Overdoses All You Need to Know

Fatal overdoses involving legal and illicit drugs increased drastically from 1999 to 2014. Americans are more likely to die from overdoses than car crashes or gun violence. Left untreated, overdoses can have dire consequences leading to death or paralysis. Emergency services are crucial to save lives but, without the proper follow-up treatment, the user risks another overdose.

What to Do During an Overdose:

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Drug overdose is an unprecedented epidemic in the United States.

Overdose deaths have increased by an alarming 137 percent since 2000, and it stems from the growing problem of substance addiction. Nationally, 2014 saw a record number of overdose-related deaths, with three out of five resulting from opioid intoxication.

Drug or alcohol overdoses can be life-threatening and require immediate medical assistance. If you witness an overdose, call 911 immediately.

Drug overdoses claimed the lives of 500,000 people from 2000 to 2014.

What Is an Overdose?

An overdose occurs when an individual takes more than the recommended amount of a drug or alcohol. The person’s body is unable to metabolize the substance fast enough, causing intoxication. People can overdose on alcohol, illegal drugs, prescription medications and over-the-counter medicine.

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The physique of the individual

The individuals’ height and weight determine how the substance affects them.

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The substance used

Consequences vary per substance consumed. Some drugs, such as Fentanyl, are deadlier than others.

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The amount of substance taken

The dosage of drug or alcohol can establish the difference between a non-fatal overdose and a fatal one.

People react differently to overdoses. While each class of drugs has its own overdose symptoms, typical signs are nausea, vomiting, breathing difficulties, incoordination, tremors, convulsions and hallucinations.

Drug overdoses can be deliberate, when the users intend to commit suicide or harm themselves. They can also be accidental through the inadvertent misuse of medication or the intentional misuse of drugs.

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Prescription Medication Overdose

There is a misconception that prescription drugs are safer because they are legal, but they are the most commonly abused substances after alcohol and marijuana. From 1999 to 2014, deaths from prescription medication overdose more than doubled, according to the National Institute on Drug Abuse.

The most commonly abused classes of prescription drugs are opioids, stimulants and depressants.

Opioids

Substance use disorders involving prescription opioids affect more than 2 million Americans. An opioid overdose involves the overconsumption of opioid-based drugs such as morphine, oxycodone and other synthetic narcotics.

Opioid overdoses have multiple long-term side effects and deadly consequences. The prolonged use causes extra fibrous tissues to form in the lungs, also known as fibrotic lung disease. This eventually leads to shortness of breath and lung complications. Other side effects include large abscesses at the injection site if the opioid is injected.

Signs of an opioid overdose include:
  • Nausea and Vomiting
  • Slowed Breathing
  • Change in Heart Rate
  • Extreme Lethargy
  • Confusion or Delirium
  • Loss of Alertness

Despite the lack of change in levels of pain reported by patients, opioid prescriptions nearly quadrupled in 15 years. The most common prescription opioids involved in overdose-related death are:

  • Methadone
  • Oxycodone
  • Hydrocodone

Methadone held a higher overdose death rate than other opioids for multidrug- and single-drug-related deaths from 1999 to 2010, according to the CDC. It was responsible for 31.4 percent of opioid-related deaths during that period. The drug also accounted for 39.8 percent of single-drug opioid overdose deaths.

Prescription opioids claim the lives of 78 Americans daily. Per a 2011 report by the Centers for Disease Control and Prevention, deaths from opioid pain relievers transcend those from all illegal drugs.

  • There was a 369 percent increase in opioid-related deaths from 1999 to 2014.
  • There was a 500 percent increase in fentanyl-involved overdose deaths from 2013 to 2014.

Benzodiazepines

The use of benzodiazepines, such as Xanax and Valium, has risen during the past decade, but so have the deaths. NIDA reported a 600 percent increase in overdose deaths involving benzodiazepines from 1999 to 2014.

Signs of a benzodiazepine overdose include:
  • Dizziness
  • Slow Reflexes
  • Confusion
  • Extreme Drowsiness
  • Blurred Vision
  • Unresponsiveness
  • Anxiety
  • Agitation

The use of benzodiazepines, such as Xanax and Valium, has risen during the past decade, but so have the deaths. NIDA reported a 600 percent increase in overdose deaths involving benzodiazepines from 1999 to 2014.

CNN reported that the rise in benzodiazepine deaths did not correlate to the number of benzodiazepine prescriptions during that period. Given that benzodiazepines have a low overdose risk on their own, this suggests that people have been misusing the drugs.

