Overdoses are tragic and on the rise, especially for opioids such as fentanyl. The Los Angeles County of Public Health recently reported that “Accidental fentanyl overdose deaths increased 1,652% from 109 in 2016 to 1,910 in 2022. From 2016 to 2021, fentanyl overdose ED visits increased 621% from 133 to 959, and fentanyl overdose hospitalizations increased 225% from 102 to 332 cases”. This surpassed methamphetamine and fentanyl accounted for 59% of all alcohol and other drug overdose deaths. And even a tiny amount of fentanyl can cause death, especially for those without high tolerance.

Understanding Overdoses

What Is An Overdose?

An overdose occurs when a person ingests a toxic amount of a substance—be it a prescription medication, over-the-counter drug, alcohol, or illicit substance—beyond what the body can safely process. The specific effects of an overdose can vary widely depending on the substance involved, the amount taken, and the individual’s body chemistry.

Overdoses can involve a range of substances, including prescription medications, over-the-counter drugs, alcohol, and illicit substances. It’s important to distinguish between accidental overdoses, which may occur by exceeding the recommended dosage of prescription medications, and intentional overdoses, often a result of drug misuse or an attempt to achieve a heightened effect from a substance. This distinction highlights the varied nature of overdoses, encompassing both unintentional harm and deliberate acts of excess.

The consequences of an overdose can be severe and life-threatening. In some cases, it can lead to a coma, a deep state of unconsciousness where the individual cannot be awakened. Comas resulting from an overdose can be temporary or permanent, depending on the extent of the damage to the brain and other vital organs.

Organ damage is another potential consequence of an overdose. Many substances toxic in high doses can harm the liver, kidneys, heart, lungs, or brain, impairing their function. For instance, an acetaminophen overdose can cause liver failure, while a cocaine overdose may lead to heart attacks or strokes.

The most dire consequence of an overdose is death. This can occur through various mechanisms, such as respiratory failure, cardiac arrest, or severe organ damage. The risk of death increases significantly without prompt medical intervention to address the overdose symptoms and underlying toxic effects of the substance.

Factors Contributing to Overdoses

Several key factors can increase the likelihood of experiencing an overdose, each contributing in different ways to the risk involved.

Tolerance: Tolerance plays a significant role in the risk of overdose. As individuals use a substance repeatedly, their bodies may become accustomed to its effects, necessitating larger amounts to achieve the desired outcome. This escalation can dangerously narrow the gap between the amount needed for effect and the amount that can cause an overdose, significantly raising the risk of toxic outcomes.

Polydrug Use: The dangers of overdosing increase exponentially when different drugs are combined or drugs are mixed with alcohol. This practice, known as polydrug use, can amplify the effects of each substance, leading to unpredictable and often more severe reactions. For example, mixing opioids with alcohol can enhance respiratory depression, a common cause of fatal overdoses, because both substances depress the central nervous system.

Relapse After Abstinence: Individuals with a history of substance use who have gone through periods of abstinence face a heightened risk of overdose upon resuming drug use. Abstinence can lower the body’s tolerance to the substance, meaning that a smaller amount of the drug might be sufficient to cause an overdose in someone who previously used the drug regularly without such severe consequences.

Mental Health Conditions: There’s a well-documented connection between mental health struggles and substance abuse, often referred to as dual diagnosis. Individuals grappling with depression, anxiety, PTSD, or other mental health conditions may turn to drugs or alcohol as a form of self-medication. 

This group is particularly vulnerable to overdoses, not only because of the potential for misuse but also due to the increased likelihood of engaging in risky substance use behaviors. The complex interplay between mental health and substance abuse demands comprehensive approaches to prevention and treatment, acknowledging the need to address both aspects simultaneously.

Understanding these factors is important in addressing the overdose crisis. By recognizing the various elements that contribute to overdose risk, individuals, healthcare providers, and communities can better tailor interventions and support systems to prevent overdoses and mitigate their devastating consequences. Awareness and education on these topics are key components of a broader strategy to reduce the prevalence of overdoses and save lives.

Recognizing the Signs of an Overdose

The ability to recognize the signs of an overdose is critical, as quick and informed responses can save lives. An overdose occurs when a person takes more of a substance, or combination of substances, than their body can handle. Overdoses can involve alcohol, prescription medications, over-the-counter drugs, and illicit substances. The signs of an overdose can vary depending on the type of substance used, but there are several common symptoms to be aware of across different categories of drugs.

Central Nervous System Depressants

Central Nervous System (CNS) depressants include substances like opioids (heroin, fentanyl, oxycodone), benzodiazepines, and alcohol. These substances slow down brain activity and often lead to pinpoint pupils, a hallmark sign of opioid overdose. Extreme drowsiness and respiratory depression manifest as slow, shallow breathing, while blue-tinged skin indicates a critical lack of oxygen. Common signs include slurred speech and severely impaired coordination, alongside drowsiness and confusion.

• Respiratory depression: This is one of the most dangerous signs of an opioid overdose, where the person’s breathing becomes slow, shallow, or stops altogether.
• Extreme drowsiness or inability to wake up: The person may seem to be in a deep sleep from which they cannot be awakened.
• Limp body: The muscles relax to an extreme degree, leading to a floppy appearance.
• Clammy, cold skin: The skin may feel cold and sweaty to the touch.
• Cyanosis: Fingernails and lips may turn blue or purplish black due to lack of oxygen.

