CPR or Naloxone First? What to Do in an Opioid Overdose Emergency

Opioid overdoses are emergencies no one wants to face, but knowing the right steps can save a life. You notice someone unresponsive—they might need CPR. Then you remember naloxone can reverse opioid overdoses. So, what do you do first? Start CPR or give naloxone?

It’s a common and crucial question, and the answer lies in understanding their condition. 

A Key Principle: Naloxone Should Not Interfere with CPR

Should CPR or Naxalone come first? Naloxone should never delay or interrupt CPR. If the person isn’t breathing normally, your priority is starting chest compressions to circulate oxygen. Naloxone can be administered while CPR is ongoing, provided it doesn’t interrupt your efforts.

For details on naloxone availability in Australia, check out the Take-Home Naloxone 

The Basics of Opioid Overdose Response

If someone has overdosed, start by checking their responsiveness and breathing. These steps guide your next actions:

1. If the person is unconscious but breathing:
   • Place them on their side in the recovery position. This protects their airway and reduces the risk of choking.
   • Ensure their airway is clear. See ANZCOR Guideline 3.
   • Give Naxalone if suitable.
2. If the person is unresponsive and not breathing normally:
   • Begin CPR immediately. Push hard and fast on their chest, following the Basic Life Support Flowchart. See ANZCOR Guideline 8.
   • Don’t hesitate—agonal breathing (gasping or ineffective breaths) is not normal breathing and requires CPR.
   • Get someone to give Naxalonee if it won’t interrupt CPR

What Is Naloxone and Where Does It Fit In?

Naloxone, often called the “opioid antidote,” temporarily reverses opioid overdose effects by restoring normal breathing. Historically used in hospitals and by paramedics, it’s now available for community use through:

• Intramuscular injection
• Intra-nasal spray (preferred for ease and safety)

Naloxone is incredibly effective in opioid overdose emergencies and can be administered when the person is unresponsive, and opioids are suspected.

It can be given quickly without disrupting CPR efforts.

Distributing naloxone widely empowers community members—especially those likely to witness overdoses—to act fast and save lives.

What to Do After Giving Naloxone

Naloxone works quickly, but its effects may wear off before the opioids leave the person’s system. Here’s what to do next:

• Monitor closely: Once naloxone restores breathing, the person might stop breathing again when its effects wear off.
• Call for an ambulance: Even if they appear to recover, they need hospital care for monitoring and possible additional naloxone doses.
• Be ready for more naloxone: Keep an eye on their breathing and administer another dose if necessary.

Why CPR and Naloxone Are Essential Together

CPR and naloxone are a life-saving duo during opioid overdoses:

• CPR ensures oxygen reaches vital organs: Chest compressions buy time for naloxone to take effect.
• Naloxone targets the overdose directly: It reverses respiratory depression caused by opioids, helping the person breathe normally again.

Together, these actions maximize the person’s chances of survival while waiting for professional help.

Final Thoughts

Opioid overdoses are overwhelming, but acting quickly with the right knowledge can save lives. Always remember: Start CPR first if they’re not breathing normally, then use naloxone as soon as possible without interrupting compressions. Ensure they get follow-up care to stay safe.

For more detailed guidance, visit ANZCOR Guidelines or learn more about naloxone programs here.