Barbiturates

Barbiturates overdoses are life threatening. Short-acting barbiturates expel out of the body within 24 to 48 hours as opposed to long-acting barbiturates such as phenobarbital, which require emergency services.

Unlike benzodiazepines, barbiturates have a high addiction and overdose potential. Popular in the early 20th century for medical and recreational use, they are now associated with suicide among elderly people. Medscape reports that barbiturates were responsible for 27.2 percent of fatal overdose suicides among the elderly.

Signs of a barbiturate overdose include:
  • Loss of Consciousness
  • Trouble Thinking
  • Drowsiness or Coma
  • Impaired Judgment
  • Incoordination
  • Shallow Breathing
  • Slurred Speech

An overconsumption or prolonged use of barbiturates may impair body functioning and cause irritability and memory loss.

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Illicit Drug Overdose

An illicit drug overdose involves taking an unsafe amount of the drug, resulting in toxicity. The unhygienic practices of illegal drug use, such as needle sharing, contribute to users’ vulnerability to overdosing.

Fatal illicit drug overdoses leapt by 210 percent from 1999 to 2014, according to NIDA. This is not surprising, given a 2014 CDC report that 10.2 percent Americans were past-month users of illicit drugs.

Large alcohol intake prevents the body from effectively clearing alcohol from the bloodstream. This magnifies the side effects of alcohol and can lead to incoordination or clouded judgment. Higher blood alcohol content (BAC) may even cause the individual to black out.

Amphetamines

Methamphetamines are the most notorious illegal amphetamines. While the overdose symptoms of crystal meth are similar to those of other drugs, meth-related overdose victims perspire excessively.

A meth overdose may be sudden or long-term. The side effects associated with an acute overdose are life-threatening and require immediate treatment.

An acute meth overdose may result in:
  • Sympathetic Overdrive
  • Cardiovascular Collapse
  • Rhabdomyolysis
  • Ventricular Tachyarrhythmia
  • Death

Fatal methamphetamine overdoses are typically associated with multiple organ failure.

Although chronic stimulant users are rarely at risk of fatal syndromes, there are multiple side effects associated with the long-term use of methamphetamine.

The side effects include:
  • Atherosclerosis
  • Hypertension
  • Myocardial Infarction
  • Chronic Heart Failure
  • Soft-tissue Infection
  • Periodontal Disease
  • Sepsis
  • Changes in Cognitive Function
  • Personality Disorders

Cocaine

Cocaine intoxication is dangerous because it affects every organ system. It is the second most common cause of drug-related emergency visits, after alcohol. Fatalities from cocaine overdoses saw a 42 percent increase from 1999 to 2014, as noted by NIDA.

A cocaine overdose can happen under various circumstances, the most obvious ones being taking too much of the drug or mixing cocaine with other drugs. Using cocaine in hot climates amplifies the risks and effects of overdose because of dehydration. Drug mules are also vulnerable to a severe overdose or death if their cocaine packets burst inside them.

There are three phases to a cocaine overdose. Frequent convulsions occurring at 2- to 3-minute intervals usually denote fatal cases.

Phase I (early stimulation) Phase II (advanced stimulation) Phase III (depression & premorbid state)
Central nervous system Pupil dilation, headache, bruxism, nausea, vomiting, vertigo, unintentional tremor, tics, pre-convulsive movements and cocaine bugs Altered brain function, seizures, epilepsy, low responsiveness, decreased reflexes and incontinence Coma, no reflexes, fixed and dilated pupils, paralysis and loss of vital support functions
Circulatory
  • Blood pressure increase
  • Change in pulse
  • Pale appearance
  • Hypertension
  • Increased heart rate
  • Irregular pulse and hypotension
  • Skin discoloration
  • Circulatory failure
  • Cardiac arrest
Respiratory Faster and deeper breaths Rapid, difficult and irregular breathing Respiratory difficulty or failure, gross pulmonary edema, skin discoloration
Temperature Elevated Severe hyperthermia n/a
Behavioral Euphoria, elation, garrulous talk, agitation, apprehension, excitation, restlessness and mood swings n/a n/a

In cases where a cocaine overdose is not fatal, it may leave the user with debilitating complications, including:

  • Seizures, stroke and paralysis.
  • Chronic anxiety and severe mental disorders.
  • Decreased mental functioning.
  • Irregular heartbeat and reduced heart functions.
  • Kidney failure.
  • Destruction of muscles, which may result in amputation.

Heroin

Heroin overdoses happen when users take more of the drug than they can handle. Heroin is so potent that many first-time users overdose on it. Similar to cocaine, heroin is smuggled across borders. The smugglers risk intoxication if the heroin packets rupture in their GI tracts.

