Opioids are a group of strong drugs. Some are medicines that doctors prescribe for pain, such as oxycodone, hydrocodone, morphine and codeine. Others are illegal, such as heroin. Fentanyl is a very strong opioid used in medicine. Illegally made fentanyl has also spread through the drug supply.

Opioids can bring pain relief and a feeling of calm. They can also slow a person's breathing too much. That is what makes an overdose so dangerous. This page explains the warning signs, how to use naloxone (a medicine that can reverse an overdose), ways to lower risk, and treatments that work. Opioid use disorder is a health condition, and people recover from it.

Key points

An opioid overdose happens when breathing slows or stops. Call 911 and give naloxone if you think someone is overdosing. If you are not sure, treat it as an overdose.²
Naloxone is safe, sold without a prescription in all 50 states, and anyone can use it. It will not harm a person who has not taken opioids.^3,4
Illegal fentanyl is often hidden in other drugs and in fake pills, so people may take it without knowing.⁶
Medicines for opioid use disorder (buprenorphine, methadone, naltrexone) lower the risk of overdose and death. Fewer than 1 in 5 people who could benefit get them.^8,9,10
Overdose deaths in the U.S. fell in 2025, but about 70,000 people still died. The risk is not over.¹

How big is the problem?

U.S. overdose deaths have been falling. CDC's early (provisional) count shows 69,973 overdose deaths in 2025, down from 81,313 in 2024. That is a drop of almost 14%.¹ Deaths that involved opioids fell from 55,296 to 44,564 in the same period.¹ These numbers can change as more reports come in. As of October 2026, they are still the newest full-year figures.

This is good news, but each number is a person and a family. Opioids still account for most overdose deaths.¹ Older adults are not exempt: many take prescription opioids for pain, often along with other medicines that add to the risk.

Prescription opioids, heroin and fentanyl

Prescription opioids are safe for many people when taken as directed for a short time, such as after surgery. The risk grows with higher amounts, longer use, or mixing with other drugs. Opioids can lead to dependence (the body adjusts and gets sick without the drug) and sometimes to opioid use disorder. Learn the difference in signs of a substance use problem.

Heroin is an illegal opioid. It is often cut with other drugs, so a person cannot tell what is in it.

Fentanyl is the biggest driver of overdoses today. Illegally made fentanyl is found in powders and in counterfeit (fake) pills made to look like real medicines. These fake pills often contain fentanyl, and sometimes illegal sedatives, "with or without people's knowledge."⁶ You cannot see, smell or taste fentanyl. A person who thinks they are taking one pill from a pharmacy-looking bottle can be taking a deadly amount.

Opioids are also more dangerous when mixed with other drugs that cause drowsiness. These include alcohol, benzodiazepines (sedatives such as Xanax and Valium), muscle relaxants and sleep aids.⁵ See cannabis, sedatives and stimulants and alcohol.

Signs of an opioid overdose

Call 911 right away if a person has any of these signs after using opioids, or you cannot tell:²

They are unconscious or cannot be woken up
Breathing is very slow or shallow, or they make choking, gurgling or snoring sounds
Lips and fingernails look blue, gray or pale
Pupils (the dark center of the eye) are very small
The body is limp and the skin feels cold or clammy⁵

If you are not sure whether the person is high or overdosing, treat it as an overdose.²

Do not wait for the person to "sleep it off." Do not put them in a cold bath or give them coffee. These do not help. Call 911 and give naloxone.

Naloxone: the overdose reversal medicine

Naloxone (the brand name Narcan is common) can reverse an opioid overdose by pushing opioids off the brain receptors that control breathing. It works on heroin, prescription opioids and fentanyl.^3,4

Key facts about naloxone:

It is safe. It will not harm a person who is overdosing on something else, so it is best to use it whenever you suspect an overdose.³
No training is needed. Anyone can give it.³
It comes in two forms: a nasal spray and a shot into a muscle or under the skin.³
You can buy it without a prescription in all 50 states, at many pharmacies and stores. Many health departments and community programs give it away free.^3,4
Most states have Good Samaritan laws that may protect both the person overdosing and the person who calls for help.⁴
If you take opioids from a doctor, you can ask your doctor to prescribe naloxone with them.³ Guidelines tell doctors to offer it, especially when the person or someone in the home is at higher risk.¹¹

Check for signs. Try to wake the person. Look for the warning signs above.
Call 911. Say that the person is not breathing well. Put the phone on speaker. The dispatcher can help you.
Give naloxone. Follow the picture instructions on the package. For the nasal spray, you place the tip in one nostril and press.
Keep the person awake and breathing. If they do not respond, you may need a second device. Read the package, and ask the 911 dispatcher.⁴
Lay them on their side. This helps keep their airway clear if they vomit.²
Stay with them. CDC advises staying until help arrives, or at least four hours.³

Naloxone can cause sudden withdrawal in a person who depends on opioids. This can bring sweating, nausea, vomiting, shaking, anxiety and a fast heartbeat. It is uncomfortable but not dangerous the way an overdose is.⁴ Naloxone can wear off before some opioids do, so the person can slip back into overdose. That is why you must call 911 even if they wake up.

Keep naloxone where you can find it fast, such as a kitchen drawer or purse. Tell family members where it is. Check the date on the package, and store it as the label says. Ask a pharmacist if you have questions.

Ways to lower the risk

You do not need to be perfect to make things safer. Harm reduction means taking practical steps to reduce harm, without judging. Small steps can save lives.

