If someone is unconscious, cannot be awakened, or is not breathing normally, call 911 immediately. If you have naloxone and believe opioids may be involved, administer it while emergency help is on the way. Do not wait to finish reading this guide.
Overdose can happen to people who use opioids, stimulants, alcohol, sedatives, or combinations of substances. Risk can also change unexpectedly because the illegal drug supply is unpredictable and substances such as fentanyl or xylazine may be present without someone knowing.
This guide is for people who use drugs, family members, friends, and anyone who wants to understand how to recognize an overdose, reduce risk, and respond effectively in an emergency. At Aftermath Addiction Treatment Center, we believe accurate information can save lives. We also believe an overdose does not have to be the end of someone’s story.
Once the immediate emergency has been addressed, our team is available at (855) 795-1226 to talk about treatment and what comes next.
Get Help Today.
Opioids include heroin, fentanyl, oxycodone, morphine, hydrocodone, and other prescription or illicit drugs. Opioid overdose is especially dangerous because opioids can slow or stop breathing.
Fentanyl presents an additional risk because it is extremely potent and may be mixed into other substances or found in counterfeit pills. Illicitly manufactured fentanyl continues to play a major role in overdose deaths nationally, and Massachusetts public health officials have repeatedly identified fentanyl as a major part of the state’s illegal opioid supply.
Someone may believe they are taking heroin, cocaine, a prescription-type pill, or another substance without knowing that fentanyl is also present. This unpredictability is one reason fentanyl addiction and overdose risk deserve particular attention.
Benzodiazepines such as alprazolam, clonazepam, and diazepam slow activity in the central nervous system. By themselves, they can cause dangerous sedation. Combining them with opioids or alcohol can increase the risk of severe respiratory depression, unconsciousness, and overdose.
Illicit pills may also contain substances different from what the person expects, including novel benzodiazepines or other sedatives.
Alcohol is also a central nervous system depressant. Heavy alcohol use can cause overdose on its own, but combining alcohol with opioids, benzodiazepines, or other sedating drugs can increase the danger.
An unconscious person who has been drinking heavily may also vomit and be unable to protect their airway, creating a risk of choking.
Stimulants such as cocaine and methamphetamine produce a different type of overdose emergency. Serious stimulant toxicity can involve chest pain, dangerously high body temperature, abnormal heart rhythms, severe agitation, seizures, heart attack, or stroke.
There is another concern: opioids and stimulants increasingly appear together in overdose deaths, sometimes because people intentionally use multiple substances and sometimes because the drug supply contains unexpected substances.
Xylazine is a non-opioid sedative that has been identified in the illegal drug supply, including in Massachusetts. It can cause profound sedation, slowed breathing, low blood pressure, and a slowed heart rate. Xylazine is frequently found alongside fentanyl or other opioids.
Naloxone does not reverse xylazine itself. However, because opioids such as fentanyl may also be present, naloxone should still be given when an opioid overdose is suspected. Emergency medical care remains essential.
Using more than one substance can make the effects harder to predict. Combining drugs that slow breathing, such as opioids, alcohol, and benzodiazepines, can compound respiratory depression. Combining stimulants and depressants does not “cancel out” their effects and can place significant strain on the heart and other organs.
Risk can also change when someone:
Understanding how different substances affect the body is an important part of recognizing overdose risk before a crisis occurs.
Overdose does not always look the same. The warning signs depend on the substance involved, whether multiple substances were used, and the individual’s health.
When you are uncertain, treat the situation as an emergency.
Possible opioid overdose signs include:
If you suspect an opioid overdose, call 911 and administer naloxone if it is available.
Alcohol, benzodiazepines, and other sedatives can cause:
Do not assume an unconscious person simply needs to “sleep it off.”
An overdose involving cocaine, methamphetamine, or another stimulant may look very different from an opioid overdose.
Possible warning signs include:
The term “overamping” is sometimes used for severe stimulant toxicity. Regardless of terminology, chest pain, seizures, loss of consciousness, severe overheating, or signs of a stroke require emergency medical attention.
Tolerance can decrease when someone stops or significantly reduces opioid use. If the person later returns to the amount they previously used, their body may no longer tolerate that dose.
This is one reason overdose risk can increase after periods of abstinence, including after detox, hospitalization, incarceration, or time in treatment.
The safest response is not to assume that a previously tolerated amount remains safe.
Surviving an overdose is an important warning sign.
A previous overdose indicates that the person’s substance use, tolerance, drug supply, health, or patterns of use have already created a potentially fatal situation. Without changes in those circumstances, another overdose may occur.
A nonfatal overdose is therefore an important opportunity to connect someone with naloxone, harm reduction resources, medical care, and addiction treatment.
The safest way to avoid a drug overdose is not to use illicit or non-prescribed substances. But people do not always stop using immediately, even when they understand the risks.