Fatal heroin overdoses more than quadrupled in 15 years. Medscape reports that heroin fatalities are associated with chronic use rather than short-term use. Users who consume alcohol and other drugs with heroin are more susceptible to respiratory failure, which leads to death.

Signs of a heroin overdose:
  • Breathing Difficulties
  • Dry Mouth
  • Discolored Tongue
  • Small Pupils
  • Low Blood Pressure
  • Weak Pulse
  • Bluish Nails and Lips
  • Constipation
  • Stomach and Intestine Spasms
  • Coma
  • Delirium
  • Disorientation
  • Drowsiness
  • Uncontrolled Muscle Movements

Marijuana

As the most commonly used illicit drug in the United States, marijuana has never been associated with fatal overdoses. However, the drug has unpleasant side effects such as troubles with short-term memory, dry mouth, low perception and red eyes. First-time users and those with a mental disorder may experience paranoia or acute psychosis.

Mixing marijuana with hallucinogens or other drugs amplifies the risks of overdose.

Some of the symptoms are:
  • Abrupt High Blood Pressure and Headache
  • Chest Pain
  • Extreme Hyperactivity and Physical Violence
  • Heart Attack
  • Seizures
  • Stroke
  • Cardiac arrest

Hallucinogens

Hallucinogens have mind-altering properties that may prove dangerous to the users and their surroundings during an overdose. The most commonly abused hallucinogen is ecstasy (MDMA), which is popular in raves.

Signs of an MDMA overdose include:
  • Seizures
  • Hyperthermia
  • Blood-clotting Impairment
  • Arrhythmia
  • Heart Failure
  • Stroke
  • Renal or Liver Failure

The hot and crowded settings of raves usually lead to severe dehydration. Most of the ecstasy-related overdose deaths involve heatstroke or hyperthermia.

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Alcohol Overdose

Large alcohol intake prevents the body from effectively clearing alcohol from the bloodstream. This magnifies the side effects of alcohol and can lead to incoordination or clouded judgment. Higher blood alcohol content (BAC) may even cause the individual to black out.

Side Effects of Consumption

Large alcohol intake prevents the body from effectively clearing alcohol from the bloodstream. This magnifies the side effects of alcohol and can lead to incoordination or clouded judgment. Higher blood alcohol content (BAC) may even cause the individual to black out.

Alcohol Blood Content Effect
0.0 – 0.05% Mild impairment
0.06 – 0.15% Increased impairment
0.16 – 0.30% Severe impairment
0.31 – 0.45% Life-threatening

The side effects of alcohol consumption grow proportionally to the blood alcohol content.

Some side effects include:
  • Impairments to speech, memory, coordination, attention, reaction time and balance
  • Poor judgment and decision-making skills
  • Amnesia
  • Vomiting
  • Loss of consciousness
  • Risk of death because of suppression of vital brain functions

Critical Signs of Overdose

Alcohol poisoning occurs when the individual’s blood alcohol content is so high that the brain begins to shut down, affecting breathing, heart rate and body temperature.

Critical signs of alcohol overdose include:
  • Confusion
  • Coma
  • Inability to Wake Up
  • Vomiting
  • Seizures
  • Slow or Irregular Breathing
  • Low Body Temperature
  • Bluish Skin
  • Paleness

An alcohol overdose is dangerous, especially when the individual is sleeping. Alcohol is a depressant, which reduces the brain’s response time. Given that alcohol sometimes causes vomiting, the inhibition of the gag reflex can cause the individual to choke on his or her vomit. This may lead to death or a permanent brain damage.

Untreated alcohol poisoning causes a plethora of issues for the individual that can eventually result in death.

Some of the consequences of an alcohol overdose are:
  • Slowed breathing until it stops.
  • Irregular heartbeat that eventually stops.
  • Low body temperature.
  • Decrease in blood sugar level, which leads to seizures.
  • Severe dehydration leading to seizures and permanent brain damage or death.
60 percent of drug overdoses involve an opioid, according to a 2014 CDC report.

What causes an overdose?

Several risk factors are at play when it comes to a drug overdose, which can be intentional or accidental.

An intentional overdose occurs when the individual knowingly takes a large amount of drugs or alcohol with self-harming intentions. Intentional overdoses are recurrent in people with a mental health disorder. Untreated suicidal thoughts and depression are major contributing factors.

Accidental Overdose

Accidental drug overdose is the primary cause of injury-related death among people from their 30s to 50s and the second-leading cause in young people.

