If opioid use disorder (OUD) affects your life or someone you care about, knowing the signs of opioid intoxication can help you recognize when medical help is needed.

Opioid intoxication can happen when someone takes too much of an opioid or combines opioids with alcohol, certain medications, or other substances. It can affect breathing, alertness, and other vital functions, and in some cases can become life-threatening.

Recognizing opioid intoxication early can help you respond quickly and potentially save a life. Even if someone doesn't have every symptom on this list, they may still need urgent medical attention. Here are some warning signs to watch for.

Opioids affect the part of the brain that controls breathing. When a person takes opioids, their breathing may slow to as few as four to six breaths per minute. In severe cases, breathing may stop completely.

Opioids can also cause the airways to tighten, making it harder to take deep breaths. Some people may wheeze or have frothy fluid around their mouths. These are signs of a serious medical emergency.

The pupils are the small black circles in the center of the eyes. Under normal conditions, they get bigger or smaller in response to light. Opioid use causes the pupils to stay small.

Tiny, constricted pupils, sometimes called pinpoint pupils, are a classic sign of opioid use.

Pinpoint pupils aren't usually dangerous on their own. Along with other symptoms, they can help identify possible opioid intoxication.

Opioid misuse can lead to head nodding. If that nodding becomes heavy, it’s sometimes referred to as “nodding off.” The person may have extreme drowsiness and appear to be falling asleep.

If you’re concerned that someone is losing consciousness from opioid intoxication, you can try to get a response from them to see if they’re OK.

In the early stages, a person using opioids may awaken and respond to yelling or touch. But with opioid intoxication, they may stop responding to these cues.

They may not be able to talk or look at you. Their body may go limp, hunch over, or slide to the ground.

Lack of oxygen from slowed breathing can turn lips and fingernails a blue or purplish color. The skin may appear pale or grayish. People may also have clammy skin, which feels cold and wet.

Another common sign of opioid intoxication is vomiting. Some people don’t fully vomit but may make gurgling sounds. This can be especially dangerous if the person is unconscious, because it puts them at risk of choking on their vomit.

When Is Intoxication an Emergency?

There are different levels of opioid intoxication. It can move from mild to severe quickly, especially with strong opioids or unknown substances.

The biggest danger is respiratory depression, which is when breathing slows or stops.

Watch for these emergency signs:

• Inability to wake up or speak
• Very slow, irregular, or stopped breathing
• Choking, gurgling, or snoring sounds
• Blue, gray, or pale lips and fingertips
• Limp body or loss of consciousness

These are signs of a likely opioid overdose. If you see these signs, don’t wait to see if the person improves on their own. Acting quickly can make the difference between life and death.

Mixing Substances Increases Risk

Opioid intoxication becomes much more dangerous when opioids are combined with other depressants. These include alcohol and benzodiazepines, such as medications used for anxiety or sleep.

Each of these substances slows the brain. When taken together, their effects can build on each other, leading to more severe sedation and stopped breathing.

Even if someone has used the same amount of opioids before, adding alcohol or benzodiazepines can make that dose dangerous.

Liver or Kidney Problems

Some people can’t process opioids well. Since these medications go through the liver and kidneys, any issues with liver or kidney function can make toxicity more likely.

This is one of the many reasons why opioids should be used only under the supervision of a healthcare provider who knows your health history.

Dangers of Unknown Supply and Strength

Opioids obtained outside of a pharmacy may be mixed with other substances. They can vary widely in strength and purity, making them especially unpredictable compared to prescription opioids that have been prescribed specifically for you.

The effects of nonprescription opioids may come on faster or be more intense. In addition, taking opioids in ways other than intended (such as snorting or smoking them) can lead to unexpected responses.

How To Respond to Opioid Intoxication

If you suspect someone is experiencing opioid intoxication, act immediately. Here’s what you can do.

Call their name, shake them gently, or use your knuckles to firmly rub their sternum (center of the chest). It may hurt the person you’re trying to awaken, but it won’t cause any lasting damage.

This can help wake the person up or prompt them to start breathing again. Signs of breathing include their nostrils flaring in and out and their chest rising and falling. If they don’t respond to your touch, call for emergency help.

Emergency services can provide lifesaving care. Let them know clearly if the person isn’t breathing normally, is unresponsive, or has other signs of intoxication.

While you wait for emergency help, you can take these steps to get the person breathing again.

1. Check that nothing is blocking their mouth.
2. Tilt their head back.
3. Pinch their nose shut and put your mouth to their mouth. Give two quick breaths.
4. Provide another breath every five seconds until help arrives or their breathing resumes.

Naloxone is a medication that can reverse the effects of opioids and restore normal breathing. Give it as soon as possible.

Naloxone is available as a nasal spray or an injection. It’s important to get familiar with how to use it before an emergency strikes. This way, you can feel prepared.

If there’s no response to naloxone after a few minutes, additional doses may be needed. You should still contact emergency services for medical supervision after giving naloxone.

If the person is unconscious, roll them onto their side. This can help prevent choking if they start breathing again and vomit.

Never leave a person alone while they’re experiencing opioid intoxication symptoms. Monitor their breathing and responsiveness until help arrives.

Join the Conversation

On MyOpioidRecoveryTeam, people share their experiences with opioid use disorder, get advice, and find support from others who understand.

Have you ever had to respond to the signs of an opioid overdose? Let others know in the comments below.