What Are the Signs of an Alcohol or Drug Overdose?

Dear Reader,

When you love someone who is struggling with substance use, your mind is often a battleground of constant worry. You might find yourself checking on them late at night, listening intently to hear if they are breathing, or constantly monitoring their mood and behavior.

The fear of an alcohol or drug overdose is a heavy, quiet burden to carry. However, knowledge is your most powerful tool. Knowing exactly what a drug overdose looks like can pierce through the panic of a crisis, allowing you to act swiftly, confidently, and ultimately save the life of the person you love.

Because different drugs affect the body in different ways, the signs of an overdose vary depending on the substance involved. Here are the critical signs to watch for, categorized by drug type.

1. How an Opioid Overdose looks like?

Opioids like fentanyl, heroin, oxycodone, etc. slow down the central nervous system, including the automatic drive to breathe. With the rise of synthetic opioids like fentanyl, overdoses can happen in seconds. Watch for what clinicians call the "opioid triad" and other key physical signs:

• Slow, shallow, or stopped breathing: Their chest may barely move, or they may breathe fewer than 8 to 10 times a minute.

• Unresponsiveness: They cannot be woken up by shouting, shaking, or firmly rubbing your knuckles on their sternum (breastbone).

• Blue, gray, or pale skin and lips: Due to a lack of oxygen, their lips, gums, and fingernails may turn blue, purple, or gray.

• Pinpoint pupils: Their pupils will look incredibly small, like the tip of a pen.

• Choking or gurgling sounds: Often referred to as a "death rattle," these snoring or choking noises indicate their airway is obstructed.

• Limp body: Their limbs will feel completely heavy and lifeless.

2. How a Stimulant Overdose looks like?

Unlike opioids, stimulants like cocaine, methamphetamine or ADHD meds speed up the body's systems to dangerous levels. A stimulant overdose (sometimes called "overlamping") can cause a sudden heart attack, stroke, or severe psychological distress. Keep an eye open for:

• Extreme chest pain or rapid heart rate: They may complain of their heart racing or feeling like it is jumping out of their chest.

• Seizures or intense tremors: Uncontrolled shaking or sudden fits.

• Dangerously high body temperature: They may feel burning hot to the touch, sweat profusely, or experience severe dehydration.

• Psychosis and extreme paranoia: They may experience hallucinations, behave aggressively, or show intense, irrational fear.

• Difficulty breathing: Gasping for air or rapid, shallow hyperventilation.

3. How a Depressant Overdose Looks Like?

Benzodiazepines like Xanax or Valium are depressants and sedatives that calm brain activity. If someone takes them in excess —or especially when mixed with opioids or alcohol— they can shut the body down completely. These are the symptoms to watch for:

• Profound drowsiness: An inability to stay awake or talk coherently.

• Slowed pulse and low blood pressure: Their pulse may feel faint or incredibly slow.

• Uncoordinated movements: Severe dizziness, slurred speech, and an inability to stand or walk.

What to Do Immediately?

If you suspect your loved one is overdosing, treat it as a medical emergency. Minutes matter.

1. Call 911 immediately. Clearly state that someone is unresponsive and not breathing. Do not let fear of legal consequences stop you; most places have Good Samaritan laws that protect you and the victim from prosecution for drug possession in an emergency.

2. Administer Naloxone (Narcan) if available. If you suspect any opioid involvement, use Narcan. It will not harm them if they have not taken opioids, but it will instantly reverse an opioid overdose.

3. Perform CPR if they are not breathing and you are trained to do so.

4. Place them in the recovery position. If they are breathing but unconscious, roll them onto their side with their top knee bent to support them. This prevents them from choking if they vomit.

5. Stay with them until paramedics arrive.

Being prepared is not paranoia; it is protection. Keep Narcan in your home, memorize these signs, and remember that your quick action is the bridge between a tragedy and a second chance at-home recovery.