Young children and the elderly are likely to be victims of unintentional overdoses. Younger children, often the ones left unattended, are prone to ingesting pills or substances within their reach.

Older people tend to have vision issues that cause them to misread labels or misunderstand the dosage required. Many of them also have memory issues so they may not remember previously taking their medicine and take double doses.

Former users are the most vulnerable to accidental overdoses. Individuals who have been in prolonged recovery often overestimate the amount of drugs their body can withstand. Their disregard for their lowered tolerance often results in fatal overdoses.

Substance abusers are more susceptible to overdosing because they usually take a combination of drugs and alcohol. They also build a tolerance to the drug from frequent use, which places them at a higher risk of overdosing. In contrast, first time users may overestimate the amount of drug their body can handle, resulting in toxicity.

Hot temperatures may be a risk factor when drugs such as cocaine or MDMA are involved. Further dehydration from these drugs may induce heatstroke or hyperthermia and magnify the side effects of overdose. Drug mules ingest drug packets to smuggle them across borders or in new countries. A rupture in those packets may result in an overdose and prove deadly for the individual.

More than 40 Americans die each day from prescription opioid overdoses, we must act now. Overprescribing opioids – largely for chronic pain – is a key driver of America’s drug-overdose epidemic.

CDC Director Tom Frieden

Consequences

The consequences of an overdose depend on the circumstances. Emergency treatment greatly helps the prognosis of overdoses, and many individuals recover without lingering side effects.

Drug overdoses kill more than cars, guns and falls, according to the CDC. However, overdoses do not always result in death.

Overdose survivors sometimes have to live with permanent lung or brain damage. Brain damage affects an individual’s senses, memory and muscles. In serious cases, it may even leave the person in a vegetative state.

Hypoxic brain injury occurs from lack of oxygen flow to the brain, typically an outcome of a heroin overdose. This may result in long-term paralysis, seizures or a coma, depending on the severity of the injury.

Some factors affecting the outcome of an overdose include:

  • The level of toxicity.
  • The frequency of substance use.
  • Drug mixing with impurities.
  • Injuries as a result of the overdose.
  • Underlying medical conditions.
There has been a 439 percent increase in heroin overdose deaths from 1999 to 2014.

Treatment

Timely treatment may be the difference between life and death.

If you suspect that someone has overdosed, seek help by calling 911. You may also reach the local poison center at 1-800-222-1222 and can speak to experts in poisoning who will walk you through the situation.

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First Aid

While waiting for emergency services, you can take a number of steps to ensure that the individual’s condition does not get worse. Remain calm to be able to help the individual.

Steps to take:

  • If the person is not breathing, provide CPR.
  • If the person is unconscious but breathing, place him or her in the recovery position.
  • If the person is conscious, loosen his or her clothing, keep them warm and reassure them.
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Emergency

Doctors will examine the patient upon arrival. They may use activated charcoal to absorb the drug from the patient’s GI tract or laxatives to help expel the drugs from the system.

What to expect in emergency care

  • Blood and Urine Tests
  • Breathing Support
  • Chest X-ray
  • CT Scan
  • Electrocardiogram
  • Intravenous Fluids
  • Medication

Naloxone

Naloxone can be a lifesaver. It reverses an opioid overdose by blocking the effects of opiates. It is available in injection form and in the form of a pre-filled injection device that can be administered to a patient at the time of overdose.

It is unlikely that overdose victims can treat themselves with naloxone, so the individuals’ entourage should learn how to use naloxone in cases of emergency.

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Long-Term Treatment

Emergency care only ensures that the person does not die from an overdose. If the underlying addiction is left untreated, the risk of overdose arises again. Patients require a full treatment plan to prevent relapse and lead them to a substance-free life.

Following their overdose treatment, patients need to go through detoxification to manage their withdrawal symptoms and slowly expel the drug from their system. Doctors should subsequently recommend them to the appropriate level of treatment so they can receive continued care.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a very successful form of therapy because it targets a specific problem and finds a solution tailored to the problem. It is useful to teach patients about the negative habits connected to their overdose and help them work toward eliminating these factors to achieve a substance-free life.

Through therapy sessions, doctors help patients recognize bad behaviors and work on changing their lifestyle. Therapists also encourage patients to change their perception about their life circumstances. Instead of going to drugs and alcohol to solve a problem, individuals have numerous healthful options.

Support Groups

Support groups allow the patient to meet people who are in different stages of recovery. By sharing similar experiences, the individuals have a safe and comfortable space to express themselves.

Peers provide an on-going support system that holds the person accountable and encourages abstinence. They also provide new perspectives for the individuals, while encouraging them to open up.

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