What exactly is overdose? An overdose occurs when a person consumes more than the recommended amount of a substance that is lethal or toxic to the body. Generally, this is caused by ingesting too much of a prescription medication, like fentanyl, or an illegal drug, such as heroin or cocaine. Mixing substances—whether legal, prescription or over-the-counter—can also increase the risk of overdose. While not all cases are fatal, overdosing can cause serious damage, bodily injury and even death.
Symptoms of overdose vary depending on the substances ingested, the amount taken and the individual. A drug overdose may occur accidentally or intentionally. This is true for both illegal drug overdose and those involving prescribed medications.
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
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.
Cocaine Overdose Symptoms
Cocaine is a dangerous stimulant that can cause overdose, and even death, in first-time and heavy users alike. In 2016 alone, the CDC estimates that cocaine was involved in 11,316 overdose deaths, more than a twofold increase from the 5,892 deaths in 2014.
The drug can be especially deadly when combined with other stimulants, such as Ritalin, or when used with depressants like heroin. Using cocaine and alcohol also carries an especially high risk of fatal overdose. Symptoms of a cocaine overdose include:
- Irregular heart rhythms, seizures or strokes
- Trouble breathing
- Elevated blood pressure
- Overheating or high body temperature
- Hallucinations, agitation or anxiety
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
- 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.
What to do if you suspect an overdose
If you believe someone may have overdosed, it is important to act quickly. Many are concerned that they may get in trouble for using drugs or alcohol illegally, however, a number of states have Good Samaritan Laws that may protect you in this situation. When in doubt, it is always best to contact emergency services, as it could be the difference between saving a life.
- Call 9-1-1 immediately. Be prepared to provide the operator with the address of where you are located. If you are able, let them know what drugs were ingested.
- Assess their responsiveness. If the person appears to be unconscious, check to see if they are breathing or are short of breath and try to wake them.
- Perform CPR if needed. If you know how, performing CPR can be a critical and, in some cases, lifesaving step, as many overdose deaths occur from a lack of oxygen. If the person is not breathing or their breath is weak, begin CPR for adults or for children.
- If you have a particular medication designed to reverse the effects of an overdose, such as Naloxone (Narcan) for opioid overdoses, it may be effective. Make sure you know how to use the medication correctly.
Seeking help following an overdose
An overdose can be a very traumatic experience, causing lasting physical and emotional damage. This experience should serve as a wake-up call for anyone abusing legal or illegal drugs and alcohol.
Does overdosing mean you are an addict?
Overdosing on illegal drugs or prescription medication is a very strong indication of a concerning drug problem. Remember, if the drug used was in fact prescribed by a doctor and you continue to take it after treatment has ended or have lied or exaggerated an issue to obtain the prescription, this can be considered drug abuse. In fact, many develop opioid addictions following prescribed use for medical conditions and other injuries.
Even if the overdose was not fatal, you or your loved one may not be so lucky the next time. It is important to take this event as a signal of a serious and damaging substance abuse problem. Other signs and symptoms of addiction include:
- Changes in appearance: Disordered appearance, significant changes in weight, red eyes, dilated pupils, damage to teeth, and strange odors
- Changes in behavior: Extreme lethargy or bouts of energy, paranoia and secretive behavior surrounding comings and goings as well as around personal belongings, exaggerated reactions, health issues, and feeling sick with no reasonable explanation
- Problems at school and work: Frequent absences, inability to meet responsibilities, conflicts with others at school or work, job loss or suspensions/expulsion from school
- Issues with relationships: Conflicts with friends and family members, damaged relationships, less time spent with one’s regular friend group, more time spent alone
- Issues with money: Constantly needing or asking for money, missing items or stolen money
If you are concerned that you or a loved one has a substance use disorder, it is important to get help immediately, especially following an overdose.
How to help after an overdose
If you are concerned that you or a loved one has a substance use disorder, it is important to get help immediately, especially following an overdose.
1. Seek treatment
If you or a loved one was taken to a hospital emergency room following the incidence of an overdose, you may expect to be discharged with a treatment plan in hand. Unfortunately, for many this, does not occur. However, the event still provides a strong impetus to seek treatment. Ask a medical professional for recommendations and contact treatment centers to find a program that is right for you or your loved one. Recovery is difficult and having the structured support system that treatment offers can be critical. Moreover, for those with physical dependence on certain drugs such as opioids, quitting cold turkey can be dangerous. Medical supervision may be required during the withdrawal process. If your child, partner, parent or loved one has overdosed, take this opportunity to suggest they seek treatment for their addiction.
2. Take protective measures
If they are not ready to address their addiction, there are some protective measures that you can take to reduce the possibility of fatal consequences should another overdose occur. This includes learning CPR, knowing what to do in the event of another overdose, and making sure they only use clean needles if they are using drugs via injection. It is also prudent for you and other close friends and family to have Naloxone on hand and to know how to use it should it be necessary. If given correctly and in a timely manner, it can reverse the effects of overdose and even save your loved one’s life.
3. Consider the emotional impact
Witnessing or experiencing an overdose can be traumatic and scary, leaving one with a constant sense of anxiety surrounding the possibility of it occurring again. While in treatment, these feelings should be addressed as part of the therapeutic experience. However, if your loved one has declined treatment, you may be left feeling helpless, afraid and even angry. Consider seeking support to process these feelings. Therapy, counseling, and joining peer support groups such as Families Anonymous and Nar-Anon can be especially helpful to those with an addicted loved one.