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How to Recognize and Respond to a Suspected Opioid Overdose 

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An overdose can happen to anyone. It may involve prescription medication, fentanyl, alcohol, or a combination of substances. Because fentanyl can be present in other drugs without a person knowing, an opioid overdose may occur even when someone did not intend to use an opioid. 

Overdose risk is not limited to people who have a diagnosed substance use disorder or who fit common stereotypes about drug use. A person may be at risk while taking an opioid prescribed after an injury or surgery, when combining an opioid with alcohol or certain medications, or after a period of not using opioids when their tolerance has decreased. Young people may also unknowingly take a substance containing fentanyl, and children can be harmed by medications that are not stored securely. 

These shared vulnerabilities cross ages, incomes, neighborhoods, professions and family backgrounds. Recognizing that overdose can affect people throughout our community helps reduce stigma and encourages more people to carry naloxone, learn the warning signs, and respond without judgment. Knowing what to look for – and acting quickly – can help save a life. 

How to recognize the signs

During an opioid overdose, breathing can become dangerously slow or stop. The person may be unresponsive and unable to wake up, even when you call their name and tap their shoulders. Remembering the BLUE acronym can help remember the key signs of an opioid-related overdose: 

Breathing – slow, shallow, irregular, or stopped breathing

Lips – blue, gray, or purple lips or fingernails

Unresponsive – unable to wake up, limp body

Eyes – very small, “pinpoint” pupils 

Other warning signs may include: 

  • Choking, snoring, or gurgling sounds 
  • Pale, cold, or clammy skin 

Not every person will show every sign. When in doubt, treat the situation as a possible overdose. Responding is safer than waiting. 

How to respond according to the California Department of Public Health:

  1. Give naloxone and call 911.
  2. If needed, provide a second dose of naloxone (using a new naloxone container) after 2-3 minutes.
  3. Keep the person awake and breathing.
  4. If the person is not breathing you can perform rescue breathing or CPR.
  5. Lay the person on their side to prevent choking.
  6. Stay with the person until 911 responders arrive.

How to prepare

Even if you think you’ll never find yourself in a situation where you’re confronted with an overdose, being prepared can save lives. Keep naloxone at home, at work, or in a bag you carry. Tell others where it is. San Mateo County residents can get free naloxone from vending machines and naloxone stand boxes located throughout the county. Naloxone is also available without a prescription at pharmacies and major retailers, and by mail from calrxnaloxone.com.  

Visit the overdose prevention page to find free naloxone near you, watch training videos, and learn how to get involved with the San Mateo County Overdose Prevention Coalition. 

By the San Mateo County Overdose Prevention Coalition