Heroin Overdose: Symptoms, Signs & Emergency Response

Heroin Overdose: Recognition and Emergency Response

Heroin (diacetylmorphine) overdose causes life-threatening respiratory depression via μ-opioid receptor agonism in the brainstem.

Classic Triad (Opioid Overdose)

1. Pinpoint pupils (miosis)
2. Respiratory depression: Rate <10/min, shallow, irregular, or apneic
3. Decreased consciousness: Unresponsive to verbal/stimuli; coma

Additional Signs

• Cyanosis (blue lips, fingertips)
• Cold, clammy skin
• Hypotension, bradycardia
• Vomiting (aspiration risk)
• Seizures (rare, usually from hypoxia)
• Track marks, drug paraphernalia nearby

Immediate Action (SAVE LIVES)

1. Call 911 / emergency services.
2. Administer naloxone (Narcan):
   • Intranasal 4 mg (single spray) or IM/IV 0.4–2 mg; repeat q2–3 min if no response.
   • Available OTC in many jurisdictions; no harm if not opioid overdose.
3. Rescue breathing: If not breathing or <6 breaths/min — 1 breath every 5 sec (12/min). Use barrier mask if available.
4. Chest compressions: If no pulse (cardiac arrest) — standard CPR.
5. Recovery position: If breathing but unconscious — left lateral to prevent aspiration.
6. Stay with person: Naloxone duration 30–90 min; heroin longer. Re-sedation risk. Monitor until EMS arrives.

Post-Overdose Care

• Hospital observation (recurrent respiratory depression)
• Buprenorphine/methadone initiation (MOUD) before discharge
• Harm reduction: naloxone kit, fentanyl test strips, safe supply referral
• Psychosocial support, linkage to treatment

Prevention

• Never use alone
• Test dose (small amount first)
• Carry naloxone
• Avoid mixing with benzodiazepines, alcohol, other depressants
• Fentanyl contamination awareness

Heroin overdose is a medical emergency. Naloxone saves lives. Carry it. Know how to use it.