How to recognize an overdose

Risk factors for overdoses

There are a number of factors that can increase the likelihood of overdosing on illegal drugs, alcohol or medications. These include:

• Substance use disorders
• Mental health issues
• Poly/drug use or abusing more than one substance
• Mixing medications with other legal or illegal drugs
• Taking long-lasting or higher concentrations of opioids (whether prescribed or not) 
• Relapses following sustained periods of abstinence
• Detoxing without treatment
• Intravenous drug use
• Suicidal ideation or attempts
• Lowered tolerance
• Previous overdose experiences

Former addicts and alcoholics may be more likely to overdose during a relapse. This is because, following a sustained period of sobriety, they no longer have the same tolerance as they once did. In other words, one’s system becomes sensitive to the substance and cannot process the same quantities the person previously consumed to get high prior to becoming sober. Unfortunately, during a relapse, an addict may try to use as they had in the past. Because their body can no longer handle such a high dose of the substance, overdose occurs.

In addition to substance abuse, one may overdose accidentally without realizing they are at risk.  Not following dosage instructions when taking medications and failing to properly store medications out of children’s reach can increase the possibility of an overdose.

Illegal drug and prescription drug overdoses

In 2018, more than 67,300 Americans died of overdose deaths involving illegal drugs or misused opioids. This number has steadily increased since 1999, when the National Institute on Drug Abuse (NIDA) estimates overdose death registered below 40,000. According to the Centers for Disease Control and Prevention (CDC), deaths involving fentanyl, heroin, and methamphetamine have climbed considerably over the past 20 years, while cocaine has consistently ranked among the top drugs involved in overdose deaths.

How to spot an overdose

The severity and symptoms of an overdose depend on the drug or drugs taken, the amount ingested, the system of that person, and any other conditions they might have. However, there are a few general signs that can indicate overdose: 

• Changes in vital signs. Shifts in temperature, pulse, respiratory and heart rates can occur during an overdose. Vital sign values may register as higher or lower than normal or be completely absent. 
• Dry or sweaty skin that is hotter or colder than normal.
• Extreme lethargy, confusion or coma. In some cases, it is not possible to wake the individual. The body may also go limp.
• Chest pain from damage to the heart or lungs and shortness of breath. Breathing may speed up or slow down and appear to be either deeper or shallower than normal.
• Pain in the abdominal area, vomiting and/or diarrhea. Blood in vomit or stool may be life-threatening. Vomiting into the lungs while passed out or in an especially drowsy state can be deadly.
• Other symptoms may occur, such as damage to organs or the worsening or triggering of a chronic disease. 

Remember, all of these signs do not have to be present to indicate an overdose situation. Symptoms of an overdose can vary, as distinct drugs have differing effects on the body. Take a closer at how different substances can affect the body and what an overdosing on different might look like. 

Fentynal, Oxycodone, Heroin and Other Opioid Overdose Symptoms

Addiction to legal and illegal opioids has become a growing problem in many states. As legal and illegal use has increased, so have deaths from overdose. Fentanyl specifically has proved to be a deadly problem, accounting for 18,335 deaths or 28.8% of all drug overdose deaths in 2016. This is a sharp uptick from 2011, when the drug was responsible for 1,662 deaths and comprised only 4% of fatal drug overdoses. Similarly, abuse of other opioids has increased.

An overdose involving this class of drugs can be identified by looking for the opioid overdose triad:

• Pinpoint pupils
• Respiratory depression
• Unconsciousness.

There are three classifications of opioids: natural, semi-synthetic and fully synthetic. Generally, legal opiates such as fentanyl, morphine, codeine, hydrocodone, and oxycodone are prescribed for pain relief, while heroin remains illegal. However, even when taken with a prescription, opioids can be habit forming and dangerous, producing a high feeling in patients. 

In addition to the triad, there are a number of other signs that can help you identify overdose. Other symptoms of opioid overdose to look for include:

• Blue-ish fingernails or lips
• Confusion, vomiting, gurgling or choking noises
• Slow or shallow breathing
• Low blood pressure
• Slurred speech
•  Slowed heart rate

CNS Depressants Overdose Symptoms

Central Nervous System (CNS) depressants are medications that are generally prescribed to treat anxiety, acute stress reactions, panic and sleep disorders. Referred to as sedatives or tranquilizers, they work by slowing brain activity, producing a sense of drowsiness and relaxation. In fact, both alcohol and opioids are actually classified as CNS depressants. Other well-known CNS depressants include:

• Benzodiazepines (known as benzos): Valium, Xanax, and Ativan 
• Non-Benzodiazepine Sedative Hypnotic: Ambien, Sonata, and Lunesta. 
• Barbiturates: Amytal, Luminal (Phenobarbital), Mebaral, Nembutal, and Seconal

Like opioids, other CNS depressants have the potential for abuse and can result in dependency, even when used with a valid prescription. They should always be taken in accordance with medical instructions. If you or a loved one is taking CNS depressants, it is important to consult a physician before combining them with alcohol, other prescription drugs, and even certain over-the-counter medications. Taking too much of a depressant or combining it with those substances can cause an overdose situation and even death. Common signs of an overdose from CNS depressants include:

• Weak or rapid pulse shallow breathing
• Clammy skin
• Dilated pupils
• Coma and even death. 

