How to Prevent Overdose in People with Substance Use Disorders

Every year, more than 70,000 people in the U.S. die from drug overdoses. Most of these deaths are preventable. The biggest killer? Fentanyl - a synthetic opioid so potent that just two milligrams can stop someone’s breathing. It’s hidden in pills, powders, and even drugs people think they’re buying, like cocaine or Xanax. If someone you care about uses substances, knowing how to prevent an overdose isn’t just helpful - it could save their life.

Understand the Real Risk: It’s Not Just Opioids Anymore

People used to think overdoses only happened with heroin or prescription painkillers. That’s not true anymore. Since 2016, fentanyl has taken over. It’s cheap, easy to make, and often mixed into other drugs without the user’s knowledge. In 2022, fentanyl was involved in about 80% of opioid-related overdose deaths. But it’s not just opioids. The CDC found that 78% of overdose deaths in 2022 involved multiple drugs - like fentanyl mixed with methamphetamine, cocaine, or benzodiazepines. Even worse, a new drug called xylazine (sometimes called "tranq") is showing up in drug supplies. It’s not an opioid, so naloxone won’t reverse it. That means even if someone has naloxone, it might not be enough.

Get Naloxone Now - And Know How to Use It

Naloxone is the only medication that can reverse an opioid overdose. It works fast - usually within 2 to 5 minutes. It’s safe, non-addictive, and has no effect if someone hasn’t taken opioids. The FDA approved the first over-the-counter naloxone nasal spray (Narcan) in March 2023. That means you can buy it at pharmacies without a prescription. You don’t need to be a medical professional to use it.

• Keep naloxone where you can find it fast - in your wallet, purse, or car.
• Train everyone around you: family, friends, even coworkers. A Johns Hopkins study found 95% of people remember how to use it six months after training.
• One dose isn’t always enough. Fentanyl is so strong that sometimes you need two or three doses. Always call 911 after giving naloxone.
• Don’t wait for symptoms to get bad. If someone is unresponsive, not breathing, or has blue lips, give naloxone immediately.

Use Fentanyl Test Strips Before Using

Fentanyl test strips (FTS) cost less than a dollar each and can detect the drug in powders, pills, or liquids. They’re simple to use: dip the strip in water with a small sample of the drug, wait 15 seconds, and read the result. If there’s a line, the drug is likely safe. If there’s no line, fentanyl is present. These strips don’t tell you how much fentanyl is there - just that it’s present. But that’s enough to make a life-saving choice.

• Test every pill, powder, or vape cartridge - even if you’ve used it before.
• Don’t assume "one hit" is safe. A single pill can contain a lethal dose.
• Test strips don’t work for xylazine. If someone uses drugs that might contain tranq, they need to avoid using alone and have someone nearby who can monitor them.

Medication-Assisted Treatment (MAT) Saves Lives

MAT isn’t a cure - it’s treatment. It combines FDA-approved medications with counseling and behavioral therapy. Three medications are used: methadone, buprenorphine, and naltrexone. Methadone and buprenorphine are opioid agonists - they reduce cravings and withdrawal without causing a high. Naltrexone blocks opioids entirely. Studies show that people on MAT are 50% less likely to die from an overdose than those who aren’t.

But here’s the problem: only 18.4% of people with opioid use disorder in the U.S. got MAT in 2022. Why? Many places - especially rural areas - have no providers. In 60% of rural counties, there’s not a single doctor who can prescribe buprenorphine. If someone you know is struggling, help them find a MAT provider. The SAMHSA treatment locator can help. And if they’re in jail or recently released? That’s the most dangerous time. Their tolerance drops fast. A 2022 study found people released from incarceration are 120 times more likely to overdose in the first two weeks. MAT before release can cut that risk dramatically.

Never Use Alone - And Use the Hotline

Using alone is one of the biggest risk factors for fatal overdose. If something goes wrong, no one’s there to help. The "Never Use Alone" hotline (1-800-477-4344) lets people call before using. A trained operator stays on the line while they use. If they stop responding, the operator calls 911 and sends help. In 2023, the service received about 12,000 calls per month. It’s free, confidential, and works 24/7. Encourage people to use it - even if they think they "don’t need it."

Build a Safety Plan - Simple Steps That Work

A safety plan doesn’t have to be complicated. The New York State Department of Health found that people who use structured safety plans have 28% fewer overdose events. Here’s what to include:

• Who to call if something happens (name and number).
• Where naloxone is kept.
• How much to use (start with one dose, then wait 3 minutes before giving more).
• When to call 911 (always call, even after naloxone).
• What to do if the person wakes up (they might relapse - don’t leave them alone).

Write it down. Save it in your phone. Share it with someone you trust. A written plan removes panic in a crisis.

Reduce Harm - Even If You’re Not Ready to Quit

You don’t have to be ready to quit to prevent an overdose. Harm reduction works. It’s not about judging - it’s about keeping people alive so they have a chance to heal. That means:

• Using clean needles (to avoid infections like HIV or hepatitis).
• Not mixing drugs (especially alcohol, benzos, or xylazine with opioids).
• Starting with a small amount - "test a little" before using more.
• Having someone nearby, even if they’re not using.

Many people think harm reduction encourages drug use. It doesn’t. It saves lives. And when people are alive, they can find treatment, recovery, and support - when they’re ready.

Break the Stigma - It’s Killing People

Stigma is a silent killer. SAMHSA reports that 41% of people with substance use disorders don’t seek help because they’re afraid of being judged, arrested, or losing their job. But stigma doesn’t just stop treatment - it stops prevention. People won’t carry naloxone if they’re ashamed. They won’t use test strips if they think it makes them a "bad addict." We need to talk about this like a health issue - not a moral failure. If someone you know uses drugs, don’t lecture them. Ask: "Do you have naloxone?" "Have you tested your drugs?" "Who’s with you when you use?" Those questions save lives.

What’s Changing in 2026?

The federal government is spending $1.8 billion a year on overdose prevention - up from $100 million in 2016. The CDC’s new 2023-2027 plan focuses on expanding MAT in prisons and jails. Nalmefene, a longer-lasting overdose reversal drug approved in 2022, is now being rolled out in some communities. It lasts 4 to 8 hours - double naloxone’s time - and is especially useful for fentanyl overdoses. Apps like MyNarcan now show nearby naloxone locations and guide users through steps with video. And in 2025, the goal is to increase naloxone distribution by 50% nationwide.

But progress is uneven. Rural areas still have 30% higher overdose death rates than cities - and half as many treatment centers. Access to MAT remains a crisis. If you live in a rural county, don’t wait for services to come to you. Learn to use naloxone. Carry test strips. Talk to your local pharmacy. Push for community training. Your actions matter more than policy.

What to Do Right Now

If you care about someone who uses substances, here’s what to do today:

1. Buy naloxone at any pharmacy - no prescription needed.
2. Get fentanyl test strips online or from a local harm reduction center.
3. Learn the signs of overdose: unresponsive, slow or no breathing, blue skin, snoring sounds.
4. Practice giving naloxone with a training kit (many health departments give them for free).
5. Have a conversation: "If you ever use again, I want you to have a safety plan. I’ll help you make one."

You don’t need to fix everything. Just do one thing. Carry naloxone. Teach someone how to use it. Share a test strip. Call someone after they use. Small actions add up. And right now, they’re the difference between life and death.