What Happens During a Heroin Overdose
A heroin overdose happens when the drug slows breathing so much that the brain and body stop getting enough oxygen. It can happen to someone who has used for years or to someone using for the first time. If you think someone is overdosing right now, call 911 and give naloxone (Narcan) if you have it.
If Someone Is Overdosing Right Now
Act even if you aren’t sure what the person took. Naloxone is safe to give when you can’t tell, and it won’t harm someone who hasn’t used opioids.
- Call 911 and tell the dispatcher the person is unresponsive or not breathing normally.
- Give naloxone as quickly as possible. Don’t wait for emergency workers to arrive.
- Try to keep the person awake and breathing.
- Lay them on their side so they don’t choke if they vomit.
- If they aren’t breathing normally after 2 to 3 minutes, give a second dose if you have one.
- Stay with them until help arrives.
Naloxone is a temporary treatment. It can wear off while heroin or fentanyl is still in the body, so the person needs emergency care even if they wake up and say they feel fine. The CDC advises staying with someone who has received naloxone until help arrives, or for at least four hours.
Signs of a Heroin Overdose
An overdose can look like a very deep sleep. The difference is that you can’t wake the person, and their breathing is slow, shallow or has stopped. Signs include:
- Very small, pinpoint pupils
- Falling asleep or losing consciousness
- Slow, shallow breathing or no breathing at all
- Choking or gurgling sounds
- A limp body
- Blue, gray or pale skin, especially on the lips and fingernails
If the person doesn’t respond when you shout their name or shake them, treat it as an overdose.
Why Heroin Overdoses Happen
Heroin attaches to opioid receptors in the brain, including the ones that control breathing. Too much of it slows breathing until oxygen levels drop, which can lead to coma, permanent brain damage or death. Several things raise the risk:
- Fentanyl is in most of the supply. According to the CDC, most heroin sold in the United States is now mixed with illegally made fentanyl, which you can’t see, smell or taste, and a very small amount can stop someone’s breathing.
- Alcohol and other drugs add to the effect. Alcohol, benzodiazepines and other sedatives also slow breathing, and their effects stack on top of heroin’s.
- Tolerance drops after a break. After detox, a hospital stay, time in jail or a stretch of not using, the body can no longer handle the amount it once did, so going back to an old dose is a common cause of overdose.
- Using alone removes the safety net. When no one else is there, no one can call 911 or give naloxone.
What Happens After an Overdose
In the emergency department, the medical team watches breathing and oxygen levels, gives more naloxone if needed and checks for harm caused by low oxygen. Vomiting while unconscious can also lead to a lung infection, so doctors watch for that as well.
Naloxone works by pushing heroin off the brain’s opioid receptors, which can bring on heroin withdrawal symptoms within minutes. Waking up sick and frightened is common, and the urge to use again to stop the sickness can be strong. If you’re with someone who has just been revived, stay calm, keep them company and encourage them to stay for medical care.
An overdose is a clear sign that heroin use has become life-threatening. For many families, it is also the moment when a conversation about treatment starts to feel possible.
Treatment After a Heroin Overdose on Cape Cod
Foundations Group Recovery Centers provides outpatient care in Mashpee, Massachusetts, for people living with opioid use disorder. We don’t run an on-site detox unit. When someone needs medically supervised withdrawal first, our team coordinates placement with partner providers and helps plan the move into treatment afterward.
Our outpatient treatment for heroin use starts with an assessment. From there, care can include day treatment (a partial hospitalization program, or PHP), our half-day treatment program, which insurers often call intensive outpatient (IOP), and standard outpatient therapy, along with medication when it fits your needs. Your care team sets the pace as you step down from one level to the next.
If you aren’t sure which level of care makes sense, a substance use evaluation with a licensed clinician gives you a written summary and treatment recommendations. You can check your insurance coverage online or call our admissions team at (844) 763-4966.
faq
Frequently Asked Questions
Massachusetts has a Good Samaritan law (M.G.L. c. 94C, § 34A) that protects people who seek medical help for an overdose. When evidence comes from the call for help, neither the caller nor the person overdosing can be charged with drug possession because of it, and it can't be the basis for a probation or parole violation. The law doesn't cover charges such as trafficking, distribution or possession with intent to distribute. If you have specific legal concerns, talk with an attorney, but don't let worry about charges delay a 911 call.
Pharmacies sell naloxone nasal spray over the counter, so you don't need a prescription. Some community health and harm reduction programs also give it out at no cost. If someone in your home uses heroin or other opioids, keep naloxone where everyone in the household knows to find it.
Yes, it can happen. A person without a tolerance to opioids is at higher risk, and because fentanyl is so common in the heroin supply, there is no reliable way to judge how strong a single use will be.
Yes, naloxone reverses fentanyl overdoses as well. Because fentanyl is so strong, more than one dose is sometimes needed, which is why it helps to keep two doses on hand.