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acute danger to life

Opioid Overdose

When When breathing becomes very shallow after heroin, morphine, fentanyl, tilidine or tramadol, the lips are blue-grey and the person is unresponsive.

review pending

Content is undergoing medical and legal review. Changes possible.

Emergency

Call 112. Calling for help is required by law (German Criminal Code § 323c). levelll cannot promise immunity from criminal or administrative consequences.

Immediate

  1. 1. Call 112. Naloxone alone is not enough.
  2. 2. Use naloxone nasal spray if available (Nyxoid, available without prescription in Germany since 2024). If there is no effect after 2–3 minutes: second dose into the other nostril.
  3. 3. Recovery position, keep the airway clear. If breathing stops: chest compressions.

Don't do

  • Don't wait to see whether naloxone is needed. Use it immediately if there is a clear suspicion — naloxone is harmless if in doubt.
  • Don't leave the person alone after giving naloxone. Naloxone lasts 30–90 minutes, many opioids last longer — rebound respiratory depression is possible.
  • Don't hesitate out of fear of the police. Providing aid is mandatory (§ 323c StGB) — see the emergency call block above.

Naloxone reverses the effect of opioids at the μ-receptor and restores breathing within minutes. It does not work for GHB/GBL, benzodiazepines, alcohol or stimulants.

Where to get naloxone:

  • Pharmacies (without prescription since 2024)
  • Low-threshold distribution through drug counselling services (DROBS Berlin, Eclipse e.V., SONAR)
  • Current distribution points at naloxoneworks.eu

Mixing with benzodiazepines or GHB is especially dangerous, because naloxone only reverses the opioid component. Monitoring breathing remains mandatory.

Fentanyl and synthetic opioid overdoses can require repeated doses of naloxone, because their duration of action exceeds that of naloxone.