Crisis Support
Addiction is a recognised medical condition — not a moral failing. Whether you or someone you care about is in crisis right now, this page provides immediate action guidance, overdose response protocols, and pathways to professional support.
Medical Understanding
Medical Emergency
Call 911 immediately upon observing any of these signs. Do not wait to see if the person improves on their own.
Unresponsive or unconscious
Cannot be woken by voice, touch, or sternal rub. No purposeful response to stimuli.
Slow, shallow, or absent breathing
Fewer than one breath every 5 seconds, or breathing has stopped. Respiratory depression is the primary cause of overdose death.
Cyanosis — blue or grey discolouration
Blue or grey tinge to lips, fingertips, or skin indicates severe oxygen deprivation. Extreme emergency.
Pinpoint pupils (miosis)
Extremely small pupils — typically 1–2mm — strongly indicate opioid overdose regardless of lighting conditions.
Gurgling or rattling breath sounds
Noisy, wet breathing sounds may indicate airway obstruction or fluid accumulation. Requires immediate intervention.
Seizures or extreme confusion
Generalised convulsions or profound disorientation may indicate stimulant toxicity, alcohol poisoning, or benzodiazepine overdose.
Emergency Protocol
Follow these steps in sequence. Every minute matters in an overdose emergency.
Call 911 Without Delay
Contact emergency services immediately. Inform the dispatcher the person is unresponsive or suspected of overdose. In most US states, Good Samaritan laws provide legal protection for callers reporting overdoses in good faith.
Administer Naloxone if Available
If opioids are suspected: spray Narcan (4mg) into one nostril. If no response within 2–3 minutes, administer a second dose into the other nostril. Continue rescue breathing as needed. Naloxone is safe if opioids are not present.
Place in Recovery Position
If the person is breathing but unconscious, roll them onto their side (lateral recovery position) to prevent aspiration of vomit. Tilt the head back slightly to open the airway. Keep them warm and monitor breathing continuously.
Provide Rescue Breathing or CPR
If the person is not breathing: begin rescue breaths if trained — one breath every 5 seconds. If trained in CPR and there is no pulse, begin chest compressions. The 911 dispatcher can provide real-time guidance if you are untrained.
Stay Until Emergency Services Arrive
Do not leave the person alone under any circumstances. Monitor their airway, breathing, and responsiveness. Note any substances you believe were used and communicate this clearly to paramedics — it directly informs medical treatment.
Connect to Treatment After the Crisis
An overdose is often a critical window of opportunity. When the individual is medically stable, connect them with SAMHSA or a local treatment provider. Motivational conversations immediately post-crisis can significantly increase treatment engagement.
Substance-Specific Guidance
Opioids — Heroin, Fentanyl, Oxycodone, Morphine, Codeine
Overdose Signs
Pinpoint pupils, unconsciousness, blue lips or fingertips, slow or absent breathing, gurgling breath sounds, limpness. Fentanyl overdoses may progress in minutes due to extreme potency.
Immediate Response
Call 911. Administer Naloxone (Narcan) immediately — it reverses opioid effects. Place in recovery position. Provide rescue breathing if trained. Note: multiple Naloxone doses may be required for fentanyl.
Treatment Options
FDA-approved medications include methadone, buprenorphine (Suboxone), and naltrexone (Vivitrol). These significantly reduce overdose mortality and improve long-term outcomes. Contact SAMHSA for providers.
Alcohol — Acute Poisoning & Alcohol Use Disorder
Overdose Signs
Severe confusion or stupor, vomiting, seizures, breathing rate below 8 breaths/minute, pale or blue-tinged skin, low body temperature, unconsciousness that cannot be reversed.
Immediate Response
Call 911. Place in the recovery position. Do not give coffee or cold water and do not allow the person to "sleep it off" if unconscious — this is a medical emergency. Monitor breathing continuously.
Critical Withdrawal Warning
Alcohol withdrawal can be fatal. Seizures (delirium tremens) may occur 24–72 hours after last drink. Medical detoxification is essential. Never advise abrupt cessation without medical supervision.
Stimulants — Cocaine, Methamphetamine, MDMA, Prescription Stimulants
Overdose Signs
Dangerously elevated heart rate, extremely high body temperature, chest pain or pressure, seizures, stroke symptoms (facial drooping, one-sided weakness), severe agitation, psychosis, or cardiovascular collapse.
Immediate Response
Call 911. Keep the person cool and in a calm environment. Do not physically restrain if they are agitated. Do not give food or liquids. Chest pain constitutes a cardiac emergency requiring immediate medical attention.
Treatment Options
No FDA-approved medications currently available for stimulant use disorders; however, Cognitive Behavioural Therapy (CBT) and contingency management are highly effective. Contact SAMHSA for local referrals.
Benzodiazepines — Diazepam, Alprazolam, Clonazepam, Lorazepam
Overdose Signs
Extreme drowsiness, slurred speech, profound confusion, severe ataxia (impaired coordination), respiratory depression, unconsciousness. Lethality increases dramatically when combined with alcohol or opioids.
Immediate Response
Call 911. Place in recovery position and monitor breathing. Important: Naloxone does NOT reverse benzodiazepine overdose. Flumazenil (a benzodiazepine antagonist) is available only in clinical settings.
Critical Withdrawal Warning
Benzodiazepine withdrawal can cause fatal seizures days to weeks after last dose. Abrupt cessation is medically dangerous. A supervised medical taper — typically over weeks to months — is required.
Medical Safety
Withdrawal from certain substances can be medically dangerous or fatal without professional supervision. Never stop use of these substances abruptly without medical guidance.
Alcohol Withdrawal
⚠ Potentially Fatal Without Medical Supervision6–24 hours: Anxiety, tremors, diaphoresis, nausea, elevated vital signs
24–48 hours: Alcoholic hallucinations, tachycardia, seizures possible
48–72 hours: Delirium Tremens (DTs) — confusion, hyperthermia, autonomic instability — life-threatening without treatment
Benzodiazepine Withdrawal
⚠ Potentially Fatal Without Medical SupervisionProtracted withdrawal syndrome can last weeks to months. Seizure risk persists for 1–2 weeks after last dose, even with long-acting benzodiazepines. Medical tapering using a standardised protocol (e.g., Ashton Manual) under physician supervision is the standard of care.
Opioid Withdrawal
Rarely Fatal — Medically UncomfortableCharacterised by severe flu-like symptoms, musculoskeletal pain, vomiting, and diarrhoea. Dehydration and electrolyte imbalance can become serious. The primary danger is relapse during withdrawal — after a period of abstinence, tolerance is significantly reduced, dramatically increasing overdose risk.