Harm reduction · UK
Overdose: recognise it, respond to it
A clear, judgment-free guide for spotting an overdose and acting in the first few minutes. Information only — never a substitute for emergency services. If you're unsure, always call 999.
If someone is overdosing
Call 999 first. Stay with them.
You will not get in trouble for calling 999 for someone who has overdosed, even if drugs are present. The call handler's only priority is saving their life.
Signs
How to recognise an overdose
Opioids (heroin, fentanyl, oxycodone, methadone, codeine)
- Very slow, shallow or stopped breathing
- Blue or grey lips, fingertips or face (lighter skin) / pale or ashen (darker skin)
- Pinpoint pupils
- Unresponsive — won't wake to shouting or a firm sternum rub
- Limp body, gurgling or snoring sound ("death rattle")
Alcohol
- Confusion, can't be woken
- Vomiting while unconscious
- Seizures or fits
- Slow or irregular breathing (fewer than 8 breaths/min)
- Cold, clammy, pale or bluish skin
- Low body temperature (hypothermia)
Stimulants (cocaine, crack, meth, MDMA)
- Chest pain, racing or irregular heartbeat
- Severe headache, confusion, agitation
- Very high body temperature, heavy sweating
- Seizures, collapse
- Trouble breathing
Benzodiazepines & mixed/poly-drug
- Extreme drowsiness, can't be roused
- Slurred speech, loss of coordination
- Slow or stopped breathing (especially with opioids or alcohol)
- Mixing benzos + opioids + alcohol is one of the highest-risk combinations
First response
What to do — in order
- 1
Try to wake them
Shout their name. Rub the centre of their chest firmly with your knuckles (a "sternum rub"). If they don't respond, treat as an overdose.
- 2
Call 999 immediately
Tell the operator: "I think someone has overdosed." Give the address. Stay on the line.
- 3
If you have naloxone, give it
For suspected opioid overdose, give a dose of naloxone (Nyxoid nasal spray or Prenoxad injection) following the kit's instructions. If no response in 2–3 minutes, give another dose. Keep going until they breathe or help arrives.
- 4
Open the airway, check breathing
Tilt their head back, lift their chin. Look, listen and feel for breathing for up to 10 seconds.
- 5
If not breathing — start CPR
30 chest compressions (centre of chest, hard and fast — about 2 per second) then 2 rescue breaths, and repeat. If you don't feel able to give breaths, just do continuous chest compressions until help arrives.
- 6
If breathing — recovery position
Roll them onto their side, head tilted back, top leg bent for stability. This keeps the airway open and stops them choking if they vomit.
- 7
Stay with them until paramedics arrive
Naloxone wears off in 30–90 minutes — they can stop breathing again. Don't let them leave, don't let them use again, don't leave them alone.
Quick reference
Do and don't
Do
- Call 999 — every time
- Give naloxone if you have it (opioids)
- Put them in the recovery position
- Keep them warm and stay close
- Tell paramedics what they took (honestly)
Don't
- Put them in a cold bath or shower
- Make them vomit
- Try to "walk it off" or give coffee/food
- Inject them with anything other than naloxone
- Leave them alone, even after they wake up
Take-home naloxone
Naloxone — the opioid reversal drug
Naloxone (brand names Nyxoid, Prenoxad) temporarily reverses an opioid overdose by knocking opioids off the brain's receptors. It only works on opioids — not alcohol, benzos, or stimulants — but giving it to someone who hasn't taken opioids causes no harm.
In the UK, take-home naloxone is free and legal for anyone to carry. You can get a kit and 5-minute training from most local drug & alcohol services, many needle-exchange pharmacies, and outreach teams.
- Find a local service via talktofrank.com/get-help/find-support-near-you
- Or via the We Are With You service finder
- Naloxone wears off — always call 999 even if the person wakes up
The next 24 hours
After an overdose
Surviving an overdose is exhausting and disorienting — for everyone involved. There's no "right" way to feel afterwards. Shock, shame, relief and fear can all show up at once.
- Get a medical check-up even if you feel okay (especially after naloxone — risk of pulmonary oedema)
- Talk to a drug and alcohol service within 24–48 hours — they can help with tolerance, prescribing and a fresh plan
- Reach out to a person who makes you feel safe
- You can talk to Sanctuary Recovery AI any time — no judgment
Harm reduction
Reducing the risk of overdose
- Don't use alone. If you must, tell someone, use the Brave app, or call the Never Use Alone line.
- Don't mix. Especially opioids + benzos + alcohol.
- Test a small amount first when using anything from a new source.
- Avoid using after a tolerance break (prison, hospital, detox, illness).
- Carry naloxone and make sure friends/family know how to use it.
- Know what you've taken. UK drug checking services: WEDINOS (free postal testing, Wales-based but UK-wide).