If you take prescription opioids:

Take them only as prescribed. Do not share or sell them.⁵
Do not drink alcohol or take sedatives with them unless your doctor has approved it.⁵
Lock them away from children, visitors and anyone who might misuse them.⁵
Remove leftover pills quickly. Use a drug take-back site, or ask your pharmacist.⁵
Do not stop a long-term opioid suddenly on your own. Doctors are asked to taper slowly and with support. Talk with your doctor or pharmacist before changing anything.¹¹

If you use illegal drugs or pills not from a pharmacy:

Never use alone. Someone nearby can give naloxone and call 911. If no one is with you, the Never Use Alone hotline at 800-484-3731 (or 877-696-1996) is confidential and open 24/7. You give your location, and if you stop responding, the operator calls EMS for you.⁷
Carry naloxone and tell people where it is.
Use fentanyl test strips. These small paper strips can detect fentanyl in pills, powder and other forms.⁶ A negative result does not guarantee safety, so they are only one tool.
Start with a smaller amount. Tolerance (how much your body can handle) drops after days or weeks without opioids, such as after a hospital stay or time in jail or treatment. The old amount can then cause an overdose.
Avoid mixing opioids with alcohol or sedatives.⁵
Go slowly with a new supply. It may be stronger than the last.

People who have had one overdose are more likely to have another, so an overdose is a strong signal to get support.⁶

Medicines for opioid use disorder

Opioid use disorder is a long-term health condition in which a person keeps using opioids despite harm, cannot cut down, and often has strong cravings. It is not a moral failing. The best-proven treatment is medicine, often with counseling. Strong evidence

There are three main medicines. Each has a different job:^8,10

Medicine	How it works	Who can provide it
Buprenorphine	Eases cravings and withdrawal; partly activates opioid receptors, which blunts the effect of other opioids	Any clinician with a standard DEA registration, in any setting
Methadone	Eases cravings and withdrawal; fully activates opioid receptors	Only a federally certified opioid treatment program
Naltrexone	Blocks opioid receptors so opioids have little effect	Any licensed prescriber; the person must be free of opioids for 7 to 10 days first

Source for the table: CDC.⁸

How well do they work? In a large Massachusetts study of adults who survived an overdose, people who took methadone were 59% less likely to die of an opioid overdose in the following year. For buprenorphine, the figure was 38%. No lower risk was seen for naltrexone, possibly because so few people got it.⁹ Most people stayed on treatment for under six months.⁹ These medicines reduce overdose deaths and lower the risk of infections such as HIV and hepatitis C.¹⁰

Some people worry that methadone or buprenorphine "swaps one drug for another." The evidence does not support that. These medicines are taken in a steady, supervised way, and they lower the risk of dying. Talk with your doctor about how long to stay on treatment. Do not stop on your own.

Counseling and social support help, but guidelines say that a person should not have to wait for counseling to start medicine.⁸ Learn about all options in treatment and recovery.

Opioids and older adults

Older bodies handle opioids differently. Drowsiness, confusion, constipation and falls are more common. Kidney or liver problems, and breathing problems such as sleep apnea, add to the risk.¹¹ Many older adults also take several medicines, and some (like sedatives or sleep aids) can combine badly with opioids.^5,11

If you or a parent takes opioids for pain, ask the doctor to review all medicines, and ask about naloxone. For ideas about pain without a heavy reliance on opioids, see chronic pain and mood. More on alcohol, medicines and older adults is on its own page.

How family members can help

If someone you love uses opioids, you can still protect them. Keep naloxone at home and learn the signs. Talk with care instead of blame. Ask whether they would like help finding treatment. See helping a family member for approaches that work and ones that backfire.

When to get help

Call 911 for any suspected overdose: no response, slow or stopped breathing, or blue lips.² Give naloxone first if you have it.

Call or text 988 if you or someone else is thinking about suicide. Help is free and available at all hours.

For treatment information: The SAMHSA National Helpline, 1-800-662-4357, is free, confidential and open 24/7 in English and Spanish. It refers callers to treatment and support.¹²
Talk to your doctor or pharmacist about naloxone and about medicine for opioid use disorder.
See more on the substance use overview and the help page.

Recovery is common, and many people find it after more than one try. A setback is not a failure. It is a sign to adjust the plan and keep going.

In crisis or thinking about suicide? Call or text 988 (Suicide & Crisis Lifeline, 24/7, free). If someone is in immediate danger, call 911.

Sources

National Center for Health Statistics. U.S. overdose deaths decrease for third consecutive year in 2025 (press release). CDC, May 2026. CDC NCHS
Centers for Disease Control and Prevention. What to do if you think someone is overdosing. CDC. CDC
Centers for Disease Control and Prevention. Lifesaving naloxone. CDC. CDC
Centers for Disease Control and Prevention. Naloxone frequently asked questions. CDC. CDC
Centers for Disease Control and Prevention. Save a life from prescription opioid overdose. CDC Rx Awareness. CDC
Centers for Disease Control and Prevention. Preventing opioid overdose. CDC. CDC
Never Use Alone Inc. Never Use Alone national overdose response hotline. Never Use Alone
Centers for Disease Control and Prevention. Opioid use disorder: treating. CDC clinical care. CDC
National Institutes of Health. Medications reduce risk of death after opioid overdose. NIH Research Matters. NIH
National Institute on Drug Abuse. Medications for opioid use disorder. NIDA. NIDA
Dowell D, et al. CDC clinical practice guideline for prescribing opioids for pain, United States, 2022. MMWR Recomm Rep, 2022. CDC MMWR
Substance Abuse and Mental Health Services Administration. National Helpline. SAMHSA. SAMHSA

Education only. This page is general information written from the sources listed. It is not medical, legal or financial advice and does not replace a doctor, therapist or lawyer who knows your situation. How we write and check pages.