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Naloxone can effectively rescue victims from opioid overdose, but less than 5% survive due to delayed or absent first responder intervention. Current overdose reversal systems face key limitations, including low user adherence, false positive detection, and slow antidote delivery. Here, we describe a subcutaneously implanted robotic first responder to overcome these challenges. This implantable system for opioid safety continuously monitors vital signs, detecting opioid overdose through an algorithm analyzing the interplay of cardiorespiratory responses. To address battery concerns with continuous monitoring and multi-sensing modality, an adaptive algorithm dynamically adjusts sensor resolution, reducing the need for frequent charging. Furthermore, the implant includes an ultra-rapid naloxone delivery pump, delivering the 10-mg antidote within 10 s. In animal trials, the robotic first responder successfully revived 96% of overdosed pigs ( = 25) within 3.2 min, showcasing its potential to dramatically improve survival rates and combat the opioid epidemic.