Overdoses can kill. As a person begins to overdose their breath slows and may even stop. The key to saving the life of a person who is overdosing is to get them breathing again as quickly as possible. Overdoses are most common among those who use opioids and may be increasing in some populations or areas recently in the context of COVID-19. Drug overdoses from other drugs (e.g., cocaine, methamphetamine) have also been increasing, largely due to the mixing of these drugs with opioids such as fentanyl. Factors that increase the risk of overdose and death include drug use following a drug-free period, mixing substances, using alone, and having other medical conditions such as lung or heart conditions.
Signs of an Overdose
• Falling asleep, loss of consciousness
• Shallow or no breathing
• Limp body (though may be rigid with fentanyl)
• Choking or gurgling sounds
• Small, constricted, 'pinpoint' pupils (may be difficult to see in an emergency)
• Pale blue or cold skin, lips, or nails (factors including skin tone could make this difficult to see)
If you suspect an opioid overdose you should:
Administer naloxone. Giving naloxone to a person who is overdosing can save their life. COVID-19 should not stop you from using naloxone when needed. It is very safe to do so.
If you are trained and comfortable doing so, you can also do rescue breathing and/or chest compressions until they wake up.
When the person wakes up, advise them that treatment can help and that medication is available for opioid use disorder and wait for emergency help to arrive.
•Rescue breathing, even with a breathing mask, and chest compressions may carry a risk for COVID-19 transmission, however, these techniques when correctly done can save lives, particularly if naloxone is not available.
• There is no mandate that rescue breathing or any other form of resuscitation be taught by programs or carried out by trained responders.
• It is an individual responder’s decision, informed by the risks, whether to provide rescue breathing.
• The most critical interventions remain administration of naloxone and calling 911.
Fentanyl is a synthetic opioid that is at least 50-100 times more potent than heroin and morphine. Depending on the analog1, the potency can be even higher than that. Pharmaceutical fentanyl is approved for treating severe pain, typically advanced stage cancer pain. Illicitly made/distributed fentanyl has been on the rise in many states across America. Nearly half of all overdose deaths in New York State now involve fentanyl or its analogs. Fentanyl is often disguised or mixed into other drugs, such as heroin, methamphetamine, cocaine (both powder and crack), MDMA and fake pain, and benzodiazepine pills, often without the dealers’ or users' knowledge. Fentanyl is undetectable by sight, smell, or taste. Drugs containing fentanyl or similar highly potent opioids, even in very small amounts, substantially increase the risk of overdose and death. Just three milligrams of fentanyl can be fatal, compared to 30 milligrams of heroin.
When made and used illicitly or recreationally, fentanyl is often:
- A liquid, or a white or brown powder;
- Pressed into a pill, often mislabeled as an actual medication, such as ‘OxyContin’ or ‘Xanax’;
- Mixed in with other illicit drugs, including heroin, methamphetamine, and cocaine (both powder and crack);
You can learn more about overdoses from cocaine and other stimulants, which often involve fentanyl, from this report issued by the OASAS Medical Advisory Panel.
Naloxone, known by the brand name Narcan, is a medication that can rapidly reverse an opioid overdose from a prescription opioid, heroin, fentanyl, and other drugs mixed with opioids. Because fentanyl is more potent than other opioids, additional doses of naloxone may be required to reverse an overdose.
Naloxone nasal spray is now available in more than 2,000 pharmacies across New York State. Individuals who are at risk for an overdose and their family members and friends may acquire naloxone in these pharmacies without bringing in a prescription. Community-based organizations also dispense naloxone kits and provide free training on how to administer naloxone, and how to recognize/respond to the signs of an overdose.
- Virtual naloxone training is now available to anyone interested in learning about this life saving medication.
- Group training can be scheduled by sending a naloxone training request to [email protected].
- Naloxone training for K-12 school personnel, law enforcement, and EMS staff should be consistent with the guidelines issued by your respective oversight agency.
- K-12 school personnel should get their training online.
- Police should be trained consistent with guidelines from the New York State Division of Criminal Justice Services.
- EMS agency staff should be trained with guidance from their Regional Emergency Medical Advisory Committee.
Naloxone is not a substitute for medical attention. The effects of naloxone will last 30-90 minutes, until emergency medical attention arrives, but could wear off, and put the person at risk of going back into an overdose. Also, overdoses are often associated with other serious medical problems that require medical attention. The New York State 911 Good Samaritan Law allows individuals witnessing or experiencing a drug or alcohol overdose to call 911 without fear of arrest or prosecution for certain crimes.
Overdose Prevention Tips
Anyone can overdose, especially when using drugs for the first time or using after a period of not using. If you have overdosed previously, you are much more likely to overdose again. Don’t use alone. If you do use alone, make sure someone knows where you are and that you are using so that they can check on you by phone/text and notify 911 if you don’t respond. You also can use the Never Use Alone number in case you don’t have anyone else you can notify.
- Be careful when using. Remember that fentanyl could be present in any drug and drastically increases your risk of overdose and the strength of a particular drug can be different every single time.
- Try not to mix drugs as this can increase the risk for overdose. Be particularly cautious when using benzodiazepines, alcohol, and/or opioids together.
- Have a safety plan written down that you can refer to before/during use. This can be helpful and decrease the chances of a fatal overdose. The NYS DOH has a resource called Build a Safety Plan available in English and Spanish.
- Never Use Alone is a number that anyone can call when they are about to use a substance. An operator will then stay on the line with the person while they use. If the person does not respond after a set amount of time after use, the operator will notify emergency services of the person’s location for response.
Help is Available
Opioid use disorder is a chronic disease— like diabetes or high blood pressure —and like any chronic disease, often requires chronic medication to manage it. Effective treatment of opioid use disorder which includes medications (buprenorphine, methadone, or long-acting naltrexone injection) can decrease the risk of overdose and recurrent use. Creating connections in your community can also help you feel less isolated and can link you to support and help.
Print and video materials are available for download and streaming free of charge in English and Spanish.
An online and mail-based harm reduction platform that deliveries harm reduction supplies to New Yorkers outside of New York City.
Harm Reduction Coalition:
COVID-19 Information and Resources
- Addiction Prevention, Treatment and Recovery Resources
- Centers for Disease Control and Prevention: Coronavirus (COVID-19) Website
- NYS Department of Health Coronavirus Website
Emotional and Mental Health
- NYS Office of Mental Health Emotional Support Help Line Call
1-844-863-9314, 7 days a week from 8am – 10pm
- COVID-19: Playing the Long Game for your Mental Health
- Coping with Stress during COVID-19, from the World Health Organization (Arabic | Chinese | French | Russian | Spanish)