If you are concerned about a CNS depressant overdose, you should contact 9-1-1 emergency services immediately. Flumazenil (Romazicon®) may be used by medical professionals to treat benzodiazepine overdoses, as well as overdoses from some other sleep medications. Although it should not be used regularly or for overdoses that may involve other substances.

Additionally, if you believe you or a loved one is dependent on CNS depressants, it is important to seek the help of a medical professional when trying to recover from addiction. Because they slow the brain, when a dependent person stops taking the depressant, a sharp rebound in brain activity can occur, causing seizures and other serious health risks. For this reason, it is necessary to seek professional support, rather than simply going “cold turkey” on one’s own. This is also true for opioid dependency.

Can you overdose while drinking alcohol?

While drinking is a common activity for many at get-togethers, sporting events and social functions, binge-drinking—or consuming large quantities of alcohol in one sitting—can be quite dangerous. Alcohol is considered to be a type of CNS depressant. Consuming too much too quickly can affect motor coordination, decision-making and impair other abilities. When one drinks more than their body can handle, an overdose can occur. 

If too much alcohol is consumed, the body becomes overwhelmed and unable to break down and clear the alcohol from the bloodstream. As a result, brain and other bodily functions such as breathing, heart rate and temperature control begin to shut down, causing an overdose from alcohol. Too much alcohol can suppress automatic responses such as the gag reflex, causing one to choke on their own vomit or die from lack of oxygen. Even if they do survive, it can cause permanent or long-lasting brain damage. Signs and symptoms include: 

• Confusion or disorientation
• Vomiting
• Trouble remaining conscious, loss of consciousness, or inability to be woken  
• Slow breathing
• Slow heart rate
• Clammy skin, pale or blue-ish skin, low body temperature, or paleness
• No gag reflex

If an alcohol overdose is suspected, it is important to act as quickly as possible and contact emergency services immediately, even if only some symptoms are present. Do not wait for all symptoms to present. 

Once you have contacted 9-1-1, make sure to keep an eye on the person whom you suspect may be overdosing to prevent them from choking or falling. Do your best to keep them seated upright or partially upright on the ground or in a chair. Help them if they are vomiting. Lean the person forward to prevent choking on their vomit, or if they are unconscious, roll them on their side so that one ear faces the ground. 

Binge drinking, or drinking that brings blood alcohol concentration (BAC) to .08 percent or higher increases the likelihood of overdose. Teenagers and young adults are more likely to binge drink, and therefore, more likely to overdose from drinking. Additionally, taking opioids or sedative-hypnotics also increases this risk.

Can you overdose if you are not abusing a substance?

While many associate overdosing with addiction and substance abuse, it is not the only way overdoses can occur. Some people overdose while using over-the-counter or prescription medications for their intended purposes. This can be the result of accidentally taking more than the recommended dose of a medication. 

There are also cases in which a person may overdose while using the indicated dosage of a medication. The recommended dose may simply be too much for their system. For various reasons, some people can be highly sensitive to certain medications. There are a number of other ways people can accidentally overdose from taking prescribed medications without intentionally abusing a substance, for instance:

1. Consuming a toxic combination of medications

 This can occur when an individual doesn’t inform their doctor about the medications that they are on. To avoid toxic interactions between medications, it is always best to let your doctor know what prescription and non-prescription medications you use. 

2. Failing to follow your doctor or pharmacist’s instructions or accidentally taking too much of a prescribed medication

For example, elderly people with Alzheimer or dementia may forget they have already taken their medication and take additional doses, resulting in an overdose. Others may simply decide to take more than needed.

3. Accidental consumption 

Young children, especially those under the age of 5, are prone to putting small objects in their mouths. If they find a pill or another form of medication within reach, they may accidentally ingest it. If you suspect a child has consumed a drug, contact emergency services immediately.  If there are other children nearby you should also check to see if they have swallowed the substance as well.

To avoid such accidental overdoses, it is important to always consult a medical professional, follow directions when it comes to dosages and mixing medications, and to keep medications properly stored and out of children’s reach.