Drugs

Almost everything on the alcohol page applies here too: stay in touch, notice the good stretches, skip the confrontation. What's different is that a single dose can kill, so the first job is making an overdose survivable.

A licensed clinician is reviewing this guidance and it may change. It is general information, not advice about a particular person. If someone is in immediate danger call 911, and for trained help call or text 988.

Know what an overdose looks like, and carry Narcan

Signs are: won't wake up, breathing slowly or not at all, blue or grey lips, pinpoint pupils. Call 911, give naloxone if you have it, and stay with them. Naloxone — Narcan nasal spray — reverses an opioid overdose in minutes and is sold over the counter with no prescription. Get emergency help even if they wake up, because it wears off before the opioid does. All 50 states protect bystanders who help in good faith.^{1, 2}

Assume any pill not from a pharmacy contains fentanyl

Counterfeit pills made to look like Xanax, Percocet or Adderall are widespread and frequently contain fentanyl in amounts that kill. Someone who thinks they know their dose does not, if they didn't get it from a pharmacy.³

What helps

Stay reachable, even when you're angry — People who use alone are the ones who die. Being someone they'll still call at 2am matters more than being someone who disapproves correctly.
Don't make contact conditional on being clean — "Call me when you're sober" sounds like a boundary and works like a door closing. You can refuse to give money and still answer the phone.
Notice the good stretches out loud — Same as with alcohol, and the same evidence behind it. Make the days they're doing well visibly worth having.⁴
Know that medication treatment exists and works — For opioids in particular, medicines such as buprenorphine and methadone are the treatment with the strongest evidence. Some people still hear this as swapping one drug for another; it isn't, and that belief keeps people away from the thing most likely to save them.⁵

What tends to backfire

None of these are stupid. Most of them are what caring looks like when it is frightened, which is why they are so common.

Cutting them off completely — Isolation is what makes drug use lethal rather than merely harmful. You can hold firm limits without disappearing.
Searching their things — It buys you one bad conversation and costs you every honest one afterwards.
Waiting for them to hit bottom — With fentanyl in the supply, the bottom is frequently death. This idea has not aged well and never had evidence behind it.

What you could suggest

Understanding the situation does not tell you what to actually do. These are things you can offer.

Get naloxone and tell them you have it — Over the counter at most pharmacies, and free from many local health departments. Keeping it isn't approval — it's the difference between an overdose and a funeral.²
Ask them not to use alone — A locked bathroom door is the most common place people die. If they will use, using with someone nearby is a genuine harm reduction.
Call SAMHSA together — Free and confidential, any hour, and they'll help you find local treatment without insurance.⁵
Ask a doctor about medication for opioid use — Buprenorphine can be prescribed in ordinary doctors' offices now. It doesn't need a residential program first.

Questions that are easier to ask than to invent

Are you using alone?
Do you have Narcan? Can I get you some?
What are you taking, and do you know where it came from?
Have you ever overdosed, or come close?
What would you want me to do if I found you and couldn't wake you?
Is there anything you'd want to change about how this is going?
What do you need that isn't money?

Words you will hear

Naloxone / Narcan

A nasal spray that reverses an opioid overdose within minutes. Sold over the counter. Harmless if you're wrong about what's happening.

Fentanyl

A synthetic opioid strong enough that a few grains can kill. Now found in most of the illicit supply, including pills sold as something else.

Medication for opioid use disorder

Buprenorphine, methadone or naltrexone. The treatment with the best evidence for opioids, and still widely misunderstood as cheating.

Tolerance loss

After a break — especially after jail or rehab — the old dose can be fatal. The period right after leaving treatment is the most dangerous.

Help Now is not a crisis line, a counseling service, or a substitute for emergency care. This is general guidance for people supporting someone they care about, not clinical advice about a particular person.