CPR for Opioid Overdoses: Combining Rescue Breathing with Narcan

Did you know that opioids caused over 80,000 overdose deaths in the U.S. in 2022? Opioids, like heroin, fentanyl, and prescription painkillers, can slow breathing to dangerous levels, leading to unconsciousness and even death. But, a simple medication called naloxone (Narcan) can reverse an opioid overdose. However, naloxone alone is not enough. Since opioids stop breathing, rescue breathing is just as important in keeping a person alive until emergency help arrives. This guide will teach you CPR for opioid overdose response and what to do next. 

What Are Opioids? What Drugs Are Considered Opioids?

Opioids are drugs that affect the brain and nervous system by reducing pain signals and creating a feeling of relaxation. They work by binding to opioid receptors in the brain, spinal cord, and other parts of the body. When this happens, the perception of pain decreases, and the person may feel calm or euphoric. However, opioids also slow down breathing, which can be dangerous if too much is taken. Because of their strong effects, opioids are highly addictive and can lead to dependence over time. Opioid overdoses are rising, largely due to the increasing presence of fentanyl, a powerful synthetic opioid often mixed into other drugs. Here’s brief comparison between prescription opiods and illegal opiods for your reference: 

Aspect	Prescription Opioids	Illegal Opioids
Definition	Prescription opioids are medications that doctors give to patients.	Doctors do not prescribe illegal opioids and are often made in unregulated conditions.
Common Uses	These are commonly used after surgeries, injuries, or for chronic pain.	These are commonly used recreationally, often leading to addiction and overdose.
Examples	Oxycodone (OxyContin, Percocet), Hydrocodone (Vicodin), Morphine, Fentanyl, Codeine	Heroin, Illicit Fentanyl
Safety	It is safe under medical supervision but still carries addiction and overdose risks if misused.	It is extremely dangerous, with a high risk of overdose and poisoning.
Risk	It is potent but regulated. Overdose risk increases when taken in higher doses than prescribed.	Illicit fentanyl is 50–100 times stronger than morphine, and even small amounts can be deadly.
Health Effects	It can cause dependence, respiratory depression, and withdrawal symptoms.	It can lead to severe addiction, respiratory failure, and death.

How to Recognize Opioid Overdose

You need to recognize an opioid overdose quickly, as it will help you save the victim’s life faster. Signs of an overdose include:

• Slow, shallow, or stopped breathing
• Unresponsive or unconscious (unable to wake up)
• Bluish or gray lips, fingernails, or skin
• Choking or gurgling sounds
• Very small “pinpoint” pupils
• Cold or clammy skin

If someone shows these signs, act immediately by calling 911, giving rescue breaths, and using naloxone if available. If you suspect an overdose, take action right away, as delaying can be dangerous. It’s safer to get help immediately rather than wait.

What Is Naloxone?

Naloxone, also known by the brand name Narcan, can reverse an opioid overdose. It works by quickly blocking opioids from attaching to receptors in the brain. When this happens, the harmful effects of opioids, like slow or stopped breathing, can be reversed. This allows the person to breathe normally again. Naloxone only works on opioids and does not affect other drugs like alcohol or stimulants.

Naloxone is an opioid receptor antagonist, meaning it attaches to the same receptors but does not activate them. Instead, it pushes the opioids off the receptors and blocks their effects. This allows the brain to send normal breathing signals again. Naloxone acts within minutes, but its effects are temporary, lasting about 30 to 90 minutes. If opioids are still in the body, a second dose may be needed. Naloxone comes in different forms, making it easy to use in emergencies:

• Nasal Spray (Narcan): A pre-filled device sprayed into one nostril. It is simple to use and takes effect within minutes.
• Injection: Given into a muscle (usually the thigh). This works quickly but requires some training.

Many states allow people to buy naloxone without a prescription. It is often carried by first responders, police officers, and even family members of those at risk for overdose. Naloxone access laws are different in each state, and rules can vary. First responders, police officers, and even family members of people at risk of overdose often carry it. Check your local regulations to see how you can get naloxone in your area.

How To Respond to an Opioid Overdose

If you think someone is having an opioid overdose, you must act fast. The biggest danger is that the person may stop breathing, which can lead to brain damage or death.  The steps to be followed in case of an opioid crisis CPR training are:

1. Check for a Response

First, try to wake the person up. Call their name loudly and tap them on the shoulder. If they don’t respond, shake them gently. You can also rub their sternum (the bone in the center of the chest) with your knuckles, which may cause pain and wake them up. If they do not respond, move to the next step immediately.

2. Call 911

Dial 911 right away. Tell the operator that the person is not breathing or is unresponsive. Be clear and give details about their condition. If you know they took opioids, tell the dispatcher. The faster help arrives, the better the person’s chances of survival.

3. Give Rescue Breaths

Opioids first affect the body by slowing or stopping breathing. Hence, rescue breaths are the most important step while waiting for naloxone to work. 

• Lay the person flat on their back. 
• Tilt their head back slightly to open their airway. 
• Pinch their nose closed to prevent air from escaping. Take a deep breath and breathe into their mouth slowly. Do this once every 5–6 seconds.
• Watch for their chest to rise. If it doesn’t, adjust their head and try again. Keep giving rescue breaths until they start breathing or emergency help arrives.

