The most common fentanyl overdose signs are tiny “pinpoint” pupils, falling asleep or passing out, slow or stopped breathing, choking or gurgling sounds, a limp body, and pale, blue or gray skin, lips or fingertips. If you see these signs, call 911 immediately and give naloxone as quickly as possible, without waiting for emergency workers to arrive. Acting fast can save a life.
This guide explains how to recognize an overdose, why fentanyl is so dangerous, exactly what to do in an emergency, and how Pennsylvania law protects people who call for help.
Fentanyl Overdose Signs to Watch For
Fentanyl is an opioid, so an overdose looks like any opioid overdose. The main danger is that breathing slows or stops. The CDC and Pennsylvania’s Department of Drug and Alcohol Programs (DDAP) list these warning signs:
- Small, constricted “pinpoint” pupils that don’t react to light
- Falling asleep, loss of consciousness, or being unable to talk or stay awake
- Slow, shallow, irregular or stopped breathing
- Deep snoring, choking or gurgling sounds
- A limp body
- Pale, clammy skin, or blue, purple or grayish lips, skin or fingernails
The CDC’s fentanyl fact sheet also lists cold, discolored skin. You do not need to see every sign. If someone is unresponsive and not breathing normally, treat it as an overdose.
When you’re not sure
It can be hard to tell the difference between someone who is very sedated and someone who is overdosing, especially in a stressful moment. Loud snoring or gurgling can sound harmless, but DDAP lists deep snoring and gurgling noises among the fentanyl overdose signs because they can mean the airway is struggling. If you are unsure, act as if it is an overdose. Naloxone will not harm someone if they are not overdosing on an opioid, according to the CDC.
Why Fentanyl Overdoses Are So Dangerous
Fentanyl is up to 50 times stronger than heroin and 100 times stronger than morphine, according to the CDC. In 2023, about 69% of all U.S. overdose deaths, nearly 73,000 deaths, involved synthetic opioids other than methadone, mainly fentanyl.
The CDC’s fact sheet notes that over 150 people die every day from overdoses related to synthetic opioids like fentanyl. Several factors raise the risk:
- You often can’t tell it is there. Drugs may contain deadly levels of fentanyl that you cannot see, taste or smell. It is commonly mixed into heroin, cocaine and methamphetamine.
- Counterfeit pills. The CDC warns that illegally made fentanyl is increasingly pressed into counterfeit pills that look like oxycodone or Xanax.
- Mixing substances. StatPearls notes that fentanyl’s effects on breathing are amplified by alcohol or other drugs. Combining opioids with alcohol or sedatives like benzodiazepines is especially risky. Learn more about the dangers of mixing benzos and alcohol.
- Other additives. The animal sedative xylazine is often mixed with fentanyl and deepens sedation. See our guide to xylazine (tranq).
What to Do if You See Fentanyl Overdose Signs
Pennsylvania’s DDAP and the CDC recommend these steps:
- Call 911. Tell the dispatcher the person is not breathing or will not wake up.
- Give naloxone. Use nasal spray naloxone (such as Narcan) or injectable naloxone as directed on the package. Don’t wait for responders.
- Give a second dose if needed. DDAP advises giving another dose if the person does not respond within 2 to 3 minutes. The CDC notes that more than one dose might be needed, especially when illegally made fentanyl is involved.
- Support breathing. Give rescue breaths if the person is not breathing.
- Use the recovery position. Once they are breathing, lay them on their side to prevent choking.
- Stay with them until emergency help arrives.
The CDC explains that naloxone comes as a prefilled nasal spray or an injectable medication, and it works on overdoses involving fentanyl, heroin, oxycodone, methadone and other opioids. For a detailed walkthrough of each type, read our guide on how to use Narcan.
After naloxone
The CDC reminds families that naloxone is a temporary treatment. Its effects can wear off, and the person can stop breathing again, so they still need emergency medical care. The FDA also notes that naloxone can cause sudden withdrawal symptoms such as body aches, fever and a fast heart rate in people who are dependent on opioids. Stay calm, reassure them, and keep them from using again to “fix” the withdrawal. Our guide to fentanyl withdrawal explains what they may be feeling.
Naloxone Access and Legal Protections in Pennsylvania
In 2023, the FDA approved the first over-the-counter naloxone nasal spray, so you can buy it without a prescription. In Pennsylvania, DDAP offers free naloxone by mail for personal use and free naloxone and test strips through local Overdose Prevention Program partners.
Fear of police keeps some people from calling 911. Pennsylvania’s Good Samaritan provision in Act 139, known as David’s Law, offers criminal and civil protections to those who seek and receive emergency medical services in the event of an overdose. Please call. Saving a life comes first.
Knowing the fentanyl overdose signs is only part of being prepared. You can also lower risk before an emergency happens: never use alone, keep naloxone nearby, and check drugs with fentanyl test strips, keeping in mind that a negative result does not mean a drug is safe.
Frequently Asked Questions
Can I buy naloxone without a prescription?
Yes. The FDA approved over-the-counter Narcan nasal spray in 2023, so it can be sold in drugstores and other stores without a prescription. Pennsylvania residents can also get free naloxone through DDAP’s Overdose Prevention Program, including by mail.
Can you overdose on fentanyl without knowing you took it?
Yes. Fentanyl is often mixed into other drugs or pressed into fake pills, and you cannot see, taste or smell it. Many overdoses happen in people who did not know fentanyl was present.
Can naloxone hurt someone who isn’t overdosing?
No. According to the CDC, naloxone will not harm someone who is not overdosing on an opioid, and it is safe for people of all ages.
Will I get in trouble for calling 911?
Pennsylvania’s Good Samaritan provision (Act 139) offers criminal and civil protections to people who seek emergency medical help for an overdose. Call 911 right away.
Get Help for Fentanyl Use in Lancaster, PA
Surviving an overdose, or watching someone you love go through one, can be a turning point. The Ranch Pennsylvania Outpatient Services offers a partial hospitalization program (PHP) and an intensive outpatient program (IOP) for opioid and fentanyl addiction, with therapy, family support and medication-assisted treatment when clinically appropriate. If medical detox is needed first, it can be coordinated with residential care at The Ranch Pennsylvania. Learn about options across the state in our guide to fentanyl addiction treatment in Pennsylvania, or verify your insurance now. Our admissions team is available 24/7, and calls are free and confidential. In an emergency, always call 911 first.
