Naloxone in an opioid emergency

An opioid overdose can become a life-threatening emergency before anyone realises what is happening. Knowing how to recognise an overdose and administer naloxone gives a bystander a way to restore breathing while an ambulance is on the way.

Treat difficult waking or absent normal breathing as an emergency rather than waiting to see whether the person recovers. Call Triple Zero (000), start naloxone when opioids may be involved, and be ready to begin cardiopulmonary resuscitation (CPR).

Recognise an opioid emergency

Opioids include heroin, methadone, fentanyl and prescription medicines such as oxycodone. Clues may include recent use, loose tablets, an injection, a patch or a known increase in dose, although no clue is required before acting.

Watch for these warning signs:

• cannot be woken or responds only faintly
• slow, shallow, absent or irregular breathing
• skin, lips or nails that look blue, grey or unusually pale
• extreme drowsiness, floppiness or collapse

Pinpoint pupils, snoring or a stiff body can occur, but their absence does not rule out an opioid emergency. Mixing opioids with alcohol, benzodiazepines or other sedatives raises the danger; people taking stable prescriptions can still overdose after a period of reduced tolerance, such as after detoxification, illness or missed doses.

Call Triple Zero and send for help

Call Triple Zero (000) and tell the operator you suspect an overdose, describe breathing and ask for an ambulance. Put the phone on speaker so the dispatcher can guide CPR; send another person for naloxone and an automated external defibrillator (AED) if one is nearby, and unlock the door for responders.

Supplies and training differ across Australia’s states and territories. Pharmacies, alcohol and other drug (AOD) services, needle and syringe programmes, peer workers and festival outreach teams may distribute naloxone, while some jurisdictions fund it directly. In regional and remote areas, the wait for an ambulance can be longer, so early CPR and naloxone matter especially.

If breathing is slow after alcohol or a mixed-drug exposure, responders still cannot assume the cause. General alcohol harm support can clarify related warning signs, but an unresponsive person needs an ambulance and naloxone when an opioid may be involved.

Give naloxone from the supplied device

If a person is unresponsive or not breathing normally and opioids may be involved, give naloxone without delay while help is being arranged. Follow the 000 operator and product instructions: consumer nasal sprays, community ampoules and hospital medicines do not all have the same strength.

For an adult nasal spray, give one labelled dose into one nostril, following the device’s priming and positioning instructions. Some Australian take-home kits contain naloxone 400 micrograms in 0.4 mL for trained peer workers to administer subcutaneously or intramuscularly as their protocol specifies; bystanders should not attempt an injection unless trained. Children need the dose specified for their age and product.

If there is still no response or normal breathing, repeat a dose at the interval stated on the device or directed by 000, often after about two to three minutes. Naloxone can be given when opioid use is uncertain because the risk of delaying lifesaving treatment is far greater, but it does not replace CPR or an ambulance.

Begin CPR when breathing stops

If the person is not breathing normally, start CPR while naloxone takes effect. For an adult, place both hands in the centre of the chest, press 30 times at a rate of 100 to 120 each minute, and let the chest rise fully. If trained, use 30 compressions and two breaths; if not, give continuous hands-only compressions and use an AED when available.

During CPR and while waiting:

• switch compressor every two minutes if several people are present
• tell responders what was taken and when naloxone was given
• stop CPR only when normal breathing returns or a responder takes over
• follow instructions from the 000 dispatcher

Continue CPR until normal breathing returns or ambulance staff take over. Give further naloxone according to the product or operator instructions; stronger opioids may require several doses, and naloxone may wear off before the opioids do.

Naloxone will not reverse cocaine, alcohol or a non-opioid sedative. If those substances were involved, CPR and urgent medical care are still necessary. A guide to cocaine withdrawal symptoms may be useful later, but withdrawal must never be confused with an acute overdose.

Prevent a second overdose

If the person wakes, keep them lying on their side, monitor breathing and explain that more naloxone may be needed because its effect is temporary. Do not let them drive or go alone before ambulance assessment; follow ambulance transport advice and tell the crew about every suspected drug, prescribed medicine, patch, dose and naloxone dose.

Once the emergency is stabilised, overdose response becomes broader treatment planning. Australian public and private pathways vary by state or territory, and a person in Darwin or Newcastle may have different local options from someone in Melbourne or Hobart. A general explanation of inpatient and outpatient detox choices can frame that next step, although the specific Singapore pathway does not apply in Australia.

Build a local support plan

Naloxone should be kept where people can reach it, not hidden in a vehicle or stored without instructions. Ask a chemist, local AOD service, needle and syringe programme or authorised peer worker how to obtain a take-home kit, practise with the training device and show household members how to call 000.

After an overdose, offer treatment without pressure and without leaving the person to manage alone. Opioid agonist treatment, alcohol and other drug care, mental health support and a written relapse-response plan can reduce the chance of another emergency. Verify any provider’s credentials and use treatment centre resources only alongside local clinical advice.