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Responding to an overdose in a toxic drug supply

Signs of an opioid overdose:

  • Not moving and can’t be woken up
  • Breathing is slow or stopped
  • Choking, gurgling or snoring sounds
  • Lips and nails may be blue or grey
  • Skin is cold and clammy
  • Pupils are tiny

Follow the SAVE ME steps to respond:


  • Say the person’s name loudly.
  • Squeeze the muscle between their shoulder and neck.
  • If they are unresponsive call 911.


  • Check if they are breathing normally - at least 10 breaths per minute and no choking or gurgling sounds.
  • Make sure nothing is in their mouth.
  • Check for a pulse (heartbeat). If no pulse, give chest compressions with rescue breathing.


If they are not breathing normally:

  • Tilt head and lift chin to open their mouth and nose. Pinch their nostrils.
  • Give 1 breath every 5 seconds. Use the breathing mask from the naloxone kit.


  • Check again: are they breathing normally? Do they have a pulse?


If they are not breathing normally:

  • Give 1 dose of naloxone.
  • Keep giving 1 breath every 5 seconds.
  • If no change after 3–5 minutes (about 40 breaths), give another dose of naloxone.
  • Repeat until they are breathing normally or have woken up.

Evaluate & Support

  • Check breathing, pulse and responsiveness.

  • Once they are breathing normally, put them in the recovery position and monitor them.

Toxic drug supply = challenging overdoses

The unregulated drug supply is toxic and can make responding to an overdose more challenging. Naloxone reverses opioid overdoses, but it does not affect other depressants, such as benzos, xylazine and alcohol.

If substances other than opioids are also present, naloxone may not work as expected and people may not wake up right away.

Tips for responding to an opioid overdose:

  • Focus on keeping the airway clear, giving breaths and giving naloxone every 3–5 minutes. Keep going until the person is breathing normally or has woken up.
  • Always give breaths if someone is not breathing. Brain injury can happen in minutes.
  • Always call 911 during an overdose. There may be other medical issues happening. The Good Samaritan Drug Overdose Act may protect you from charges for simple possession or breach of conditions related to simple possession.
  • Talk to the person and tell them what you’re about to do before you touch them, even if they are not awake. Once they wake up, stay calm and tell them what happened.
  • Naloxone wears off in 20–90 minutes. Opioids can stay in the body for much longer. When naloxone wears off, an overdose can come back.


CATIE thanks Professionals for Ethical Engagement of Peers (PEEP) members, Toward the Heart BCCDC Harm Reduction Services, the Ontario Harm Reduction Distribution Program and the community and medical reviewers who contributed their expertise to this resource.

Production of this publication has been made possible through a financial contribution from the Ontario Ministry of Health and the Public Health Agency of Canada. The views expressed herein do not necessarily represent the views of our funders.