Overdose Prevention

This page shares information and resources on overdose prevention. You’re invited to draw on this information as you create your messaging!

Overdose Prevention 101

Overdose prevention refers to strategies that help people stay safe when using drugs and reduce the risk of fatal overdose. Overdose prevention includes a wide range of strategies including: recognizing the signs of an overdose, carrying naloxone, testing your drugs and avoiding using alone.

What is overdose prevention?

Overdose risk is highest when someone uses opioids or uses multiple types of drugs at the same time. Opioids include:

Fentanyl
Heroin
Prescription pills (oxycodone/percocet/oxycontin)
Codeine (lean)

You can also overdose on stimulants such as cocaine, crack, ecstasy/MDMA and meth. This is sometimes referred to as overamping and may look and feel different than an opioid overdose. Less stimulant overdose prevention tools exist and naloxone is not effective at reversing stimulants.

Which drugs can you overdose on?

The quality of street drugs (their strength, purity, and potency) is always unpredictable and most are “cut” with other drugs like fentanyl, xylazine, acetaminophen or caffeine. Because you can’t determine drug purity by just looking at it, drug testing is always recommended. This includes testing street pills, since many fake pills are cut, re-pressed and sold as “prescription pills” to appear higher in quality. Sometimes fake pills are easy to spot, and other times nearly impossible.

Know your source

Tolerance is your body’s ability to process a certain amount of a drug. A low tolerance means it takes less of the drug to feel its effects, while a high tolerance means your body has adapted to larger amounts, so it takes more to achieve the same effects as before.

Tolerance develops over time but can decrease quickly when someone stops using a drug, such as during detox, substance use or mental health treatment, incarceration, or hospitalization. If you have recently taken a break from using drugs—especially opioids—start with a small amount and increase slowly. Even a few days of reduced use can lower your tolerance, making your previous “normal dose” potentially fatal.

Know your dose

Most fatal overdoses are the result of mixing drugs (using multiple different drugs at the same time, or within a short time frame). If you can, avoid mixing drugs with the same effects, such as depressants like opioids and alcohol, and drugs with opposite effects, such as heroin and cocaine (speedballing).

Mixing drugs (poly-drug use)

Signs of an overdose

Signs can look different depending on the substance, but some common signs include:

Opioids

Pinpoint pupils (center part of eye is very small)
Slow, irregular, or stopped breathing
Unresponsive to voice or touch
Slow heartbeat or low blood pressure

Stimulants

Passing out (but still breathing)
Irregular breathing
Racing heartbeat
Overheating
Unable to sit still
Erratic state (“tweaking”)
- Intense panic
- Extreme paranoia and agitation
- Increased aggressiveness
- Jerking movements
- Intense teeth grinding

Key Terms

Opioid

Opioids are a class of drugs used to relieve pain. They include prescription medications (like morphine) as well as non-prescribed substances like heroin and fentanyl. Opioids affect the brain and body by slowing breathing, which can lead to fatal overdose.
Naloxone

Naloxone is a medication used to rapidly reverse an opioid overdose. It works by blocking the effects of opioids on the brain, which can quickly restore breathing. Because it is safe and has no effect if opioids are not present, it can be given even when an overdose is only suspected.
Naloxone comes in two FDA-approved forms: injectable and nasal spray.
Narcan

Narcan is a brand name for naloxone and works in the same way. It is used to reverse an opioid overdose by blocking the effects of opioids on the brain, which can quickly restore breathing.
Narcan has no effect on someone who does not have opioids in their system.
Fentanyl

Fentanyl is a highly potent opioid used in medical settings for severe pain, but is now commonly found in the street drug supply. Because it is much stronger than many other opioids, fentanyl significantly increases the risk of overdose, particularly when individuals are unaware it has been mixed into other substances. Even a tiny amount can be dangerous.
Xylazine

Xylazine is a powerful sedative used in veterinary medicine but is now increasingly found in the street drug supply. It can depress the central nervous system, slow breathing, and lower blood pressure, increasing the risk of overdose—especially when people don’t know it has been mixed into other substances.
Unlike opioids, xylazine cannot be reversed with naloxone.
Test Strips

Test strips are tools used to check for substances like fentanyl and xylazine before use. Different strips are used to detect each substance. They work by testing a small amount of a drug mixed with water.
Using test strips can help reduce the risk of overdose by allowing people to make safer decisions if these substances are present.
Overamping

Overamping refers to what some may consider an “overdose” on stimulants like meth, crack or cocaine. It can involve both physical symptoms, like a racing heart or overheating, and psychological effects, like anxiety or paranoia.
Hepatitis C

Hepatitis C Virus (HCV) is a viral infection that causes liver inflammation but is not classified as an STI because the risk of getting HCV through sex is so low. HCV is only passed through blood-to-blood contact, not sexual fluids, and is more commonly spread by sharing needles/syringes and unsterile tattooing equipment.
HCV can be acute (a short infection that you recover from) or chronic (infection for a long time or for life). For a small percentage, acute HCV clears on its own without treatment. However, acute HCV that does not clear, and remains untreated, progresses into chronic HCV. Chronic HCV is a long-term condition that can cause severe liver damage, including cirrhosis, liver failure and liver caner.
Hepatitis B

Hepatitis B Virus (HBV) is a viral infection that causes liver inflammation. Unlike HCV, HBV is classified as a STI because it is most commonly spread through sexual fluids. It can also be spread through blood-to-blood contact.
HBV can be acute or chronic. Most healthy adults who contract acute HBV are able to clear the virus on their own without permanent damage. However, if the body cannot clear the virus, it progresses into chronic HBV. Chronic HBV is a serious, lifelong condition that can lead to severe liver complications, including cirrhosis, liver failure, and liver cancer.