How to Prevent Overdose in People with Substance Use Disorders

Overdose isn’t just a tragedy-it’s often preventable. Every day, people with substance use disorders die from overdoses that could have been stopped with simple, proven tools. The crisis isn’t getting better because we’re still treating it like a moral failure instead of a medical one. The truth is, overdose prevention works when we use the right tools, at the right time, and with compassion.

Know the Real Danger: Fentanyl and Polysubstance Use

Most overdose deaths today aren’t from heroin or prescription pills alone. They’re from fentanyl-a synthetic opioid 50 to 100 times stronger than morphine. It’s not always labeled. It’s mixed into cocaine, methamphetamine, counterfeit pills that look like oxycodone or Xanax, and even fake MDMA. In 2022, fentanyl was involved in about 80% of opioid-related overdose deaths in the U.S. And it’s not alone. Nearly 78% of overdose deaths now involve more than one drug-like fentanyl plus alcohol, benzodiazepines, or xylazine (a veterinary sedative sometimes called “tranq”). Xylazine is especially dangerous because naloxone doesn’t reverse it.

Naloxone: The Lifesaving Tool Everyone Should Have

Naloxone is the only medication that can reverse an opioid overdose. It’s safe, fast, and easy to use. The FDA approved the first over-the-counter naloxone nasal spray (Narcan) in March 2023, meaning you can buy it at pharmacies without a prescription in every state. It’s also available for free through community programs, syringe exchanges, and local health departments.

There are two main types: intranasal (spray) and injectable. The nasal spray is the most common for non-medical users. You don’t need to be a nurse to use it. Just follow the steps:

1. Call 911 immediately-even if you give naloxone, the person still needs medical care.
2. Place the person on their back.
3. Insert the nozzle into one nostril and press the plunger firmly.
4. Wait 2-3 minutes. If no response, give a second dose in the other nostril.
5. Stay with them until help arrives. Naloxone wears off in 30 to 90 minutes, but opioids can stay in the system longer.

Studies show 96% of people trained in naloxone use can successfully reverse an overdose. Training takes less than 20 minutes. And retention is high-95% still remember how to use it six months later. If you know someone who uses drugs, carry naloxone. If you’re using drugs yourself, keep it nearby. It’s not enabling-it’s saving lives.

Fentanyl Test Strips: Know What You’re Taking

You can’t tell if something has fentanyl just by looking at it. That’s where fentanyl test strips (FTS) come in. These small paper strips cost less than a dollar each and can detect fentanyl in powders, pills, and even dissolved in liquid. You dip the strip in water mixed with a tiny bit of the substance. In 15 seconds, you’ll see one or two lines:

• One line = fentanyl is present
• Two lines = no fentanyl detected

They’re not perfect. They can miss very low doses or different fentanyl analogs. But they’re better than guessing. The CDC says they detect fentanyl at levels as low as 0.25 nanograms-enough to kill. Use them every time. Even if you’ve used the same source before. The drug supply changes daily.

Medication-Assisted Treatment (MAT): The Most Effective Long-Term Solution

Naloxone saves lives in the moment. But MAT saves lives over time. It’s not “replacing one drug with another.” It’s treating a chronic brain disease like diabetes or hypertension-with medicine.

Three FDA-approved medications are used:

• Methadone: Taken daily in a clinic. Reduces cravings and withdrawal. Proven to cut overdose deaths by 50%.
• Buprenorphine: Can be prescribed by doctors in offices, including telehealth. Less risk of misuse than methadone.
• Naltrexone: Blocks opioids entirely. Comes as a daily pill or monthly injection. Best for people already detoxed.

The WHO says opioid agonist treatment (methadone or buprenorphine) retains 40-60% of patients in care-compared to just 10-20% with counseling alone. And yet, only 18.4% of Americans with opioid use disorder got any medication-based treatment in 2022. Why? Stigma. Lack of providers. Insurance barriers. Rural areas are hit hardest-60% of rural counties have no MAT provider at all.

If you or someone you know is ready for treatment, ask for buprenorphine. It’s accessible, effective, and doesn’t require daily clinic visits.

Never Use Alone: The Simple Rule That Saves Lives

Most overdose deaths happen alone. That’s why “Never Use Alone” programs exist. These services let you call or text someone before you use. They stay on the line with you. If you stop responding, they call emergency services and send help.

The “Never Use Alone” hotline receives about 12,000 overdose-related calls per month. It’s free, anonymous, and works 24/7. You don’t have to be in crisis to use it. Just call before you use. It’s not about judgment-it’s about safety.

Build a Safety Plan

A safety plan isn’t just for suicide prevention. It works for overdose too. Here’s what to include:

• Who to call before using (a friend, hotline, peer support)
• Where to use (a safe, supervised place, not alone)
• How much to use (start small if you’ve been abstinent)
• Where naloxone is kept (on your person, with your buddy)
• What to do if things go wrong (call 911, give naloxone, stay with them)

A 2022 study found people who used structured safety plans had 28% fewer overdose events. It’s not about quitting-it’s about staying alive until you’re ready for more.

What About Xylazine and Other New Threats?

Xylazine, a non-opioid sedative, is showing up more and more in street drugs. It causes severe skin wounds, slows breathing, and doesn’t respond to naloxone. People using drugs with xylazine often need higher doses of naloxone and longer monitoring. Emergency responders are learning to treat it with supportive care-breathing support, wound care, and fluids.

There’s no antidote yet. So the best defense is:

• Testing for fentanyl (xylazine often comes with it)
• Using with someone who can monitor you
• Calling 911 even if naloxone doesn’t work

What’s Changing in 2026?

The U.S. government is pushing hard to expand access. Naloxone is now available in vending machines in some states. Apps like “MyNarcan” show you the nearest place to get it. The FDA approved nalmefene in 2022-a longer-acting overdose reversal drug that works for 4-8 hours, compared to naloxone’s 30-90 minutes. It’s being rolled out in harm reduction centers.

But the biggest barrier isn’t technology-it’s stigma. 41% of people with substance use disorders say they avoid treatment because they’re afraid of being judged. We need to change that. You don’t have to be “clean” to deserve help. You don’t have to hit rock bottom to get support. You just have to want to live.

Where to Start Today

If you’re reading this, you care. Here’s what you can do right now:

• Get naloxone. Buy it at your pharmacy. Or find a free distribution site through Harm Reduction International.
• Keep test strips in your wallet or purse. They’re cheap and easy to carry.
• Teach someone how to use naloxone. Your friend. Your sibling. Your neighbor.
• Ask your doctor about buprenorphine if you’re struggling with opioids.
• Call a “Never Use Alone” line before you use-any time.
• Share this information. Not to shame. To save.

Overdose isn’t inevitable. It’s a system failure. We have the tools. We have the data. We just need the will to use them.