Last updated: 07 July 2025

What is an overdose?

The signs and symptoms of an opioid overdose are:

  • Pinpoint pupils (although not always present in all individuals)
  • Pale skin colour
  • Bluish tinge to lips, tip of nose, eye bags, fingertips or nails
  • No response to noise (where the helper ‘shouts’ at the casualty and gets no response)
  • No response to touch (shoulder shake)
  • Loss of consciousness i.e. the suspected overdose casualty cannot be woken
  • Breathing problems: slow/shallow or infrequent breaths/snoring/rasping sounds/ not breathing at all.

When someone has overdosed they can look and sound like they are asleep. Always check when you hear snoring that the person is actually asleep and not in an overdose situation. Snoring/rasping, sometimes referred to as the ‘death rattle’, can be an indication of breathing difficulties. The time gap between a person taking drugs and slipping into an overdose and can vary from a few minutes to several hours.

What is naloxone?

Naloxone is the emergency antidote for overdoses caused by heroin and other opiates/opioids (including synthetic variations), such as fentanyl, nitazenes, methadone and morphine. Naloxone temporarily reverses the main life-threatening effect of these drugs, which is the slowing and stopping of breathing, therefore providing more time for an ambulance to arrive and take over from the rescuer(s).

Naloxone is a prescription-only medicine, so pharmacies cannot sell it over the counter. However, drug services and others can supply it without a prescription if they are making it available for the purpose of saving lives. Anyone can use available naloxone to save a life in an emergency.

Even if you are not sure an opioid overdose has occurred, if the person is unresponsive, administer naloxone, give Basic Life Support and seek emergency medical care.

Who can supply naloxone without a prescription?

People working for drug treatment services can give out naloxone without a prescription. This includes naloxone products in nasal (sprayed into the nose) or intramuscular (injected into the muscle) forms.

In December 2024, legislation was updated to enable a wider range of people to supply naloxone without a prescription. Under these arrangements, these people can supply:

  • take home naloxone
  • naloxone products to be carried in case they are needed

They can only supply naloxone if they are suitably trained.

As well as people working for drug treatment services, others who can supply naloxone without a prescription include:

  • people employed or engaged by:
    • medical services of the armed forces
    • police forces and services, including drug treatment workers commissioned to work in these settings
    • prison services
    • probation and youth justice services
  • registered nurses and midwives
  • pharmacists and pharmacy technicians
  • registered paramedics

Any one of these could supply naloxone for use in an emergency, for example to:

  • a person at risk of overdose
  • a family member or friend of a person at risk of overdose
  • an outreach worker for a homelessness service whose clients include people who use opioids
  • a hostel manager
  • any individual working in an environment where there is a risk of someone overdosing.

This means that naloxone can be stored in homelessness services, in order to be used in emergencies.

What the regulations do not do is allow homelessness staff to dispense naloxone in the same way as treatment services i.e. to supply users, friends etc. to use in the event of an emergency. So, although staff in homelessness services can use naloxone in an emergency situation, they cannot supply it clients.

Under the new regulations, where permission from the person using opioids cannot be sought or obtained, it is permitted to provide naloxone to a family member or friend without the express permission of the person, as long as it is being supplied by the drug treatment service, in order for the family member or friend to be able to use it to save life in an emergency.

Registration service for non-named professionals and services to supply take home naloxone

The legal framework enables individuals in professions and services that are not named in the legislation to supply take home naloxone subject to registration with a new registration service. Work to set up this registration service is ongoing and we will provide further information in due course.

How can homelessness services acquire naloxone?

Homelessness services can acquire a naloxone kit from their local drug treatment service provider. Services should contact their local drug treatment service and discuss, with the support of commissioners, issues such as: how much naloxone your staff, service users, volunteers etc. may need, its safe storage and review, and suitable record keeping of any support and use.

‘Take home’ naloxone is where naloxone is issued by a prescriber or someone within a recognised drug treatment service in order to be used in an emergency situation. This includes current or previous opioid users, as well as their support workers, family members, carers, peers and friends.

Why is naloxone so important?

People who use or are dependent on drugs – heroin and other opiates in particular – have mortality rates in the range of 1-2% per year, representing an excess mortality 10 to 20 times greater than expected. The main cause of premature death among people who use drugs in the UK is drug overdose. The vast majority of these deaths are potentially avoidable.

Given the potential for reversing opioid overdoses to save lives, training in the use of naloxone should be widespread, particularly in first responders likely to be available to administer naloxone. Legislation allows anyone to use anyone else’s naloxone in an emergency to reverse a suspected opioid overdose for the purpose of saving a life.

How can homelessness services use naloxone to save lives?

Identifying and supporting people that use drugs in the community is crucial in ensuring that they are made more aware of the risks associated with their situation and so that support can be offered in a timely manner.

For homelessness service, including day centres, and hostels, naloxone supplies should be kept in an easily identifiable place, such as behind the reception desk, or with the first aid kit. The most important thing to note is that they should not be locked away. Every staff member should know where they are and have easy access to them in the event of an overdose. Naloxone should be stored away from strong light in a cool dry place (although not refrigerated). The injection will have a shelf life and should be replaced as it approaches its expiry date.

Training for staff and people accessing services

The supply of naloxone alone is not sufficient to prevent drug-related deaths. Training people accessing services, peers, volunteers and staff in how to recognise and respond appropriately to a suspected opioid overdose is just as important.

Training clarifies the causes of overdose and dispels myths about how to respond when someone overdoses, and leaves people more willing to intervene.

There are four key aspects to the training:

  1. Risk factors for opioid overdose
  2. How to recognise the signs and symptoms of opioid overdose
  3. How to respond on discovering a suspected opioid overdose (including practical instruction in the assembly of the injectable naloxone product or use of the nasal forms)
  4. The recovery position for those breathing normally and CPR for those who aren’t.

Injectable Naloxone training is often provided by the local drug service and takes approximately 30 minutes. It may take place in a one-to-one setting or be delivered to a group. Contact your local drug treatment provider to request training (including train-the-trainer), which should be provided free of charge.

It is worth noting that staff working in homelessness services should receive more comprehensive training given the high risk of them encountering overdose situations. This training should include:

  • Scene management
  • Stayin’ Alive Planning
  • How to restore normal breathing
  • Postvention care
  • The bystander effect
  • Use of barrier devices to limit cross infection risks if giving mouth to mouth resuscitation.

Free nasal naloxone training is available online here. It includes a film, as well as various training materials to download and print. Your local drug treatment service may also offer additional training as part of their supply procedure.

You can ask the drug service to deliver an initial group session to the staff team. Some services invite people accessing services to join staff for the session. Nominated staff could receive train-the-trainer training to be able to cascade information to others, including those not engaged with drug treatment. If you have a local service user group or peer volunteers, consider getting them involved as peer trainers. This can be particularly effective in sharing information among people accessing services.

Further Resources

Homeless Link Resources

Cranstoun

https://cranstoun.org/

Cranstoun provides services for adults and young people facing difficulties with alcohol and other drugs, domestic abuse, housing and criminal justice. They have a range of resources on their website related to harm reduction approaches.

Free E-Learning: Naloxone Saves Lives

https://www.ap-elearning.org.uk

Naloxone Website (UK)

https://naloxone.org.uk/