What to Do During a Heroin Overdose

A heroin overdose is a medical emergency and one that can be fatal within minutes.^1,2 With the introduction of the extremely potent synthetic opioid fentanyl to the heroin market all across the United States, overdose deaths have risen significantly in recent years.^3,4 Now more than ever, it’s important to know the signs of an overdose and act quickly.

It’s also imperative that if you use heroin or other opioids, or know someone who does, to have Narcan, the opioid overdose reversal drug, on hand. Many states have enacted legislation that widens access to naloxone to friends, family, or anyone witness to a potential overdose situation.⁵ Using this medication immediately can save the life of an overdosing person.⁵

How to Help if Someone is Experiencing a Heroin Overdose

The first thing to do if you notice someone exhibiting the signs of a heroin overdose is call 911. Even if you use Narcan, you must call 911 for emergency medical assistance. Narcan will eventually wear off, and the person will need medical care, or they could re-experience the symptoms of overdose.⁶

Here’s what to do after you’ve called 911:^6,7

• Give a dose of naloxone (Narcan). View our naloxone training video.
• Perform CPR if trained to do so.
• If there is no reaction to the naloxone within 2-3 minutes, administer another dose.
• Once the person has begun breathing again, prevent choking by placing them in the recovery position: Put them on their side with one hand under their head for support. Bend the knee of the topmost leg and pull both the leg and the top arm over the body to keep the person from rolling onto their back.
• Stay with the person until help arrives. 

Laws Protecting Good Samaritans

If you’re worried about helping someone in an overdose situation because you fear legal trouble, don’t be. In many states, including Nevada, legal protections are in place for those who seek help for themselves or others in an overdose situation.^5,6,7

Per NV law, as long as you act “in good faith and with reasonable care,” you cannot be arrested for possessing controlled substances or drug paraphernalia or for being intoxicated by alcohol if you are underage.⁶

Legal protections don’t apply for charges related to intent to sell/distribute or for child neglect or endangerment. You are also not legally protected if you have an active warrant for your arrest.⁷

Signs of a Heroin Overdose

Common signs of a heroin overdose include:⁸

• Pinpoint (extremely small) pupils.
• Extreme sleepiness or loss of consciousness.
• Slow, shallow, or stopped breathing.
• Gurgling and/or choking sounds.
• Limpness of the body.
• Pale or blue skin or fingernails.

Heroin Overdose Risk Factors

While anyone who uses heroin is at risk for overdose at any time, certain situations may make overdose more likely. Risk factors for heroin overdose include:⁹

• Having an opioid use disorder.
• Injecting heroin.
• Using heroin again after an extended period of not using (for example, after completing a detox program).
• Using heroin in combination with alcohol or other substances that slow the breathing, such as benzodiazepines (e.g., Xanax) or sleep aids (e.g., Ambien).
• Having an additional medical condition such as HIV, liver disease, lung disease or concurrent mental health issues.

Opioid Overdose Deaths in the U.S.

The United States has been battling an opioid overdose epidemic for many years, especially with the increasing presence of fentanyl and fentanyl analogues in heroin and other illicit drugs.⁴

The COVID-19 pandemic also seems to have worsened the crisis. Between the 12-months ending in June 2019 to the 12-months ending in May 2020:⁴

• The number of deaths resulting from opioid overdose increased more than 18%, totaling approximately 81,230.
• 25 states and the District of Columbia saw an increase of more than 20% in opioid overdose deaths.
• 11 states and New York City saw increases of 10-19% in opioid overdose deaths.
• Deaths resulting from synthetic opioids such as fentanyl increased by more than 38%.
• Whereas synthetic opioids were largely found in states east of the Mississippi prior to 2019, during this time period 10 western states saw a 98% increase in synthetic opioid-related deaths.
• Deaths involving cocaine rose nearly 27%, an increase largely associated with the co-use of cocaine and synthetic opioids.