Harm reduction focuses on practical steps that can reduce the likelihood that substance use results in death or serious injury. It is not an endorsement of continued drug use. It is a way to keep people alive long enough to have choices, including the choice to enter treatment.
When someone overdoses alone, there may be nobody available to recognize the emergency, administer naloxone, or call 911.
Massachusetts specifically recommends not using alone as an overdose-prevention strategy. The state also provides information about overdose monitoring and harm reduction resources for people who may otherwise be alone.
Naloxone is a medication that can rapidly reverse an opioid overdose. It works by blocking opioid effects and can restore breathing when opioids such as fentanyl or heroin are involved.
If you use opioids, know someone who does, or may encounter an overdose, keeping naloxone nearby can save a life.
Tell the people around you where it is and how to use it.
Naloxone is widely available in Massachusetts. State guidance says naloxone rescue kits are available from pharmacies and many stores with or without an individual prescription. Massachusetts also operates a statewide pharmacy standing order that can be used to obtain naloxone.
Community harm reduction programs throughout Massachusetts can also provide naloxone and other overdose-prevention resources.
For more information, read our guide to what Narcan is and how it works.
Combining opioids with alcohol, benzodiazepines, or other sedatives can greatly increase respiratory depression. Using opioids and stimulants together can also create unpredictable effects and does not make either drug safer.
Polysubstance use may also happen unintentionally because an illicit substance contains drugs the person did not expect.
Fentanyl test strips can help identify the presence of fentanyl in a drug sample. Massachusetts harm reduction programs distribute fentanyl test strips and other drug-checking resources.
Testing cannot guarantee that a substance is safe. A sample may contain multiple drugs, concentrations can vary, and test results do not tell you how much fentanyl or another substance is present.
Still, information about what may be in the drug supply can help people make more informed decisions.
If someone knows that a person has used opioids or a substance that could contain fentanyl, they may be able to recognize an overdose more quickly.
Keeping naloxone accessible rather than hidden away can also save valuable time during an emergency.
For a broader look at this approach, read Aftermath’s guide to harm reduction.
The simplest rule is this:
If the person cannot be awakened or their breathing is abnormal, call 911.
Do not wait to see whether they improve. Do not assume they will simply sleep it off.
Give the dispatcher the information you know. This can include:
You do not need to know exactly what drug caused the overdose before calling for help.
Follow the dispatcher’s instructions while emergency services are on the way.
Fear of legal consequences should not stop someone from calling 911 during a drug overdose.
Massachusetts law provides certain protections for a person who, in good faith, seeks medical assistance for someone experiencing a drug-related overdose, as well as for the person experiencing the overdose. The law limits certain possession charges and certain probation, pretrial release, or parole consequences when the evidence results from seeking medical assistance.
However, the law does not provide blanket immunity from every possible offense. It does not prevent charges involving drug trafficking, distribution, or possession with intent to distribute.
The priority in an overdose is saving a life. Call 911.
Do not:
If opioids may be involved, administer naloxone and follow emergency-dispatch instructions.
Emergency treatment depends on what substances are involved and the person’s condition.
Care may include naloxone for suspected opioid overdose, oxygen or other breathing support, cardiac monitoring, treatment of seizures or dangerous body temperature changes, laboratory testing, intravenous fluids, and observation.
The immediate goal is stabilization.
If you’re reading this after calling 911 and the emergency is being handled, Aftermath is here when you’re ready to talk about what comes next. Call (855) 795-1226.
During a suspected overdose, calling 911 is usually safer than trying to research or choose a hospital yourself. Emergency medical professionals can begin treatment and determine where the person should be transported.
If emergency transportation is not needed but a clinician has advised you to go directly to an emergency department, several hospitals near Wakefield provide 24-hour emergency care.
MelroseWakefield Hospital Emergency Department
Melrose, MA
Open 24 hours a day, seven days a week.
Winchester Hospital Emergency Department
Winchester, MA
Open 24 hours a day, seven days a week.
Lahey Clinic Emergency Department
Burlington, MA
The Joseph C. Corkery Emergency Center provides 24-hour emergency care.
Salem Hospital Emergency Department
Salem, MA
Provides adult and pediatric emergency care at 3 Dove Avenue.
CHA Everett Hospital Emergency Department
Everett, MA
Provides 24-hour emergency care.
These locations are provided as local reference points, not as a reason to delay emergency care. If someone is unresponsive, is having trouble breathing, has a seizure, or appears to be experiencing an overdose, call 911.
The Massachusetts Substance Use Helpline is a statewide resource for people who use substances, people in recovery, and their loved ones. It is available 24 hours a day, seven days a week at (800) 327-5050, and can help connect callers with harm reduction, treatment, and recovery resources.
After the emergency stage has passed, you can also contact Aftermath to discuss treatment options in Wakefield.
An overdose can be frightening for the person who experienced it and for everyone who witnessed it.
