They cannot be woken up
Snoring or gurgling breathing, blue or grey lips, fewer than about eight breaths a minute, no response to their name shouted or to knuckles ground into the breastbone. On darker skin, check the lips and gums.
Call 911- Call 911.Say: “Someone is unresponsive and not breathing.” Give the address before anything else — if the call drops, the address is the part that still brings help.
- Put them on their side.It keeps the airway open so they cannot choke if they vomit. Steps are below.
- Give naloxone if there is any.Give it rather than deciding first: it does nothing at all if opioids turn out not to be involved. One dose, wait two to three minutes, another if normal breathing has not come back.
- Do not leave them alone.Naloxone wears off before many opioids do, so someone who woke up can go back under. Stay until responders take over.
Something else is wrong
Open the one that matches what you can see.
Overheating, muscles rigid or twitching, or seizing
Body temperature is the emergency here, not how they are behaving. Both of these kill by cooking the body from the inside, and both build over minutes to hours rather than arriving all at once. The person cannot judge it from inside, and neither can you from how they are talking.
Serotonin syndrome or stimulant hyperthermia- Get them somewhere cool and take layers off.Cool skin with water and moving air. This is the single most useful thing you can do before help arrives.
- Nothing further of anything.No more doses, and nothing to counteract it. A stimulant to bring them round makes both of these worse.
- Call 911 for a fever, rigid or jerking muscles, or confusion.Say what was taken. Serotonin syndrome is very treatable, but only when staff know to look for it.
- If they are seizing, clear the space around them and time it.Do not hold them down and do not put anything in their mouth. A seizure over five minutes, or a second one, is a 911 call on its own.
Chest pain, or a pounding, racing or irregular heartbeat
Stacked stimulants raise heart rate and blood pressure and narrow blood vessels, and heat, dancing and dehydration all push the same way. The strain adds up even though the effect people are chasing does not.
Cardiovascular strain- Sit them down somewhere cool and stop all movement.
- Sip water steadily, around a pint an hour.Not more. Drinking a lot of water quickly is its own danger, particularly with MDMA.
- Chest pain, fainting, or weakness on one side means 911 now.Tell them what was taken — treatment for a stimulant-driven cardiac event differs from the standard one.
Terrified, confused, or seeing things that are not there
Most of these pass on their own with the right surroundings. The exception is delirium — from diphenhydramine or a similar anticholinergic — where the person cannot tell hallucination from reality at all, and which comes with hot dry skin and a rising temperature. That one is a medical emergency and the rest are not.
Psychological crisis or delirium- Change the room before you try to change their mind.Lower the light and the noise, fewer people, somewhere they can sit down. Arguing with the content of it does not work.
- Say who you are, where they are, and that it will pass.Repeat it calmly as often as needed. Being frightened of being frightened is most of what makes these escalate.
- Stay with them and take away anything they could fall onto.Sleeping it off next to a friend who is also asleep is not supervision.
- Hot dry skin, a temperature, or no memory of the last hour means hospital.That is delirium rather than a bad trip, and it has a specific treatment. It does not simply wear off safely.
The recovery position
- Roll them onto their side, towards you.
- Stretch the arm underneath out above their head.
- Bring the top hand under their cheek to cushion the head.
- Bend the top knee forward so they cannot roll onto their face.
- Tilt the head back a little and lift the chin, so the airway stays open.
- Check they are still breathing every couple of minutes until help arrives.
If they stop breathing entirely, the dispatcher will talk you through chest compressions. Do what they say — you cannot make this worse.
What to say
- “Someone is unresponsive and not breathing.”Lead with this. It is the sentence that sets the priority of the call.
- The address, and how to get in.Gate code, building, floor, which door, whether anyone can meet them outside. This is the part that most often wastes minutes.
- What was taken, how much, and how long ago.As much as you actually know. A guess said as a guess is far more useful than nothing.
- Whether naloxone was given, and when.It changes what they do on arrival.
- Stay on the line.They will talk you through everything above, including chest compressions if it comes to that.
Can I be arrested for calling?
For possession, in California, no — and that protection covers the person who overdosed as well as the person who called.
Health and Safety Code § 11376.5 says it is not a crime to be under the influence of, or to possess for personal use, a controlled substance or paraphernalia if you sought medical help in good faith for someone having a drug-related overdose. The same applies to the person overdosing. The conditions are that the call is made in good faith and that you do not obstruct the responders.
What it does not cover, stated plainly: selling or supplying, driving under the influence, and anything made dangerous by the drug beyond possessing it. The statute says in its own words that no protection beyond the ones it lists can be read into it, so an outstanding warrant or a probation condition is not cleared by making the call.
Most US states have some version of this law and the protections are not the same in each. If you are not in California, look up your own state's — but not now.
Cal. Health & Safety Code § 11376.5 · Summary, not legal advice.
Lines worth having in your phone
- Poison Control — 1-800-222-1222Free, 24/7, and the right call for “is this bad?” before it is an emergency. They are not police and they do not report you.
- Never Use Alone — 1-800-484-3731Stays on the line while you use and sends help to your address if you stop responding.
Not in the US? The emergency number is 112 across the EU, 999 in the UK and Ireland, 000 in Australia, 111 in New Zealand and 911 in Canada and Mexico. From a mobile, 112 reaches the local service in much of the world.
This page works with no signal once MixSafe is on your home screen. Keep it on your phone — it installs under any name you choose, and a basement at 2am is exactly the situation it is for.