Signs and Symptoms of Medication Overdose You Should Recognize

Knowing the signs of a medication overdose could save a life-yours or someone else’s. It doesn’t matter if it’s a prescription painkiller, a sleeping pill, or something bought off the street. Too much of any drug can shut down your breathing, stop your heart, or cause irreversible brain damage in minutes. You don’t need to be a doctor to spot the warning signs. You just need to know what to look for.

What Does an Overdose Actually Look Like?

An overdose isn’t always dramatic. It doesn’t always involve screaming, collapsing, or foaming at the mouth. More often, it’s quiet. Someone is unusually sleepy, barely responding to their name, or breathing so slowly you can barely see their chest rise. That’s the danger. By the time someone looks obviously sick, it might be too late.

The most common cause of fatal overdose in the U.S. today is synthetic opioids like fentanyl. These drugs are 50 to 100 times stronger than morphine. A single counterfeit pill made to look like oxycodone can contain a lethal dose. And because people don’t know what’s in it, they take what they think is a normal dose-and it kills them.

General Signs of Overdose Across All Drugs

No matter what drug is involved, some warning signs are universal:

• Unresponsiveness-the person can’t be woken up, even when shaken or called loudly.
• Slow, shallow, or irregular breathing-fewer than 12 breaths per minute, or pauses longer than 10 seconds between breaths.
• Blue or gray lips and fingernails-this means oxygen levels are dropping dangerously low.
• Pale, clammy skin-especially on the face and extremities.
• Gurgling or snoring sounds-this isn’t sleep; it’s fluid building up in the airway because the person can’t swallow or breathe properly.
• Vomiting while unconscious-this is a major red flag for alcohol or depressant overdose.
• Confusion, agitation, or hallucinations-common with stimulants like cocaine or meth.

If you see even one of these signs, don’t wait. Call 911 right away.

Signs by Drug Type

Different drugs affect the body in different ways. Recognizing the pattern helps you respond faster.

Opioids (Heroin, Fentanyl, Oxycodone, Codeine)

Opioid overdoses follow a clear pattern called the “triad”:

• Pinpoint pupils-the black part of the eye shrinks to the size of a pinhead.
• Unconsciousness-the person can’t be roused, even with pain.
• Slow or stopped breathing-this is what kills. Breathing drops below 8 per minute.

Other signs: extreme drowsiness, cold skin, limp body, and a snore-like gurgle. In 91% of fatal opioid overdoses, breathing stops completely.

Stimulants (Cocaine, Methamphetamine, Adderall)

These drugs overwork the heart and brain:

• High body temperature-over 104°F (40°C). Skin feels hot and dry.
• Fast, pounding heartbeat-pulse over 120 beats per minute.
• Seizures-uncontrolled shaking or convulsions.
• Paranoia, aggression, or hallucinations-the person may believe they’re being chased or attacked.
• High blood pressure-systolic over 180 mmHg.

Unlike opioids, stimulant overdoses often start with panic and hyperactivity before crashing into heart failure or stroke.

Depressants (Alcohol, Benzodiazepines, Barbiturates)

These drugs slow everything down:

• Slurred speech-like they’re drunk, but not from alcohol.
• Loss of coordination-tripping, falling, can’t walk straight.
• Very slow breathing-as few as 6 breaths per minute.
• Vomiting while passed out-this is deadly. People choke on their own vomit.
• Low body temperature-skin feels cold to the touch.

Alcohol poisoning is a type of depressant overdose. If someone drinks too much and passes out, they’re not “sleeping it off.” They’re dying.

What to Do If Someone Overdoses

Time is everything. Here’s what to do-step by step:

1. Call 911 immediately. Don’t wait. Don’t try to handle it alone. Say, “Someone is overdosing. They’re not waking up and not breathing right.”
2. Give naloxone if you have it. Naloxone (brand name Narcan) reverses opioid overdoses. It comes as a nasal spray. Spray one dose into one nostril. If there’s no response after 2-3 minutes, give a second dose. You can’t overdose on naloxone-it’s safe even if the person didn’t take opioids.
3. Put them on their side. This is called the recovery position. It stops them from choking if they vomit.
4. Stay with them until help arrives. Even if they wake up, they can crash again. Don’t leave them alone.
5. Don’t try home remedies. No ice baths, no coffee, no slapping them. These don’t work-and can make things worse.

What NOT to Do

Many people make these mistakes-and they cost lives:

• Don’t let them “sleep it off.” One in three fatal overdoses happens because someone waited too long.
• Don’t give them a cold shower. It can cause shock or heart rhythm problems.
• Don’t try to make them vomit. They could choke.
• Don’t assume they’re just drunk. Many overdoses happen in people who drink alcohol with other drugs.

Prevention: How to Reduce the Risk

The best way to avoid an overdose is to prevent it before it happens:

• Use fentanyl test strips. These cost about $1 each. Put a tiny bit of powder in water, dip the strip, and wait a minute. If it shows fentanyl, don’t use it. In 2022, 67% of counterfeit pills tested in California contained fentanyl.
• Don’t use alone. If something goes wrong, someone can call for help. Many states now have “Good Samaritan” laws that protect people who call 911 during an overdose.
• Carry naloxone. Since March 2023, Narcan has been available over the counter at pharmacies for around $40-$50. Keep one in your bag, car, or medicine cabinet.
• Know your tolerance. If you’ve been away from opioids for a week or more, your body has lost tolerance. A dose you used to take can now kill you.
• Check pill colors and markings. Fake pills look real-but they’re often made in unregulated labs. If a pill looks different from what you usually take, don’t take it.

Why This Matters Right Now

In 2022, over 107,000 people in the U.S. died from drug overdoses. Most were from synthetic opioids. Fentanyl is now found in nearly every drug supply-from cocaine to counterfeit Xanax. The death rate among Black Americans rose 21% between 2020 and 2022. It’s no longer a problem that affects only one group. It’s everywhere.

And it’s getting worse. Experts predict overdose deaths will hit 120,000 per year by 2025 unless something changes. But change is possible. States with naloxone distribution programs saw a 14% drop in overdose deaths. People who carried naloxone saved 85% of opioid overdoses when they acted within 2-3 minutes.

You don’t need to be an expert to make a difference. You just need to know the signs. You just need to act.

Next Steps: What You Can Do Today

- Download the Naloxone Saves app to find free naloxone kits near you. It works in all 50 states.

- Ask your pharmacist for Narcan. You don’t need a prescription. It’s on the shelf next to pain relievers.

- Keep a fentanyl test strip in your wallet. If you or someone you know uses drugs, this simple tool can prevent death.

- Talk to someone. If you’re worried about a loved one’s drug use, call SAMHSA’s National Helpline at 1-800-662-4357. It’s free, confidential, and available 24/7.

The next overdose might happen in your home, your neighborhood, or your workplace. You won’t always know it’s coming. But if you know the signs-and you know what to do-you can stop it.