Beyond Naloxone: Why Rescue Breathing Saves Lives in Opioid Overdoses

When someone witnesses an opioid overdose, the first thought is often to reach for naloxone. This life-saving medication has rightfully earned its reputation as a crucial intervention tool, capable of rapidly reversing the effects of opioid overdose (National Institute on Drug Abuse, 2024). However, focusing solely on naloxone creates a dangerous gap in overdose response—one that can mean the difference between life and death.

The reality is that naloxone, while extremely important, is only part of the solution.

Rescue breathing, a fundamental life support technique, is equally critical and often more immediately necessary than naloxone.

The Silent Killer: Respiratory Depression

Opioids can kill by suppressing the body's drive to breathe. Unlike other medical emergencies where the heart might stop first, opioid overdoses typically follow a predictable pattern: the person becomes unconscious, their breathing becomes shallow and irregular, and eventually stops altogether (Bateman et al., 2023; Dahan & Boom, 2024). The heart may continue beating for several minutes after breathing has ceased, creating a critical window where intervention can prevent death.

In overdose situations, excessive stimulation of opioid receptors in the brain leads to respiratory depression and ultimately death by respiratory arrest (Khanna & Pillay, 2025). When no prompt rescue is initiated, opioid-induced respiratory failure results in asphyxia, a combination of low arterial oxygen and high arterial carbon dioxide levels that can cause fatal cardiac arrest (Dahan & Boom, 2024).

This is where rescue breathing comes in. While naloxone works to reverse the opioid's effects on the brain's respiratory centers, it takes time—usually 2 to 5 minutes—to take effect. During those crucial minutes, the person's brain and organs are being deprived of oxygen. Without intervention, brain cells begin to die within minutes of not receiving adequate oxygen (Cleveland Clinic, 2025).

Rescue breathing fills this gap by manually providing oxygen to the person's lungs, maintaining vital oxygen levels until naloxone can restore natural breathing patterns.

Why Isn’t Naloxone Enough?

Even when administered correctly, naloxone requires time to circulate through the bloodstream and reach the brain. During this period, oxygen deprivation continues while the person remains in respiratory arrest.

Research indicates that opioid overdoses cause respiratory failure that can lead to cardiac arrest, requiring comprehensive intervention beyond medication alone (Ontario HIV Treatment Network, 2024).

The Life-Saving Power of Rescue Breathing

Rescue breathing is a simple technique that can be performed by anyone, requires no special equipment, and provides immediate benefit. The process involves:

1. Positioning the person on their back with their head tilted back slightly to open the airway

2. Pinching the nose closed and creating a seal over the mouth

3. Delivering slow, steady breaths every 5 to 6 seconds

4. Watching for chest rise with each breath to ensure proper technique

This technique can maintain oxygen levels for extended periods, buying precious time for naloxone to work or for emergency medical services to arrive. In many cases, rescue breathing alone can keep someone alive until professional help arrives.

While some experts debate the necessity of rescue breathing in all overdose situations, many believe it remains important to include in overdose response protocols due to the hypoxic nature of cardiac arrest that occurs during opioid overdose (Glick et al., 2023). The American Heart Association emphasizes the importance of educational programs that include rescue breathing and CPR training for those most likely to encounter opioid-related emergencies (Sasson et al., 2020).

Using Both Approaches

The most effective overdose response combines both interventions strategically. Best practices include:

Immediate assessment: Check for responsiveness and breathing. If the person is unconscious and not breathing normally, begin rescue breathing immediately.

Parallel administration: If naloxone is available, administer it while continuing rescue breathing. Don't stop breathing assistance to give naloxone.

Sustained support: Continue rescue breathing even after giving naloxone until the person's natural breathing returns or emergency services arrive.

Call for help: Contact emergency services immediately, as professional medical care is essential for complete recovery and monitoring. In situations where naloxone isn't accessible, rescue breathing alone can sustain life until help arrives.

The Broader Perspective

Effective overdose response reflects a broader understanding of harm reduction—meeting people where they are and providing practical, life-saving interventions. While the ultimate goal is connecting people with treatment and recovery resources, the immediate priority is keeping them alive.

This approach recognizes that overdose response is a community responsibility. Family members, friends, coworkers, and even strangers might find themselves in a position to help. Equipping people with multiple response tools increases the likelihood of successful intervention.

In the fight against opioid overdoses, every breath matters.

By teaching people to provide both naloxone and rescue breathing, communities can build a more robust safety net that saves more lives and gives more people the chance to recover.

References

Bateman, J. T., Saunders, S. E., & Levitt, E. S. (2023). Understanding and countering opioid-induced respiratory depression. British Journal of Pharmacology, 180(7), 813-828. https://doi.org/10.1111/bph.15580

Cleveland Clinic. (2025, June 26). Opioid overdose: Signs, symptoms & treatment. https://my.clevelandclinic.org/health/diseases/24583-opioid-overdose

Dahan, A., & Boom, M. (2024). Opioid-induced respiratory depression. BJA Education, 24(3), 88-94. https://doi.org/10.1016/j.bjae.2023.11.004

Glick, J. L., Christenson, E. C., Mohd Rosli, R., Evans, E., Yap, T., Kit, B., ... & Hargarten, S. W. (2023). Evaluating rescuer performance in response to opioid overdose in a community setting: Evidence for medically appropriate process measures. Resuscitation, 185, 109717. https://doi.org/10.1016/j.resuscitation.2023.109717

Khanna, I. K., & Pillay, R. S. (2025). Opioid toxicity. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470415/

National Institute on Drug Abuse. (2024, February 12). Naloxone DrugFacts. https://nida.nih.gov/publications/drugfacts/naloxone

Ontario HIV Treatment Network. (2024). Chest compressions and rescue breathing when administering naloxone in opioid overdose. https://www.ohtn.on.ca/rapid-response-chest-compressions-and-rescue-breathing-when-administering-naloxone-in-opioid-overdose/

Sasson, C., Haukoos, J. S., Bond, C., Rabe, M., Colbert, S. H., King, R., ... & Adelgais, K. (2020). Barriers and facilitators to learning and performing resuscitation skills: A systematic review. Resuscitation, 147, 103-116. https://doi.org/10.1016/j.resuscitation.2019.12.011