Once the immediate medical crisis is over, there is often a temptation to simply move forward and hope it never happens again. But an overdose is important information. Something about the person’s drug use, tolerance, combination of substances, health, or drug supply created a life-threatening event.
That is the time to ask what can change.
Treatment does not have to begin with a lecture, ultimatum, or confrontation.
For family members, a more productive conversation may sound like:
“I’m glad you’re alive. What happened scared me, and I want to help you figure out what would make this less likely to happen again.”
Listen before arguing. Ask what the person believes contributed to the overdose. If they are willing to discuss treatment, help them make the call rather than handing them a list of numbers and expecting them to manage everything alone.
A previous overdose is a strong reason for the person and the people around them to have naloxone available.
Family members, partners, roommates, and close friends can learn the signs of opioid overdose and how to administer naloxone.
Emergency care stabilizes an overdose. It does not treat the substance use disorder that may have contributed to it.
Treatment can help address:
If you’re trying to understand the larger picture, our substance abuse guide explains addiction, common substances, and available treatment approaches.
Aftermath Addiction Treatment Center provides structured outpatient addiction treatment in Wakefield, Massachusetts.
For many members of our team, recovery is personal. Our staff includes people with lived experience of addiction and recovery as well as professional and educational experience treating substance use and mental health conditions. We combine that perspective with evidence-based, individualized care.
Treatment options may include:
Our partial hospitalization program (PHP) provides Aftermath’s most intensive level of outpatient care. Clients receive structured daytime treatment while returning home in the evening.
Our intensive outpatient program (IOP) provides structured therapeutic support with greater flexibility than PHP, helping clients continue building recovery skills while managing responsibilities outside treatment.
Our evening intensive outpatient program provides another option for people who need ongoing structured treatment while balancing work, family, school, or other daytime commitments.
Lower-intensity outpatient care and aftercare can help clients remain connected to treatment and their recovery community as they gain greater independence.
Aftermath provides treatment for people struggling with opioids, alcohol, stimulants, benzodiazepines, prescription drugs, and other substances.
For clients experiencing substance use alongside depression, anxiety, trauma, or other mental health concerns, dual diagnosis treatment addresses both conditions together.
An overdose may feel like a dividing line between “before” and “after.” What happens next matters.
If you or someone you love is ready to explore treatment after an overdose, call Aftermath Addiction Treatment Center at (855) 795-1226. You can also verify your insurance or contact our team online.
If someone cannot be awakened or is not breathing normally, call 911 immediately. If opioids may be involved and naloxone is available, administer it while emergency help is on the way. Stay with the person and follow the dispatcher’s instructions.
Common signs include inability to wake up, slow or shallow breathing, choking or gurgling sounds, discolored lips or fingertips, and very small pupils. When in doubt, treat the situation as an emergency.
Naloxone is intended to reverse opioid overdose and will not reverse overdoses caused solely by alcohol, benzodiazepines, cocaine, methamphetamine, or other non-opioid substances. If the cause of an overdose is uncertain but opioids may be involved, administering naloxone while calling 911 is recommended.
Yes. Naloxone can reverse an opioid overdose involving fentanyl. Because fentanyl is a highly potent opioid, more than one dose of naloxone may be needed. Call 911 even if the person responds to naloxone, as its effects can wear off and additional emergency medical care may be necessary.
Naloxone does not reverse xylazine because xylazine is not an opioid. However, xylazine is often found with fentanyl or other opioids, so naloxone should still be administered when opioid overdose is suspected. Call 911 because additional medical support may be needed.
Yes. Tolerance to opioids can decrease during periods of abstinence. Returning to a previously used amount can therefore increase overdose risk. A return to use after detox, treatment, hospitalization, incarceration, or another period without opioids should be treated as a serious safety concern.
Yes. Massachusetts provides certain legal protections for people who seek medical assistance in good faith during a drug-related overdose and for the person experiencing the overdose. These protections are important but are not blanket immunity from every criminal offense. Call 911 during a suspected overdose.
Naloxone is available through pharmacies, many retail locations, and community harm reduction programs throughout Massachusetts. The state pharmacy standing order also allows people to obtain naloxone without first getting an individual prescription from their own clinician.
Important overdose-prevention strategies include avoiding using alone, keeping naloxone available, avoiding combinations of drugs that increase overdose risk, using available drug-checking resources, and recognizing that tolerance may decrease after a period of abstinence. Massachusetts harm reduction programs can provide additional overdose-prevention resources.
This page is for general educational purposes and is not a substitute for medical advice, diagnosis, or emergency care.
If someone is unresponsive, cannot be awakened, is having a seizure, or is not breathing normally, call 911 immediately.
For help finding substance use treatment, harm reduction, and recovery resources in Massachusetts, call the Massachusetts Substance Use Helpline at (800) 327-5050, available 24 hours a day, seven days a week.
Aftermath offers same-day admission for those seeking help for substance use disorder treatment. Our simple admissions process takes just minutes. Call today for a free private consultation.