Note: The author is a licensed behavioral health provider, not a medical provider. Content is based on a review of the literature and practical experience in managing opioid dependence. Always follow applicable medical direction and departmental protocols. This article is for informational purposes only and is intended to supplement, not replace, live hands-on training.
Introduction
I was grocery shopping at the local supermarket one morning and stopped in the men’s room. I noticed a syringe on the floor beneath a bathroom stall and reported it. An employee came in with gloves and a sharps container. I went about my shopping and then noticed commotion at the front of the store. A man was lying on the floor between the inner and outer doors, with several employees leaning over him, including the store pharmacist, who was administering Narcan. Shortly thereafter, EMS arrived — but the man had recovered and fled the scene.
This is a scene that has become increasingly familiar. Opioid addiction is widespread in the United States, and overdose claims tens of thousands of lives every year — including children in the homes of users. Understanding opioid overdose response for first responders, civilians, and bystanders is no longer optional — it is a core public safety skill. Infants and children are especially vulnerable, and the risk extends to pets as well.
Narcan (naloxone) saves lives. Knowing how to recognize an opioid overdose and respond quickly can be the difference between life and death.
What Are Opioids and Opiates?
Opioids and opiates1 are highly addictive sedative analgesics intended to relieve moderate to severe pain. What sets them apart from other analgesics is that they also produce sedation and euphoria — a powerful, pleasurable sensation that removes the emotional response to pain. This makes opiates highly rewarding and drives a compulsion to use again. Repeated use leads to increased tolerance and severe withdrawal symptoms when use stops.
Opiates are widely abused, typically in the form of heroin, fentanyl, or OxyContin, among others. When taken intravenously (IV) or through insufflation (snorting), a large dose is absorbed directly into the bloodstream and produces effects within seconds — including euphoria, analgesia, and dangerous respiratory suppression. According to StatPearls, the mechanism of respiratory suppression is threefold:
- Slowed breathing. Opiates suppress the brainstem breathing reflex, causing shallow breaths and incomplete lung inflation.
- Airway obstruction. Muscles in the pharyngeal area (the back of the throat) lose tone and collapse, constricting the airway.
- Disabled CO2 alarm. Normally, rising CO2 levels in the blood trigger a deep compensatory breath. Opiates shut off this reflex, removing the body’s built-in warning system.
The opioid antagonist Narcan (naloxone) is the primary tool used to reverse this process. Opiates bind to receptors in the central nervous system — a process called agonism. Narcan works as a competitive antagonist, displacing opiate molecules from the mu, delta, and kappa receptors and temporarily blocking them so no additional molecules can attach. The mu-receptor is the primary concern, as it governs the respiratory depression that makes opioid overdose lethal.
| Receptor | Effects |
|---|---|
| Mu-receptor | Analgesia, euphoria, sedation, and respiratory depression |
| Delta-receptor | Analgesia and miosis (constricted pupils) |
| Kappa-receptor | Analgesia |
Table from StatPearls, 2025
According to the manufacturer, Narcan takes effect within two to three minutes; multiple doses may be needed in some cases. Importantly, if someone is not overdosing and is experiencing a different medical crisis, Narcan will not harm them.
Signs of an Opioid Overdose
According to Drugs.com, indicators of an opioid overdose include:
- Miosis — pupils constricted to pinpoints
- Bradycardia — pulse low or difficult to detect
- Respiratory depression — breathing slow, absent, snoring, or gurgling
- Cyanosis — blue skin, particularly the lips and nail beds
- Unresponsiveness to verbal or physical stimuli (calling their name, shaking them, or a sternal rub)2
- Nodding — eyes closing and head drooping, then briefly reopening
- Hypodermic needle still present in the skin
- Nearby paraphernalia: hypodermic needles, small plastic bags, burnt spoons, or ligatures
- Track marks — linear bruising in the antecubital area (inner elbow), or between the fingers or toes, on the sides of the neck, inner thighs, genitals, or under the eyelid or tongue
Opioid Overdose Response for First Responders and Civilians
The appropriate opioid overdose response for first responders depends on role, training, and the resources available. Here is what each group needs to know.
Police and EMS
Law Enforcement Officers (LEOs) are often first on scene when someone overdoses. Many departments offer or require training in administering Narcan via nasal inhaler. Effective co-responder programs pair law enforcement with behavioral health professionals to improve outcomes at these scenes.
