You’re partying with someone and things suddenly take a turn. It’s unclear if they’re experiencing an overdose, but something isn’t right. You want to call for help but hesitate because illegal substances are involved.
What if you or the other person get arrested, or worse?
As a paramedic, chemist, and researcher, I find this limbo we force upon people who use drugs — call 911 and face arrest and trauma, or accept that you may watch your friend die without aid — deeply unjust.
But it’s a reality that many have to face.
Here’s my advice on what to do if you find yourself in this situation.
When talking about an overdose, we’re usually talking about a situation involving opioids, including prescription medications like hydrocodone and illegal substances like heroin.
When someone experiences an overdose, it’s often due to contamination from a stronger substance, like fentanyl or benzodiazepines.
You often hear about this kind of contamination in the context of opioids (especially heroin), but cocaine, meth, molly, and other non-opioid substances can also be contaminated.
Regardless of the substances involved, start by checking for these signs of an overdose:
- slow or ragged breathing
- a loud, rattling snoring sound when breathing
- constricted pupils
- pale or gray, clammy skin that’s cool to the touch; people with darker skin may look washed out or ashen rather than pale
- blue or gray fingertips
- nausea, vomiting, or both
- dozing off, even as you try to keep them awake
If you haven’t already, try to wake them up with a gentle tap. If that doesn’t work, loudly call for them to wake up and give their shoulders a shake.
If they’re still not responding, try vigorously rubbing their chest with a flat palm.
If this still isn’t waking them up, form a fist with one hand and quickly rub your knuckles up and down their breastbone in the center of the chest. This is painful, so you don’t need to press hard.
If the person still isn’t waking up after you do this, it’s time to call 911 or local emergency services. Even if this person isn’t experiencing a drug overdose, something’s wrong and they’re in need of help.
If you’re worried about legal consequences, it might help to understand what happens when you call 911.
In most areas, it goes like this:
- Your call is routed to a dispatch center.
- A trained dispatcher takes the call and asks a set of standardized questions.
- Based on the answers to those questions, they send out police, fire, and/or emergency medical services (EMS) as needed.
Since dispatchers only have the word of the caller to go on, they tend to err on the side of caution. Typically, this means that mention of drugs or overdose, even offhand, will summon the police and EMS.
My suggestion to people on the fence about calling 911 is to have a story ready to go in advance.
You don’t need to mention the substances involved, but try to be specific about the symptoms the person is experiencing, like trouble breathing, loss of consciousness, or vomiting.
Make sure that the dispatcher knows exactly where you are. This is the most important piece of information for them.If you aren’t sure of the address, mention any nearby businesses, landmarks, or other features. C
ellular location data may allow Uber drivers to find you within a couple of feet, but this accuracy does not typically extend to 911 call centers.
If you’re unsure, ask the dispatcher to confirm the exact location. They can often get a more specific location from your cell phone carrier, though this can take some extra time.
Stay with the person and follow the 911 dispatcher’s instructions. They will walk you through how to help the person while EMS is on the way.
The dispatcher will have a lot of questions and want to keep you on the phone and engaged. This might feel unnerving, but it’s pretty standard.
When EMS arrives, this is when you’ll want to be as honest as possible about what happened, including the substances involved. This will help them determine the best course of action.
EMS personnel are busy folks focused on saving lives. They typically won’t involve law enforcement at this point unless they see something concerning, like evidence of child or elder endangerment.
Regardless of what you told the dispatcher, EMS will have naloxone — a medication that can reverse an opioid overdose — on hand.
They’ll also have equipment to support the person’s breathing and heart while they wait for the naloxone to kick in.
While the steps outlined above can help you lessen the chances of law enforcement showing up, they’re not a guarantee. Things vary by region, and the police may still be involved despite efforts to avoid them.
Unfortunately, some EMS personnel can also be punitive and cruel to people who use drugs. It’s inexcusable, but it happens.
If you elect not to call 911, know the risks and be as equipped as possible to respond. The human body is endlessly complex. There’s no guarantee that the situation you’re facing will be resolved easily.
Even if you have naloxone on hand and can administer it, you may still want to call for extra support.
It’s possible that there’s a contaminant in what the person took that naloxone won’t reverse, like a benzodiazepine, including Xanax.
There’s also the chance that after receiving naloxone, the person may wake up, only to have the naloxone wear off too soon, causing them to experience another overdose.
Some areas have good Samaritan laws intended for this kind of situation.
These laws vary in specifics, but they’re designed to protect people who step in to help someone in distress, like an overdose.
Ideally, good Samaritan laws should make people feel safer about calling 911, but they’re far from perfect. If you have a good Samaritan law in your area, be sure to research its language and understand its limits.
In some areas, for example, laws are limited to a one-time use per person or disregarded if you’re found to have more than a small amount of drugs.
If you’re not familiar with the laws in your area, Google “good Samaritan law” and your state.
Emergencies happen, but there are certain steps you can take to keep yourself and those around you safe while using drugs.
If you or people you spend time with use drugs, naloxone is a must. Remember, drugs like cocaine, molly, and meth can also be contaminated with opioids, so it’s worth having naloxone even if you don’t use opioids.
If possible, have at least two doses of naloxone. It’s available for free and without a prescription nearly everywhere, even during the pandemic.
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NEXT Distro can help you find naloxone in your area and even send you some by mail.
Naloxone comes as either a nasal spray or in a glass vial that needs to be drawn up into a syringe and injected into muscle or fat.
Regardless of the type you have, practice going through the motions of administering it. In a panic moment, even simple tasks can become difficult unless you have some muscle memory to fall back on.
Pharmacists are a great resource for this. You can take the naloxone and syringe to them and ask them to show you how it’s used. Most will gladly teach you this skill. It’s not as hard as it sounds!
Make sure others around you know where it is as well as when and how to use it. Put it someplace that’s easy to remember but out of direct sunlight and away from high heat (like a radiator).
While naloxone is safe for everyone, unless you have an allergy to it, it’s best to keep it out of reach from children and pets due to the glass and needle (if you get that version of it).
As an individual, you have incredible power to save lives and reduce harm. Don’t be afraid to use it.
Never use drugs alone
Never use drugs alone, and don’t let your friends use drugs alone, either.
This is a simple step to saving lives but not always easily achieved, especially in the era of COVID-19.
Tools like FaceTime and Zoom allow you to “be there” for your friends who use drugs and either directly intervene or call for help if needed.
There’s also the Never Use Alone hotline (800-484-3731), which only asks for your specific physical location in case they need to send EMS, and will stay on the line with you in case help is needed.
Make a plan
There are a lot of reasons why someone might hesitate to call 911 in case of a drug-related emergency.
Perhaps they have an open warrant, or there are things in their environment that would invite arrest. Maybe they’re undocumented, Black, or Indigenous and face disproportionate risk from an encounter with law enforcement.
No one should ever feel like they have to choose between saving a life and having a potentially harmful interaction with law enforcement. Fortunately, there are steps you can take to reduce the chances of police showing up when you call 911.
With a bit of preparation, you and your friends can also devise a plan to help you look out for one another when using drugs.
Ms. Claire Zagorski earned a bachelor’s degree at the University of Texas at Austin and a master’s degree at the University of North Texas Health Science Center. She has practiced clinically as a paramedic in multiple treatment settings, including as a member of the Austin Harm Reduction Coalition. She founded Longhorn Stop the Bleed and is committed to supporting healthcare professionals who seek to integrate harm reduction principles in their practice.