911, 988 or Poison Control: Who to Call About Drugs

When someone you love has taken too much of something, or has stopped drinking and started shaking, the hardest question in the first minute is often the simplest one: who do I call? Families sometimes reach our admissions line while an emergency is still unfolding, and the honest answer is usually that we are not the right first call.

Four numbers that cover most substance-related emergencies

In the United States, four phone numbers cover most drug and alcohol emergencies, and each one does a different job. 911 sends emergency medical services and is the right call for anyone who is unresponsive, breathing slowly or not at all, having a seizure, or reporting chest pain. The Poison Help line, 1-800-222-1222, connects you free of charge, 24 hours a day, to a poison center specialist who can tell you whether a swallowed substance or medication mix-up needs the emergency room. 988, the Suicide & Crisis Lifeline, answers calls and texts around the clock for anyone in emotional crisis, including crisis tied to drug or alcohol use. The SAMHSA National Helpline, 1-800-662-4357, is a free, confidential treatment referral line that runs 24 hours a day, 365 days a year; it helps you find treatment but does not dispatch help.

A residential program’s admissions line, including ours, is not on that list. An admissions team cannot send an ambulance, cannot safely assess a medical emergency over the phone, and a small six-bed residence is not an emergency department. If you call us during an overdose or a seizure, the first thing we will tell you is to hang up and call 911. Call us once the person is medically stable.

When to call 911 without hesitating

Call 911 first and do everything else second if you see any of the following:

• Unresponsiveness: the person cannot be woken by shouting their name or by a firm rub on the breastbone.
• Breathing changes: slow, shallow, gurgling or snoring-type breathing, or no breathing at all, which are hallmark signs of opioid overdose.
• Color changes: blue, gray or ashen lips and fingertips.
• Seizure: any seizure during alcohol or benzodiazepine withdrawal, any seizure lasting longer than five minutes, or seizures that repeat.
• Chest pain or extreme agitation: particularly after cocaine or methamphetamine use, and especially with a very high body temperature.
• Severe confusion with tremor or hallucinations: during alcohol withdrawal, which can signal delirium tremens.

If opioids could be involved and naloxone is available, give it and call 911. The National Institute on Drug Abuse (NIDA) describes naloxone as a medication that can rapidly reverse an opioid overdose, but its effect can wear off in roughly 30 to 90 minutes, while fentanyl and longer-acting opioids may stay in the body longer. A person can wake up and then slip back into overdose, which is why emergency care still matters after naloxone works. Stay with the person and place them on their side if they are breathing.

Fear of legal trouble keeps some people from calling. California has a 911 Good Samaritan law (Health and Safety Code section 11376.5) that offers limited protection from arrest and prosecution for small-amount possession to a person who seeks medical help for someone experiencing an overdose. It is not blanket immunity, and its exact reach depends on the circumstances, but it exists precisely so that people call.

Why withdrawal and relapse can turn into emergencies

Stopping a substance, or returning to it after a break, can be more dangerous than families expect. Three mechanisms explain most of that risk:

• Rebound nervous-system excitability: alcohol and benzodiazepines both slow brain activity, so stopping suddenly after heavy, regular use can tip the brain into overactivity that produces tremor, hallucinations and seizures.
• Lost tolerance: after days or weeks without opioids, tolerance drops, so a dose the person used to take can now stop their breathing.
• Unpredictable supply: illicit pills and powders may contain fentanyl or other substances the person did not intend to take, so the amount and the effect cannot be known in advance.

Alcohol and benzodiazepine withdrawal both carry a real risk of seizures and require medical supervision rather than an attempt to tough it out at home. Withdrawal seizures from alcohol most often occur within the first 6 to 48 hours after the last drink, which is why that window is closely monitored in medically supervised alcohol detox. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends that people with alcohol use disorder talk with a health professional before stopping, because withdrawal can be dangerous. Benzodiazepines prescribed for anxiety or sleep should never be stopped abruptly without the prescriber or a detox team planning a taper.

When Poison Control is the right first call

Poison Control is the most underused number on the list. It fits situations where the person is awake, talking and breathing normally, but something has gone wrong: an extra dose of a prescription taken by mistake, two medications combined with alcohol, a pill that cannot be identified, or a child who got into someone’s medication. A specialist asks targeted questions and tells you whether it is safe to watch at home or whether to go to the emergency room, and they can connect you to 911 if needed. If at any point the person becomes hard to wake or their breathing changes, stop and call 911 instead.

Have these ready before you dial, because they are the first questions you will be asked:

• The name of the substance or medication, with the bottle or package in your hand.
• The strength printed on the label, such as milligrams per tablet.
• How much was taken and roughly what time.
• The person’s age and approximate weight.
• Anything else taken in the last 24 hours, including alcohol.

When 988 or the SAMHSA Helpline fits

988 is for emotional crisis: someone who is overwhelmed, panicking, talking about not wanting to be alive, or in distress about their own drinking or drug use. You can call or text 988 for yourself or for someone else. If a person has taken something with the intention of harming themselves, or is in immediate danger, call 911.

The SAMHSA National Helpline is for the next step rather than the emergency itself. It provides referrals to local treatment facilities, support groups and community organizations, in English and Spanish, and the call is confidential.

What to ask before leaving the emergency room

An emergency department stabilizes; it rarely starts treatment. Before leaving, ask these questions and write down the answers:

• Was withdrawal treated, and what medications were given, at what doses and at what time?
• Is there a risk that withdrawal symptoms will start or worsen after discharge, and over what timeframe?
• Can we have a printed copy of the discharge summary and current medication list?
• Was naloxone offered, and if not, can it be prescribed before we leave?

Residential admission generally requires medical clearance, and a hospital discharge summary is usually the fastest way to show what was given and what still needs to be monitored. If the person is also living with co-occurring depression, anxiety, PTSD or another mental health condition alongside their substance use, ask whether it was assessed; both conditions shape the plan in dual diagnosis treatment. To talk through whether residential care is the right next step, you can reach our admissions team at (855) 778-8668.

Do this today: a two-minute phone setup

1. Save 1-800-222-1222 in your phone as “Poison Control”.
2. Save 1-800-662-4357 as “SAMHSA Helpline”. You do not need to save 988, but remember that texting it works too.
3. Photograph the label of every prescription in the home, including the strength, so you can read it out under pressure.
4. If anyone in the household uses opioids or any illicit drug, keep naloxone somewhere everyone knows. California pharmacists can furnish naloxone without an individual prescription.
5. Agree on a simple plan with the people you live with: who calls 911, who stays with the person, and who unlocks the door for paramedics.

Talking to us about treatment

Annandale Behavioral Health is a small, licensed residential program in the Los Angeles and Pasadena area for adults with substance use disorders, including people with co-occurring mental health conditions. Once someone is medically stable, we can explain how admission works, what our residential treatment program in Los Angeles involves, and whether it fits their needs. Call (855) 778-8668 to talk it through. If you or someone near you is in danger right now, call 911, or call or text 988.

Educational disclaimer: this article is for general education only and is not medical or legal advice, diagnosis, or a substitute for care from a licensed clinician. Phone services and laws can change, and no program can promise a specific result. In an emergency, call 911.