Drug Harm Reduction Guide

Opioid Overdose Recognition & Response

Signs: Slow, shallow, or stopped breathing; pinpoint pupils; blue or grey lips/fingertips (cyanosis); unresponsive; gurgling or choking sounds (death rattle).

Response Steps

1. Try to rouse the person — sternal rub (knuckles on breastbone)
2. Call 911 immediately — stay on the line. Good Samaritan laws protect callers in most Canadian provinces and many US states
3. Administer naloxone: intranasal (Narcan nasal spray) — one spray in each nostril; OR intramuscular injection into the outer thigh
4. Place in recovery position (on their side) if breathing — prevents choking
5. If not breathing — begin rescue breathing (one breath every 5 seconds)
6. Naloxone wears off in 30–90 minutes — stay with the person; second dose may be needed
7. Do not leave the person alone until professional help arrives

Stimulant Overdose (Cocaine, Methamphetamine, Amphetamines)

Signs: Racing or irregular heartbeat; chest pain; very high temperature (hot, dry skin); extreme agitation or paranoia; seizures; loss of consciousness.

Response Steps

1. Call 911 for chest pain, seizures, unconsciousness, or temperature above 40°C (104°F)
2. Move to a cool environment — stimulant overdose can cause fatal hyperthermia
3. Apply cool wet cloths to neck, armpits, and groin if overheated
4. Keep the person calm and still — exertion worsens cardiac risk
5. Do not restrain forcibly if aggressive — redirect and contain safely
6. Recovery position if they lose consciousness and are breathing
7. No antidote exists for stimulant overdose — supportive care is treatment

Benzodiazepine and Alcohol Overdose

Signs: Extreme sedation; confusion; slurred speech; loss of coordination; slow or stopped breathing; unresponsive; cold clammy skin.

Critical warning: Benzodiazepine + alcohol + opioid combinations are the leading cause of overdose death. Respiratory depression is additive. Naloxone does not reverse benzodiazepine or alcohol overdose — call 911.

1. Call 911 for any unconscious or non-breathing person
2. Recovery position if breathing to prevent aspiration of vomit
3. Do not leave unattended — breathing can stop suddenly
4. Keep warm — hypothermia is a risk with CNS depressant overdose
5. Flumazenil (benzo antagonist) exists but is rarely available outside medical settings

Psychedelic Crisis (Difficult Trip / Psychological Emergency)

Psychedelics (LSD, psilocybin, DMT, mescaline) rarely cause physical overdose at common doses. The primary risk is psychological distress, panic, or erratic behavior leading to physical harm (falls, traffic). True physiological emergency is rare but possible with novel psychedelics or adulteration.

Response for Difficult Trip

1. Create a calm, safe physical environment — low light, quiet, comfortable space
2. A calm, trusted person should stay with them ("trip sitting")
3. Grounding techniques: breathing exercises, cold water, physical contact (with consent)
4. Do not leave them alone near heights, water, or traffic
5. Benzodiazepines (diazepam) can reduce intensity if available — do not combine with other CNS depressants
6. Fireside Project (1-623-473-7433, US) provides free support for psychedelic distress
7. Call 911 if physical emergency, violence risk, or suspected adulteration with dangerous substances

General Emergency Response

1. Assess responsiveness — speak loudly, tap shoulders
2. Call emergency services — 911 (US/Canada), 999 (UK), 112 (EU)
3. Airway — tilt head back, lift chin, check for breathing
4. Breathing — if not breathing, begin CPR
5. Recovery position — if breathing but unconscious, roll onto side
6. Stay — do not leave the person until help arrives
7. Inform paramedics — tell them what was taken if known; this helps treatment and does not waive Good Samaritan protections in most jurisdictions