How to Prevent Overdose in People with Substance Use Disorders: Proven Strategies That Save Lives

Every year, more than 70,000 people in the United States die from drug overdoses. Most of these deaths are preventable. The problem isn’t just about willpower or choice-it’s about access, education, and systems that fail people when they need help the most. If someone you care about has a substance use disorder, knowing how to prevent an overdose isn’t just helpful-it’s life-saving.

Know What’s in the Drugs Now

The biggest killer today isn’t heroin or prescription painkillers. It’s fentanyl. This synthetic opioid is 50 to 100 times stronger than morphine. A dose as small as two grains of salt can kill. And it’s not just in pills that look like oxycodone-it’s mixed into cocaine, methamphetamine, and even fake Xanax. Most people don’t know they’re taking it.

That’s where fentanyl test strips come in. These small paper strips, costing less than a dollar each, can detect fentanyl in powder, pills, or liquids. You just mix a tiny amount of the substance with water, dip the strip, and wait a few minutes. A single line means fentanyl is present. Two lines mean it’s not.

The CDC says these strips can detect fentanyl at levels as low as 0.25 nanograms. That’s enough to catch even trace amounts. People using them report cutting back, using less, or avoiding use altogether when they test positive. They’re not a cure-but they give people real-time information to make safer choices.

Carry Naloxone. Always.

Naloxone is the only medication that can reverse an opioid overdose. It works by kicking opioids off brain receptors and restoring breathing. It doesn’t work on cocaine, meth, or xylazine-but it works on fentanyl, heroin, and prescription opioids.

You don’t need a prescription to get it anymore. In the U.S., Narcan (naloxone nasal spray) is available over-the-counter at pharmacies like CVS, Walgreens, and Walmart. It’s easy to use: just spray one dose into one nostril while the person is lying on their back. No training is required, and 96% of people who’ve been shown how to use it can do it correctly.

Keep it with you. Keep it in your car. Keep it in your bag. Keep it in your partner’s pocket. If someone overdoses, time is everything. Every minute without oxygen can cause brain damage. Naloxone can bring someone back in under five minutes.

And here’s the truth: you don’t have to be a medical professional to save a life. A friend, a sibling, a stranger on the street-anyone can use it. The Johns Hopkins study found that 95% of people remembered how to use naloxone six months after training. That’s not luck. That’s design.

Medication-Assisted Treatment Works Better Than Anything Else

The most effective way to prevent overdose isn’t just reacting to it-it’s stopping it before it happens. That’s where medication-assisted treatment (MAT) comes in.

MAT uses FDA-approved medications-methadone, buprenorphine, and naltrexone-to help people manage opioid use disorder. These aren’t replacements. They’re treatments. Methadone and buprenorphine reduce cravings and withdrawal. Naltrexone blocks opioids from working at all.

The World Health Organization says people on MAT are 50% less likely to die from an overdose. A CDC study found communities with strong MAT programs had 14% fewer opioid deaths. Yet only 18% of U.S. counties have access to all three medications. In rural areas, 60% have no MAT provider at all.

If someone is ready to get help, getting them on buprenorphine or methadone isn’t a last resort-it’s the first step. And it’s not just for heroin. It works for people addicted to prescription pills, fentanyl, or even those who use multiple drugs.

Never Use Alone

Most overdoses happen alone. People hide their use out of shame. They don’t want to be judged. But isolation is deadly.

The “Never Use Alone” hotline (1-800-477-1805) 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, they received about 12,000 calls a month. Many of those calls prevented deaths.

You don’t need to be a hero. Just ask: “Are you using alone?” If the answer is yes, help them call the line. Or stay with them until they’re done. Even if you don’t use drugs yourself, your presence can be the difference between life and death.

Build a Safety Plan

A safety plan isn’t a one-time thing. It’s a living document. It answers: What will you do if things go wrong?

The New York State Department of Health created a simple template: list trusted contacts, keep naloxone nearby, know your tolerance (it drops after a break), avoid mixing drugs, and have a plan for what to do if you overdose.

People who use safety plans have 28% fewer overdose events. Why? Because they’ve thought through the worst-case scenario. They’ve made decisions before crisis hits.

You can write one on a napkin. Or type it into your phone. Include: who to call, where naloxone is, what drugs you use, and your emergency contacts. Share it with someone you trust.

Know the New Threats

Fentanyl isn’t the only danger anymore. Xylazine-also called “tranq”-is showing up in more and more drug supplies. It’s a veterinary sedative. It doesn’t respond to naloxone. It causes severe skin wounds, slow breathing, and long comas.

The DEA found it in 23% of fentanyl powder and 7% of fentanyl pills seized in 2022. If someone overdoses and naloxone doesn’t work, xylazine might be the reason.

There’s no antidote yet. So the best defense is awareness. If someone is unresponsive after naloxone, call 911 anyway. Tell responders they may have taken xylazine. And if you’re using drugs, assume they’re mixed with something you can’t see.

Help After Release from Jail or Prison

People leaving incarceration face the highest overdose risk of any group. Their tolerance drops fast. If they go back to using the same amount they did before jail, they die.

Studies show they’re 120 times more likely to overdose in the first two weeks after release. That’s not a statistic-it’s a crisis.

The CDC’s 2023-2027 plan says we must expand MAT in jails and prisons. Start buprenorphine before release. Give naloxone on the way out. Connect them to care within 24 hours.

If you know someone being released, help them get on treatment before they walk out. Don’t wait. Don’t assume they’ll “get it together.” Their body has changed. Their risk is extreme.

What Doesn’t Work

Abstinence-only programs don’t prevent overdoses. Neither do scare tactics. “Just say no” doesn’t work when someone’s brain is wired for addiction.

Stigma kills. People avoid treatment because they’re afraid of being judged. They hide their drug use. They don’t carry naloxone because they’re ashamed.

The truth? Addiction is a medical condition. Like diabetes or hypertension, it needs ongoing care. You wouldn’t shame someone for needing insulin. Don’t shame someone for needing buprenorphine.

Where to Get Help

You don’t have to figure this out alone.

- Naloxone: Available at pharmacies without a prescription. Ask for Narcan or Kloxxado.

- Fentanyl test strips: Order free ones from harm reduction organizations like DanceSafe or the North American Syringe Exchange Network.

- Medication-Assisted Treatment: Call SAMHSA’s helpline at 1-800-662-HELP (4357) to find providers near you.

- Never Use Alone: Call 1-800-477-1805 or text “HELP” to 741741.

- Safety plans: Download free templates from the New York State Department of Health website.

What You Can Do Today

- Carry naloxone. Even if you don’t use drugs.

- Ask someone if they’ve tested their drugs.

- Learn how to use naloxone. It takes 20 minutes.

- Don’t assume someone’s “just using too much.” They might not know what’s in it.

- Support policies that fund harm reduction and MAT. These programs save lives at a fraction of the cost of emergency care.

Overdose isn’t inevitable. It’s a failure of systems-not of people. With the right tools, knowledge, and compassion, we can stop it. One life at a time.