the effect of opioids, which together reduce the likelihood of a return to risky use.
Ongoing support and relapse prevention
Because overdose risk is highest during unstable transitions, staying connected to care matters. Counseling, group work, relapse prevention planning, and family involvement all help a person hold onto progress after the acute danger has passed. Ascend coordinates step-downs between levels of care within its own system, so support does not abruptly end when detox does. Keeping naloxone on hand is part of any realistic safety plan, giving a person and their loved ones a safety net during the vulnerable early weeks.
Being Prepared: Naloxone Access for Families and Communities
Naloxone is most useful when it is already on hand before an emergency happens. SAMHSA and the CDC encourage people who use opioids, along with their families, friends, and anyone likely to witness an overdose, to carry naloxone and to know how to use it. Because it is available without a prescription in many pharmacies and through community programs, keeping it accessible is a straightforward way to prepare.
Having naloxone within reach is not a sign of expecting the worst. It is the same kind of preparation as keeping a fire extinguisher or learning basic first aid. For families whose loved one is early in recovery or has recently completed detox, when tolerance is lower, naloxone offers a critical margin of safety during the highest-risk period.
- Keep naloxone in an easy-to-reach place at home and know where it is kept.
- Make sure more than one person in the household knows how to recognize an overdose and give naloxone.
- Check expiration dates periodically and replace naloxone as needed.
- Pair naloxone with a simple plan: call 911 first, give naloxone, and use the recovery position while waiting for help.
- Contact a pharmacy, local health department, or the SAMHSA National Helpline to find no-cost or low-cost naloxone nearby.
Overdose Is a Medical Emergency, and Recovery Is Possible
Surviving an overdose is not the end of the story. An overdose is a serious warning sign, and it is also a moment when support can change the course of a person's life. After the immediate emergency is handled, connecting with treatment can address the underlying substance use disorder and reduce the risk of another overdose.
For opioid use disorder, medication assisted treatment combines medications such as buprenorphine or naltrexone with counseling and support, and it is recognized by NIDA and SAMHSA as an effective, evidence based approach. Medically supervised detox followed by ongoing care gives a person a stable, supported path forward. When a person or their loved one has experienced an overdose, reaching out for help is a powerful next step.
Frequently Asked Questions
What should a bystander do first when someone may be overdosing?
Does naloxone work on all drug overdoses?
Can a person overdose again after naloxone wears off?
What is the recovery position and why does it matter?
Will a caller get in trouble for calling 911 during an overdose?
What happens after someone survives an overdose?
Why is fentanyl such a serious overdose risk?
Why is overdose risk higher after detox or a break from using?
How does treatment lower the risk of a future overdose?
Should families keep naloxone at home?
After an overdose, help is available
When a person or their loved one has survived an overdose, the Ascend clinical team in Albuquerque can help with a confidential assessment and a supported path into care, from medical detox through medication assisted treatment. In an emergency, always call 911 first.