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The opioid crisis continues to affect several lives in the United States. These medications can quickly suppress breath and cause fatalities if not treated in time. Data from the Centers for Disease Control and Prevention (CDC) states that there were 81,806 casualties related to opioid overdose in the U.S. in 2022. That is why several healthcare professionals are undergoing naloxone training to administer the medication to help overdose victims.
However, cardiopulmonary resuscitation (CPR) is also mandatory for saving lives in drug overdose emergencies. Let’s learn more about opioid overdose CPR and its role in improving survival outcomes among victims.
Opioids are a class of powerful medications often prescribed to relieve severe pain, especially after surgery, injury, or during cancer treatment. Healthcare providers may use them in hospitals and outpatient settings when other painkillers aren’t strong enough.
Natural opioids, known as opiates, are derived directly from the opium poppy plant. Common opiates include morphine, which is used medically, and heroin, which is illegal and highly addictive. You will find several other synthetic opioids on the market, such as fentanyl and methadone. However, these are not made from the poppy plant and are quite powerful.
Prescription opioids, like oxycodone and hydrocodone, are effective in managing pain when taken correctly. However, misuse can lead to addiction, overdose, or death. According to the CDC, over 75% of drug overdose deaths in 2021 involved an opioid, which shows the seriousness of the opioid crisis in the U.S. Moreover, many non-prescription opioids, especially illicit fentanyl, are distributed illegally and are major contributors to this issue.
Opioids are powerful painkillers, but misusing them can quickly spiral into something life-threatening. Many individuals take opioids without a prescription because of their pain-relieving and relaxation effects. This often leads to misuse, addiction, and overdose. The addiction starts with developing excessive opioid tolerance.
As tolerance builds, people may begin increasing their dosage to feel the same relief. This quickly leads to opioid dependence when they develop symptoms of withdrawal (e.g., nausea, sweating, anxiety, and muscle pain) after stopping it.
Please note that opioid dependence and opioid use disorder (OUD) are not the same. Dependence refers to physical reliance, while OUD includes harmful behaviors and life disruptions. According to the National Institute on Drug Abuse (NIDA), about 2.5 million people in the U.S. had an opioid use disorder in 2021.
Opioid use disorder happens when people take more of the drug, which starts causing distress or harm. This is among the critical medical emergencies you should be prepared to handle ahead of the arrival of medical personnel.
Healthcare providers often report witnessing more teenagers with opioid use disorder. It happens to those who come from diverse backgrounds and income levels. In many cases, a few teens purchase opioids, specifically fentanyl, through social media.
Meanwhile, here are some signs and symptoms to look out for in someone having an overdose:
The only solution is to call 911 immediately if someone is having an opioid overdose. Trained professionals can also provide CPR for drug overdose during this time. If you’re helping the person, make sure to stay with them until the emergency personnel arrive.
Opioid overdoses can be fatal if not handled quickly. While CPR helps, it often isn’t enough on its own. Naloxone, also known by its brand name Narcan, is a medication designed to reverse the effects of opioid overdose. With naloxone administration, opioids get blocked from attaching to the brain’s receptors, helping the person breathe again within minutes.
Naloxone is safe to use, has no addictive properties, and doesn’t cause a high. In fact, the Centers for Disease Control and Prevention (CDC) reports that in 2023, nearly 74,702 overdose deaths in the U.S. involved synthetic opioids like fentanyl. Many of these deaths could have been reversed with timely naloxone administration.
Today, naloxone is available without a prescription in most U.S. states. The most common form is the nasal spray, which is easy to carry and use, even by someone with no medical background. Other versions include an injectable form and an autoinjector EpiPen that goes into the muscle, but for public use, the nasal spray is the most practical.
You can find naloxone in all 50 states of the U.S. Several healthcare providers also co-prescribe naloxone in case of an overdose if you’ve already been prescribed an opioid. You can also ask them for an advanced prescription if they do not prescribe it. Here’s how you can safely and effectively use a naloxone nasal spray during a suspected opioid overdose:
If someone is unresponsive, breathing slowly or not at all, has blue lips or fingertips, or is making gurgling sounds, they may be experiencing an opioid overdose. Try calling their name loudly or rubbing your knuckles on their chest to check if they respond.
