It can be difficult to tell if someone is experiencing a substance-induced high or an overdose. The following is some information on how you could tell the difference. If you’re having a hard time telling the difference, it is best to treat the situation like an overdose by calling 911– it could save someone’s life.

If someone is really high and using downers like heroin, or pills:

• Pupils will contract and appear small
• Muscles are slack and droopy
• They might “nod out”
• Scratch a lot due to itchy skin
• Speech may be slurred
• They might be out of it, but they will respond to outside stimuli like loud noise or a light shake from a concerned friend.

If you are noticed that someone is getting too high, it is important that you do not leave them alone. If the impaired person is still conscious, walk them around, keep them awake, and monitor their breathing.

The following are signs of an overdose:

• Loss of consciousness
• Unresponsive to outside stimulus
• Awake, but unable to talk
• Breathing is very slow and shallow, erratic, or has stopped
• For lighter-skinned people, the skin tone turns bluish purple, for darker-skinned people, it turns grayish or ashen.
• Choking sounds, or a snore-like gurgling noise (sometimes called the “death rattle”)
• Vomiting
• Body is very limp
• Face is very pale or clammy
• Fingernails and lips turn blue or purplish black
• Pulse (heartbeat) is slow, erratic, or not there at all

If someone is making unfamiliar sounds while they are “sleeping” wake them up, especially if you know the person has a history of using or abusing opioids. Many people think the person is snoring, when in fact the person is overdosing. It is rare for someone to die immediately from an overdose and when people survive, it’s because someone was there to help.

The most important thing is to not panic and act right away! Click here for information on how to respond to an opioid overdose by SAVE ME acronym.