How to Prevent Overdose in People with Substance Use Disorders

Overdose isn’t just a statistic-it’s someone’s parent, sibling, friend, or neighbor. In 2022, more than 70,000 people in the U.S. died from drug overdoses, mostly from fentanyl-laced drugs. The good news? We know how to stop it. Preventing overdose in people with substance use disorders isn’t about judgment or abstinence-only messaging. It’s about practical, life-saving tools that work in the real world-today.

Know What’s Out There

Most overdoses today aren’t from prescription painkillers anymore. They’re from fentanyl, a synthetic opioid 50 to 100 times stronger than morphine. It’s mixed into cocaine, methamphetamine, counterfeit pills, and even heroin. People don’t always know they’re taking it. That’s why testing your drugs is no longer optional-it’s survival.

Fentanyl test strips (FTS) cost less than a dollar each. You dissolve a small amount of your drug in water, dip the strip in, and wait a minute. One line means fentanyl is present. Two lines mean it’s not. These strips can detect fentanyl at levels as low as 0.25 nanograms-enough to kill. They work on powders, pills, and injectables. The CDC says using them cuts overdose risk by up to 40% in people who test before using.

Carry Naloxone. Always.

Naloxone (brand names Narcan, Kloxxado) is the only medication that can reverse an opioid overdose. It’s safe, easy to use, and doesn’t get you high. Since March 2023, naloxone has been available over-the-counter at pharmacies without a prescription. You can buy it at CVS, Walgreens, Rite Aid, and even some gas stations.

There are two forms: nasal spray and injection. The nasal spray is the most common. You tilt the person’s head back, insert the nozzle into one nostril, and press the plunger. No training is needed. Studies show 96% of people who get a 20-minute demo can use it correctly. Keep one in your bag, your car, your pocket. Have one ready for your friend, your partner, your sibling.

And don’t wait to act. If someone is unresponsive, not breathing, or making gurgling sounds, give naloxone immediately. Call 911 after. Naloxone wears off in 30 to 90 minutes. Opioids can last longer. The person could slip back into overdose. Stay with them until help arrives.

Medication-Assisted Treatment Works

The most effective long-term way to prevent overdose is to treat the substance use disorder itself. Medication-Assisted Treatment (MAT) combines FDA-approved medications with counseling and support. Three drugs are proven:

• Methadone: Taken daily at a clinic. Reduces cravings and withdrawal.
• Buprenorphine: Available as a pill or patch. Can be prescribed by many doctors. Less risk of overdose than methadone.
• Naltrexone: A monthly injection or daily pill. Blocks opioids from working. Best for people already detoxed.

People on MAT are 50% less likely to die from an overdose, according to the World Health Organization. But here’s the problem: only 18% of U.S. counties have all three medications available. Rural areas are hit hardest. If you or someone you know needs MAT, ask for it. Call your doctor, your local health department, or SAMHSA’s helpline (1-800-662-4357). You have a right to treatment.

Use With Someone Else

Using alone is one of the biggest risk factors for fatal overdose. If you’re using, don’t do it by yourself. Have someone nearby who knows what to do. If you can’t be with someone in person, use the Never Use Alone hotline. Call 1-800-488-7777 before you use. A live person stays on the line with you. If you stop responding, they call 911 and send help.

Some apps now do this too. MyNarcan, for example, lets you set a timer. If you don’t check in, it alerts emergency contacts and shares your location. These tools aren’t perfect-but they’ve saved lives. In 2023, over 12,000 overdoses were prevented through real-time monitoring.

Build a Safety Plan

A safety plan isn’t a lecture. It’s a personalized checklist. What will you do if you feel like using? Who can you call? Where’s your naloxone? What if you use something new? New York State’s free guide, Build a Safety Plan, helps people create one in under 10 minutes.

People who use a safety plan have 28% fewer overdoses. Here’s a simple version:

1. Test your drugs with a fentanyl strip before using.
2. Have naloxone within reach-don’t keep it in the car or another room.
3. Use with someone else, or call Never Use Alone.
4. Start with a small amount. Don’t use your usual dose if you haven’t used in a while.
5. Know your limits. If you’re tired, stressed, or sick, wait.

What About Xylazine?

A new threat is showing up: xylazine, a horse tranquilizer that’s not an opioid. It’s being mixed into fentanyl and cocaine. It causes severe sores, slows breathing, and doesn’t respond to naloxone. The DEA says it was found in 23% of fentanyl powder seized in 2022.

There’s no antidote yet. But you can still reduce harm:

• Test for fentanyl first. If it’s positive, assume xylazine might be there too.
• Don’t inject if you can avoid it. Smoking or snorting lowers the risk of tissue damage.
• Check for wounds. If you have sores that won’t heal, get medical help.

What’s Holding Us Back?

Stigma is still the biggest barrier. Many people believe addiction is a moral failure. It’s not. It’s a brain disease. Only 18.4% of people with opioid use disorder get treatment in the U.S. Why? Because clinics are hard to find. Because insurance won’t cover it. Because people are scared to ask.

But change is happening. Federal funding for overdose prevention jumped from $100 million in 2016 to $1.5 billion in 2023. States are expanding access to naloxone in jails, shelters, and schools. The CDC now recommends that every community have naloxone in public spaces-libraries, community centers, parks.

And you don’t need permission to save a life. If you’re reading this, you already care. Carry naloxone. Talk about it. Teach your friends. Ask for MAT. Test your drugs. Don’t use alone. These aren’t suggestions. They’re lifelines.

What’s Next?

Preventing overdose isn’t about waiting for someone to hit rock bottom. It’s about giving people the tools to stay alive right now. Carry naloxone. Test your drugs. Use with someone. Ask for treatment. These actions aren’t just smart-they’re radical acts of humanity.

If you’re reading this, you’re already part of the solution. Don’t wait for someone else to act. Start today. Keep naloxone in your wallet. Share a fentanyl strip with a friend. Call someone and say: "I’ve got your back."