Before anything else, call for emergency help. Even if naloxone works, the person still needs medical attention. Tell the operator you suspect an opioid overdose so they can send appropriate support.
Lay them flat on their back to prepare for naloxone administration. Make sure their airway is clear. If there’s anything in their mouth (like food or vomit), remove it carefully.
Open the naloxone nasal spray package. Hold the device with your thumb on the bottom of the plunger and your first and middle fingers on either side of the nozzle. Gently insert the tip into one nostril and press the plunger all the way in to release the full dose.
Watch the person closely. If they start to breathe normally or regain consciousness, stay with them and reassure them. If there’s no response after 2–3 minutes, give another dose in the other nostril using a new spray device.
If the person is still not breathing or their heart has stopped, begin chest compressions or rescue breaths if you’re trained to do so. Continue until emergency help arrives.
After receiving naloxone, some individuals may wake up feeling disoriented, agitated, or even nauseous. Stay calm and keep them lying on their side (in the recovery position) to prevent choking if they vomit.
Contrary to some myths, fentanyl and other opioids are not absorbed through the skin by casual contact. You can safely touch or assist someone having an overdose without putting yourself at risk.
Opioid overdoses can cause dangerously slow or stopped breathing, which can quickly become fatal without immediate help. CPR is a key first aid step in opioid emergency response that can keep the person alive until emergency responders arrive or naloxone reverses the overdose. Here’s how to perform CPR in such emergencies, step by step.
Always call for emergency help before you start chest compressions. Tell the dispatcher that the person may be experiencing an opioid overdose and is unresponsive. Providing this detail ensures paramedics bring naloxone and other life-saving tools. If possible, use speaker mode on your phone so you can follow instructions while keeping your hands free for CPR.
Now assess their breathing and pulse at the same time. Your actions will depend on what you find:
| Breathing | Pulse | What to Do |
| Normal | Present | Place the person on their side in a recovery position if there’s no suspected spinal, neck, or pelvic injury. Monitor them until emergency help arrives. |
| Not normal | Present | Begin rescue breathing—1 breath every 5–6 seconds. Administer naloxone. Check for a pulse every 2 minutes. |
| Not breathing | No pulse | Begin full CPR with chest compressions (30:2 ratio). Attach an AED and administer naloxone as soon as available. |
| Not breathing | Present | This is respiratory arrest. Provide rescue breaths and give naloxone. Monitor pulse and breathing regularly. |
As soon as naloxone is available, give it right away; don’t wait for breathing or pulse to stop. Use 0.4 mg via IV or IM injection or 2.0 mg via intranasal spray. If there’s no response within 2–3 minutes, you can repeat the dose. Naloxone helps reverse opioid effects but should not delay CPR or breathing support if those are needed.
If you find no pulse, attach the AED pads and turn the device on. Follow the AED’s prompts. If a shock is advised, deliver it and immediately resume CPR. If no shock is advised, start or continue CPR without delay.
You should continue CPR until one of the following happens: the person shows signs of life (such as movement or breathing), trained responders take over, you become too exhausted or unsafe to continue, or you’re presented with a valid Do Not Resuscitate (DNR) order.
Always prioritize your safety. Avoid direct contact with any suspicious powders or sharp objects near the person, and use gloves or other protective gear. Be aware that patients may vomit after receiving naloxone, so place them on their side if it’s safe to do so.
Naloxone and opioid overdose CPR and first aid are the two primary techniques to help victims in emergencies. Every second counts in such situations, especially if the breathing has reduced or stopped completely. However, you must be trained enough to help drug overdose victims. This requires you to enroll in a CPR and first aid certification that teaches you how to recognize the signs of an overdose and administer naloxone correctly. This allows you to increase the chances of the person’s survival until the arrival of emergency medical personnel.
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