Heroin Dosage Guide

Opioid overdose is a medical emergency that is rapidly fatal without intervention. Heroin overdose causes respiratory depression, meaning breathing slows and eventually stops, leading to death by asphyxiation and cardiac arrest within minutes. Most opioid-related deaths involve co-use of other depressants (benzodiazepines, alcohol) or exposure to fentanyl. Signs of opioid overdose include: extremely slow, shallow, or stopped breathing (fewer than 10 breaths per minute), blue or grayish lips, fingernails, and skin (cyanosis), pinpoint pupils (miosis), unresponsiveness (cannot be woken by stimulation, sternal rub, or shouting), gurgling or snoring sounds (indicating airway obstruction), and limpness. Immediately call emergency services (911). Administer naloxone (Narcan) if available: intranasal naloxone is sprayed into one nostril; intramuscular naloxone is injected into the outer thigh. If no response after 2-3 minutes, administer a second dose. Begin rescue breathing or CPR if the person is not breathing. Place the person on their side (recovery position) to prevent aspiration if they vomit. Stay with the person until emergency services arrive. Naloxone wears off in 30-90 minutes, so the person may re-enter overdose if the opioid outlasts the naloxone. Good Samaritan laws in most US states protect individuals who call 911 during an overdose from drug-related prosecution. ## Community-Sourced Overdose Response Guidance ### Recognizing Overdose Community members and harm reduction workers emphasize that recognizing the difference between a normal "nod" and an actual overdose is critical. Key distinctions include: - A person who is **nodding** will still respond to stimulation (shaking, shouting, sternal rub) and continues to breathe - A person who is **overdosing** will not respond to stimulation, may have stopped breathing or have very slow and shallow breaths, and may display blue or gray discoloration of lips and fingertips Experienced harm reduction workers caution against administering naloxone to people who are simply very sedated but still breathing adequately, as this causes precipitated withdrawal without medical benefit. ### Practical Naloxone Administration Community experience highlights several important practical points: - **Nasal naloxone (Narcan)** is preferred for most situations due to ease of use - **Injectable naloxone** requires drawing the solution from a vial into a syringe, which can be difficult under stress. Community members report that many bystanders cannot successfully perform this during an emergency, leading to preventable deaths - With fentanyl-contaminated heroin, **multiple doses are often required** — administer one dose every 2-3 minutes until breathing resumes - After administering naloxone, **always call emergency services** as naloxone's duration is shorter than most opioids and the person can stop breathing again - Place the person in the **recovery position** (on their side) to prevent aspiration if they vomit ### After an Overdose Community members emphasize that experiencing an overdose does not mean the person was reckless — the unpredictable potency of street opioids means overdose can occur even with cautious dosing habits. Post-overdose, individuals should: - Seek medical evaluation even if they feel recovered, as respiratory depression can recur - Consider this a critical opportunity to discuss treatment options including MAT - Not use again for at least 24 hours, as tolerance may have been affected - Be aware that subsequent doses from the same batch may also cause overdose due to uneven fentanyl distribution ("hot spots")