TempoLife › Features › Defibrillators and cardiac arrest response › overdose
Opioid and drug-related arrest
Breathing stops long before the heart does, so this is a ventilation emergency. Where naloxone fits, why it never replaces CPR, and the practical fear — that calling for help will get somebody arrested.
CPR in sixty seconds
- Unresponsive and not breathing normally? Gasping is not breathing. Treat it as a cardiac arrest.
- Call 112 (113 in Norway). Speaker on, phone on the floor. Stay on the line — the dispatcher will coach you.
- Push hard and fast in the centre of the chest: 5–6 cm in an adult, 100–120 per minute, letting the chest come all the way back up.
- Send somebody else for a defibrillator. Do not go yourself unless it is seconds away. Keep compressing.
- Turn the device on and do what it says. It decides whether to shock. After a shock, go straight back to compressions.
This is a reference written for bystanders, not a diagnosis, a training course or medical advice. It cannot tell you what is wrong with a particular person, and it does not replace the dispatcher on the other end of an emergency call — they can see what is near you and they will talk you through it. If you are worried about your own heart, or about a symptom, that is a conversation with a clinician rather than a page on a website.
A breathing emergency wearing a cardiac disguise
Opioids — heroin, fentanyl and its analogues, methadone, prescription painkillers — suppress the drive to breathe. The person becomes unrousable, breathes slower and slower, turns grey or blue at the lips, and the heart stops only after the oxygen runs out. That order matters: by the time there is an arrest the blood is already depleted, so this is one of the situations where rescue breaths genuinely change the outcome and compression-only CPR is a poorer choice if you are able to ventilate.
If they are breathing, this is still an emergency
Very slow, shallow breathing with pinpoint pupils and an unrousable person is the stage before the arrest and it is the stage where intervention is easiest. Call 112, open the airway with a head tilt and chin lift, put them on their side, and stay and watch the breathing continuously. Do not put them to bed to sleep it off and do not leave them alone — respiratory depression deepens for as long as the drug is being absorbed, and most opioid deaths happen with other people in the building.
Naloxone: useful, and not a substitute
Naloxone reverses opioid effects at the receptor and is available in this region as an intramuscular injection or a nasal spray, distributed through harm-reduction and take-home programmes in several countries. If it is to hand, give it — but the sequence for an unresponsive, non-breathing person is unchanged: call, start CPR, and administer naloxone alongside rather than instead. It takes minutes to act, it does not restart a stopped heart, it wears off before many opioids do, and the person can slide back into respiratory arrest afterwards. Everyone who receives it goes to hospital.
Stimulants and other drugs
Cocaine, amphetamines and their derivatives cause arrest by a different route: rhythm disturbances, dangerously high body temperature and coronary spasm. There is no antidote to give. The response is the standard one — call, compress, use the defibrillator, follow it — with active cooling if the person is very hot: remove clothing, wet the skin, move air over them. Alcohol and sedatives more often kill by airway obstruction and vomiting in an unconscious person, which is why the recovery position matters so much in that group.
The fear of calling
People delay calling because they are afraid of the police. Emergency medical services in this region attend overdoses to treat them, and the dispatcher's interest is the patient. If you are frightened of the consequences, the honest advice is still to call and to stay: an overdose without a call is very often fatal, and a bystander who leaves the scene is the difference between a survivable event and a death. Report exactly what was taken if you know it, including how much and when — it changes the treatment and nobody is going to be shocked.
Sources: European Resuscitation Council Guidelines · checked 2026-09-08
Frequently asked questions
Should I give naloxone before starting CPR?
No. For an unresponsive person who is not breathing normally, call for help and start CPR first, then give naloxone if it is available. It works at the receptor over minutes and does not restart a heart.
The person woke up after naloxone — can they go home?
No. Naloxone typically wears off before the opioid does, so breathing can fail again after apparent recovery. Anyone given naloxone needs to be seen by the ambulance service and observed.
Do rescue breaths matter more in an overdose?
Yes. The arrest is caused by breathing failure, so oxygen is the missing ingredient. Give breaths if you are able and willing; if you are not, compressions alone still beat doing nothing.
What to do, right now
Is this a cardiac arrest?
Two checks decide it: not responding, and not breathing normally. The noisy gasping that fools nearly everyone, why a brief seizure at the start is a cardiac sign, and why a heart attack is a different emergency.
Hands-only CPR, in sixty seconds
Centre of the chest, 100 to 120 pushes a minute, 5 to 6 cm deep, let the chest come all the way back up, and do not stop. The rate, the depth, the fatigue problem, and a pacer that keeps you on the beat.
The emergency call, and the address problem
What the dispatcher asks, why the phone goes on speaker on the floor, how dispatcher-guided CPR works, and the single hardest question in a rural arrest: where exactly are you?
Using a defibrillator, step by step
Open it, turn it on, bare the chest, follow the voice. What the machine decides for you, what it will never do, and the one instruction people get wrong — go straight back to compressions after the shock.
Where the pads go, and what gets in the way
Right collarbone and left ribs, or front and back. Chest hair, sweat, snow, a medicine patch, a pacemaker lump, an underwired bra, a tattoo: which of these actually matter and what to do about each.
Everything on this subject
Before the emergency, there is a long quiet stretch
Blood pressure, resting heart rate, movement and sleep are the part of this you can act on for years beforehand. TempoLife keeps them in one place, free to start.