4. Give Naloxone (Narcan)

Naloxone is used as an overdose reversal technique. If you have Narcan nasal spray, follow these steps. Place the spray tip into one nostril. Press the plunger firmly to release the medication. Wait to see if the person starts breathing again. If you have an injectable form of naloxone, then inject it into the thigh or upper arm muscle. Hold the needle in place for a few seconds before removing it. If the person doesn’t start breathing within 2–3 minutes, give another dose of naloxone. Keep going until they wake up or help arrives.

5. Continue Rescue Breathing and CPR if Needed

If the person is still not breathing after giving naloxone, keep giving rescue breaths every 5–6 seconds. If they have no pulse, start chest compressions (CPR). Place your hands in the center of their chest. Push hard and fast, about 100–120 times per minute. Give another dose of naloxone after 2–3 minutes if they do not wake up. This method of naloxone administration with CPR ensures oxygen is flowing through the vital organs, and also opioid effects are being reversed. Do not stop until emergency responders take over.

6. Stay with the Person

Even if the person wakes up, opioids can still be in their system and may stop their breathing again. That’s why someone should stay with them. Once they regain consciousness, they may feel confused, scared, or even angry. Stay calm and reassure them. Naloxone only lasts 30–90 minutes, but the effects of opioids can last much longer. This means the overdose could return once the naloxone wears off. They still need medical help, even if they seem fine. Stay with them and monitor their breathing until emergency responders arrive.

Read More: What is the Correct Ventilation Rate for Effective Chest Compressions

Don’ts When Responding to an Opioid Overdose

When helping someone during an opioid overdose, it’s important to act correctly. Some actions can be dangerous and make the situation worse. The things you should not do are:

• Don’t let them “sleep it off.” An opioid overdose is an emergency, not just deep sleep. They need medical help.
• Don’t put them under a cold shower or bath. This does not wake them up but  can lead to shock or drowning.
• Don’t slap, shake, or hit them, as it won’t wake them up and only wastes precious time. Pain will not reverse the overdose. Instead, focus on what truly helps the victim i.e. rescue breathing and naloxone.
• Don’t try to make them vomit. Opioids act on the brain, not the stomach. Vomiting may cause choking.
• Don’t try home remedies like salt water or stimulants as they do not work and could also be dangerous. 
• Don’t leave them alone. They could stop breathing again. Stay with them until emergency responders arrive.

Aftercare for a Person After an Opioid Overdose

Surviving an opioid overdose does not mean the danger is over. Naloxone (Narcan) only works for 30–90 minutes, but opioids can stay in the body longer. Once naloxone wears off, the person may stop breathing again if opioids are still in their system. This is why medical care is necessary, even if they wake up and seem fine.

Narcan wears off fast, but opioids can stay in the body much longer. This means the person could stop breathing again, even if they seem okay. Overdoses can happen again, so getting medical help is necessary. It is important to encourage the person to go to the hospital. Emergency doctors can monitor their breathing, prevent another overdose, and offer medical support. If they refuse, someone should stay with them and watch for signs of overdose returning. If they become drowsy again or have trouble breathing, give them another dose of naloxone and call for help. If someone has overdosed once, they are at risk of it happening again. Getting help now could save their life in the future.

After the immediate emergency, it is a good time to talk to them about treatment options. Many people who overdose struggle with opioid use disorder, which is a medical condition that requires professional help. Support from doctors, counselors, and addiction specialists can help them safely stop using opioids. Encourage them to enroll in community overdose response programs as it will also help them overcome their addiction. 

Saving Lives and Supporting Recovery

Opioid overdoses are a serious problem, but knowing what to do can save a life. Naloxone and CPR for opioid overdose response can help a person breathe again. However, surviving an overdose is just the first step. Opioids can be highly addictive, and many people need long-term help to recover. Rehabilitation centers provide medical care, counseling, and support to help people stop using opioids safely. These centers also teach coping skills and offer therapy to prevent future overdoses.

If you see someone overdosing, act fast by calling 911, giving rescue breaths, and using naloxone. Stay with the person until help arrives. Opioid addiction is a disease, and treatment saves lives. Learn how to use naloxone, perform CPR, and encourage those struggling with addiction to seek help. Together, we can prevent overdoses and support recovery.

FAQs

1. Do you do CPR for an opioid overdose?

Yes, if the person is not breathing or has no pulse, start CPR. Chest compressions help circulate oxygen, and rescue breaths can restore breathing. If available, give naloxone (Narcan) to reverse the overdose. Keep doing CPR until emergency help arrives or the person starts breathing.

2.  What are the steps to respond to an opioid overdose?

First, check if the person is awake. If not, call 911. Give naloxone if you have it. Start CPR with chest compressions and rescue breaths. Keep the person on their side to prevent choking. Stay with them and continue care until medical help arrives.

3. Should normal BLS procedures be followed if an opioid overdose is suspected?

Yes, follow Basic Life Support (BLS) steps. Check for breathing and a pulse. If absent, start CPR. Use naloxone if available. Keep giving rescue breaths because opioids slow breathing. Continue CPR until emergency help arrives or the person responds.

4. What is the antidote for opioid overdose?

Naloxone (Narcan) is the antidote. It quickly reverses opioid effects and helps the person breathe again. It can be given as a nasal spray or injection. If there’s no response in 2-3 minutes, give another dose. Always call 911, even if the person wakes up.