EMS units carry naloxone (Narcan) and can administer it intravenously (IV), intramuscularly (IM), or via nasal inhaler. EMS personnel are also trained in advanced airway management. According to the Physicians’ Desk Reference (PDR), naloxone is a full opioid antagonist at the mu, delta, and kappa receptors, preventing opiates from binding and producing their effects.
One important consideration for opioid overdose response for first responders: some individuals may emerge from unconsciousness disoriented and combative. While many will wake with relief and gratitude, others may respond with hostility or aggression — unaware that their life was just saved. Co-responders trained in de-escalation can be critical in these moments. Learn more about how Julota supports Mobile Integrated Healthcare teams coordinating these responses.
Civilians
According to the CDC, Narcan is available over the counter — often at no charge — at nearly any pharmacy in every state. It can be carried in a standard first aid kit. The civilian version is an easy-to-use nasal inhaler that requires minimal training.
The American Red Cross offers a low-cost, four-hour Narcan training course, available both in person and online.
Secondary Exposure and Risk to First Responders
LEOs and EMS face a low but real risk of secondary exposure to opiates when searching a suspect or their vehicle for illegal substances.
There are widespread misconceptions about this risk. Videos circulating online — typically body camera footage — appear to show officers overdosing from secondary exposure. While alarming to watch, secondary exposure through inhalation or skin contact is possible but highly unlikely.
If fentanyl or carfentanil contacts a first responder’s hands, it is unlikely to penetrate intact skin during the brief duration of a typical field encounter. Mucous membranes (nose, mouth) or broken skin are higher-risk pathways. Prolonged or heavy exposure to intact skin increases risk. Transdermal patches, such as fentanyl patches, should never be handled with bare hands.
Universal Precautions and Chemical Exposure
Always treat any powdery substance as potentially dangerous. Take the following precautions:
- Wear nitrile gloves
- Wear a NIOSH-approved N95 mask
- Remove gloves by pinching near the wrist, peeling off inside-out, and discarding properly — do not touch your face until hands are thoroughly washed
- After handling any suspicious material, decontaminate with soap and running water
- Do not use alcohol-based hand sanitizer for potential chemical exposure — it kills germs but does not remove chemical substances
Handling Sharps
A needle stick is a low-probability but real risk for inadvertently delivering an illicit opiate to a first responder.
Exposure to bloodborne pathogens is also a concern:
- HIV is fragile and cannot survive outside of wet bodily fluids; it deactivates rapidly
- Hepatitis B and C are far more resilient and can survive for over a week in dried bodily fluids on non-porous surfaces
- Always ask before searching a suspect or vehicle: “Is there anything in there that will stick me, poke me, or cut me?” — and do not assume a truthful answer
- Always wear gloves
- Use puncture-resistant gloves or grabber tools to transfer needles to sharps containers
- After handling sharps, wash hands with soap and running water — use alcohol-based sanitizer only if soap and water are unavailable
Always follow all applicable departmental protocols.
Conclusion
Illicit opioid use in the United States shows no signs of slowing. Effective opioid overdose response for first responders — and for civilians — is one of the most direct ways to reduce harm at the street level, giving people a second chance while protecting bystanders, children, and pets. Whether you are a paramedic, a law enforcement officer, or a bystander, knowing how to recognize an opioid overdose and administer Narcan could save a life.
For agencies looking to improve coordination and outcomes across these calls, explore Julota’s resources for first responders or schedule a demo to see how the platform supports co-responder and MIH programs.
Endnotes
- Opioid: a broad category of mu-agonist sedative analgesics — natural, synthetic, or semisynthetic. Opiate: a narrower category of natural-only mu-agonist sedative analgesics.
- A sternal rub is used to try to rouse an unresponsive person: make a fist and rub your knuckles firmly on the sternum (the bone at the top of the chest). This uncomfortable stimulus can elicit a response from someone who is not deeply unconscious.
About the Author
David A. Porter is a Licensed Alcohol and Drug Counselor (LADC) with decades of experience in behavioral health. He has worked in halfway houses for the severely and persistently mentally ill, community mental health clinics, and a Medication-Assisted Treatment (MAT) program.
He is currently in private practice, providing evaluation and therapy to those struggling with addiction, anger management, PTSD from violent crime, and domestic violence or sexual offenses. For 29 years, he has also taught behavioral sciences at SUNY and Vermont State Colleges.
He is the author of over 400 articles on behavioral science, self-protection, photography, and culinary arts.
