How to Prevent Overdose in People with Substance Use Disorders

Overdose isn’t just a statistic-it’s someone’s parent, sibling, friend, or neighbor. Every day, people die from overdoses because they used a drug they thought was safe, didn’t have access to help, or didn’t know what to do when things went wrong. The truth is, overdose prevention works-but only if we use the right tools, at the right time, and with real compassion.

Know What’s in the Drugs

Most overdose deaths today aren’t from heroin or prescription pills. They’re from fentanyl, a synthetic opioid 50 to 100 times stronger than morphine. It’s mixed into cocaine, meth, counterfeit pills, and even MDMA. People don’t know they’re taking it. That’s where fentanyl test strips come in.

These small paper strips cost less than a dollar each. You mix a tiny bit of the substance with water, dip the strip in, and wait a minute. One line means no fentanyl detected. Two lines? Fentanyl is present. It’s not perfect-some tests miss low doses or don’t work with all chemicals-but it’s the best early warning system we have. The CDC says these strips can detect fentanyl at levels as low as 0.25 nanograms. That’s enough to kill.

Use them. Always. Even if you’ve used the same source before. Drug supplies change daily. A pill that was safe last week could be deadly this week.

Keep Naloxone On Hand

Naloxone (brand names Narcan, Kloxxado) is the only medicine that can reverse an opioid overdose. It’s safe, easy to use, and doesn’t work on non-opioid drugs like cocaine or xylazine. But it saves lives when opioids are involved.

The FDA approved the first over-the-counter naloxone nasal spray in March 2023. You don’t need a prescription. You can buy it at pharmacies, community centers, or online. It’s designed for anyone-even someone with no medical training.

Here’s how to use it:

1. Call 911 immediately.
2. Check if the person is breathing. If not, give two rescue breaths.
3. Place the nozzle in one nostril and press the plunger firmly.
4. Wait 2-3 minutes. If no response, give a second dose in the other nostril.
5. Stay with them until help arrives.

Studies show 96% of people trained to use naloxone can reverse an overdose correctly. The CDC found communities with widespread naloxone access saw 14% fewer opioid overdose deaths. Keep it in your bag, your car, your home. Don’t wait for someone to overdose before you have it.

Medication-Assisted Treatment Works

The single most effective way to prevent overdose is to treat the addiction-not just the overdose. Medication-assisted treatment (MAT) uses FDA-approved drugs: methadone, buprenorphine, and naltrexone.

Methadone and buprenorphine reduce cravings and withdrawal. They don’t get you high when taken as prescribed. Naltrexone blocks opioids entirely. All three cut overdose death risk by about 50%, according to the World Health Organization. That’s better than any therapy alone.

But here’s the problem: only 18.4% of Americans with opioid use disorder got any medication-based treatment in 2022. In rural areas, 60% of counties have no MAT provider at all. If you or someone you know needs help, don’t wait for the perfect clinic. Call SAMHSA’s helpline (1-800-662-HELP). They’ll connect you to providers-even if it’s a telehealth appointment.

Never Use Alone

Most overdoses happen alone. People hide their use out of shame, fear, or isolation. But using alone is the biggest risk factor.

The “Never Use Alone” hotline lets you call someone before you use. They stay on the line while you do. If you stop responding, they call 911 and send help. In 2023, they responded to 12,000 overdose incidents per month. That’s 360,000 lives potentially saved in a year.

You don’t need to be “addicted” to use this service. You don’t need to be in recovery. You just need to be alive. If you’re using alone, call them. Or better yet-use with someone who has naloxone and knows how to use it.

Build a Safety Plan

A safety plan isn’t just for suicide prevention. It works for overdose too. The New York State Department of Health found people who used a structured safety plan had 28% fewer overdose events.

Here’s how to build one:

• Who will you call before you use? (A friend, hotline, family member)
• Where will you use? (Safe, not alone, not in bed)
• Do you have naloxone? (Keep it with you)
• Do you know how to use it? (Practice with a trainer or video)
• What’s your exit plan if things go wrong?

Write it down. Save it in your phone. Share it with someone you trust. It’s not a sign of weakness. It’s a survival tool.

Know the New Threats

Fentanyl isn’t the only danger anymore. Xylazine, a veterinary sedative, is now showing up in street drugs. It’s not an opioid. Naloxone won’t reverse it. It causes severe skin ulcers, slow breathing, and deep sedation. The DEA found it in 23% of fentanyl powder and 7% of fentanyl pills seized in 2022.

If someone is unresponsive, has shallow breathing, or looks unusually pale or cold, treat it like an overdose anyway. Give naloxone anyway-it won’t hurt, and it might help if opioids are mixed in. Call 911. Stay with them. Even if naloxone doesn’t fully wake them, medical help can still save their life.

Help After Release from Jail or Prison

People released from incarceration are 120 times more likely to die of overdose in the first two weeks. Why? Their tolerance drops fast. They go back to using the same dose they used before jail. Their body can’t handle it.

The CDC and SAMHSA now recommend giving naloxone and starting MAT before release. If you or someone you know is getting out of jail, ask for help before leaving. Bring your safety plan. Get naloxone. Connect with a community health worker. Don’t rely on luck.

Reduce the Stigma

Stigma kills. It stops people from calling 911. It keeps them from asking for naloxone. It makes them feel like they don’t deserve help.

If you’re a friend, family member, or coworker, say this: “I care about you. I want you to be safe.” Don’t judge. Don’t lecture. Don’t wait for them to “hit rock bottom.” Rock bottom is often a funeral.

Offer naloxone. Ask if they’ve used fentanyl test strips. Suggest the Never Use Alone hotline. You don’t need to fix their life. You just need to be someone who shows up.

What to Do If You See an Overdose

You don’t need to be a medic. You just need to act.

1. Check responsiveness. Shake gently. Shout their name. No response? Move to step two.

2. Call 911. Say: “Someone is not breathing. I think it’s an overdose.”

3. Give naloxone. Use the nasal spray. One dose in each nostril if needed.

4. Give rescue breaths. Tilt head back, pinch nose, give one breath every 5 seconds.

5. Stay until help arrives. Even if they wake up, they can relapse into overdose. Naloxone wears off faster than opioids.

6. Don’t leave them alone. Even if they say they’re fine. Monitor breathing for at least 2 hours.

Where to Get Help

You don’t have to do this alone.

• Naloxone: Available at most pharmacies without a prescription. Many community health centers give it out for free.
• Fentanyl test strips: Available through harm reduction organizations like Dances with Drugs, DanceSafe, or local syringe services.
• Medication-assisted treatment: Call SAMHSA’s helpline at 1-800-662-HELP (4357). They’ll find providers near you.
• Never Use Alone: Call 1-800-484-3731 or text 1-800-484-3731. Available 24/7.
• MyNarcan app: Free app that shows nearby naloxone locations and guides you through overdose response.

It’s Not Too Late

Overdose prevention isn’t about perfection. It’s about possibility. One person with naloxone can save a life. One test strip can prevent a death. One conversation can change everything.

You don’t need to be a doctor, a policymaker, or a nonprofit leader to make a difference. You just need to care enough to act.

Start today. Carry naloxone. Talk about fentanyl. Ask if your friend has a safety plan. Don’t wait for the next headline. The next overdose could be someone you love.