Stimulants

Stimulants, such as cocaine, methamphetamine, and certain prescription drugs used to treat ADHD, like Adderall, increase activity in the brain and body, which can lead to:

• Hyperthermia: An extremely high body temperature, which can be life-threatening.
• Seizures: Stimulant overdoses can lead to convulsions and uncontrollable shaking.
• Psychosis: Hallucinations, paranoia, and disorientation are common, leading to potentially dangerous behavior.
• Chest pain or cardiac arrhythmias: The heart can beat irregularly or too rapidly, reflecting the excessive strain on the heart which can cause a heart attack or stroke.

Hallucinogens and Dissociatives

While overdoses on hallucinogens (like LSD) and dissociatives (such as PCP or ketamine) are less likely to be fatal, they can still cause severe physical and psychological effects. These substances can cause disorientation and intense, unpredictable hallucinations. Physical signs might include a rapid heart rate and, in extreme cases, seizures, indicating the drug’s profound impact on brain activity.

• Extreme agitation or paranoia: The individual may become highly distressed, aggressive, or fearful.
• Disassociation from reality: They may experience intense hallucinations, losing touch with reality.
• Increased blood pressure and heart rate: These can reach dangerous levels, leading to cardiovascular complications.

Recognizing an Overdose: General Indicators

Recognizing these signs enables bystanders and caregivers to respond effectively in case of an overdose. Overdoses can manifest through a variety of symptoms, which vary depending on the substance involved. Recognizing these signs is crucial for timely intervention and potentially saving lives. Here’s a detailed look at general indicators of an overdose, followed by drug-specific symptoms. 

Changes in Breathing: One of the most critical signs to observe is the change in breathing patterns. This can range from slow, shallow breathing often seen with opioid overdoses, to rapid breathing associated with stimulant use, or even an absence of breathing in severe cases. These variations highlight the body’s inability to manage the toxic levels of substances ingested.

Changes in Consciousness: Overdoses often cause alterations in the level of consciousness. This can manifest as unresponsiveness, where the individual is unable to wake up or respond to stimuli, or confusion and disorientation, making it hard for them to understand or interact with their environment.

Physical Signs: Look for physical indicators such as pale, clammy skin, which suggests the body’s struggle to maintain normal functions. Blue or purple fingernails and lips indicate oxygen deprivation, a severe and immediate concern. Other signs include vomiting, which is the body’s attempt to expel the toxic substance, gurgling noises indicating potential airway obstruction, and changes in pupil size—either pinpoint or significantly dilated, depending on the drug.

Behavioral Changes: Behavioral changes can range widely, from agitation and seizures typically associated with stimulant overdoses to an unusual calmness or stupor often seen with depressants. Loss of coordination and difficulty moving are also common, signaling the drug’s impact on the brain’s motor control centers.

Immediate Actions: What to Do If You Suspect an Overdose

When faced with a suspected overdose, swift and informed action can be the difference between life and death. Overdoses can occur with a variety of substances, including prescription medications, over-the-counter drugs, alcohol, and illicit substances, each carrying its own set of challenges. Below is a guide on what to do in the event of an overdose, designed to prepare individuals for an effective first response.

First Response Steps

Call 911 Immediately: The first and most crucial step is to call emergency services without delay. Time is of the essence in overdose situations, and professional medical help is needed as quickly as possible. Be ready to provide as much information as you can, including the type of substance(s) involved, the amount taken, and the time of ingestion.

Stay with the Person: It’s important to remain with the person who has overdosed. Keeping them safe and monitored can prevent further harm until emergency responders arrive. Try to keep them awake and responsive if possible, but do not exert excessive force or cause stress.

Open the Airway and Check for Breathing: Ensure the person’s airway is open to allow for proper breathing. This can be done using the tilt-chin maneuver: gently tilt the person’s head back and lift their chin. This simple action can open up the airway effectively. Check if the person is breathing and look for any signs of life.

Administer Naloxone (if available and legal): If you suspect an opioid overdose and naloxone is available, administer it according to the instructions provided with the kit. Naloxone is a life-saving medication that can reverse the effects of an opioid overdose, and in many areas, it can be obtained without a prescription. Be prepared to administer a second dose if the first does not prompt a response within a few minutes, and remember that naloxone is not a substitute for medical care; calling 911 remains essential.

Gather Information: While waiting for emergency services, try to gather as much information as possible about the substance(s) involved in the overdose. This includes any prescription bottles, packaging, or personal notes about the drugs taken. Information about the person’s medical history and any known allergies can also be crucial for emergency responders.

What Not to Do

In the urgency of responding to an overdose, it’s also important to know what actions to avoid, as they can exacerbate the situation or put the person at further risk.

Delaying Calling 911: Never wait to see if the symptoms will resolve on their own. The effects of an overdose can worsen rapidly, and the sooner medical help arrives, the better the chances for recovery.

Forcing the Person to Vomit: Inducing vomiting is not advised and can be extremely dangerous, especially if the person is unconscious or semi-conscious. There’s a high risk of choking or aspiration, where vomit is breathed into the lungs, causing further complications.

Punishing or Judging the Person: An overdose is a medical emergency, not a time for judgment or reprimand. Staying focused on the immediate need for medical attention and support is paramount. Showing compassion and maintaining a calm demeanor can make a significant difference in the outcome.

Recognizing and responding to an overdose promptly and effectively can save lives. It’s essential to act quickly, follow the first response steps carefully, and avoid actions that could worsen the situation. By preparing yourself with this knowledge, you can make a critical difference in an emergency overdose situation, offering the best possible chance for recovery and support to those in need.

Prevention and Support

Preventing Overdoses

Overdose prevention is a multifaceted approach that involves both individual and community efforts to reduce the risks associated with substance use. Safe Medication Practices are fundamental; this includes securely storing medications away from others, strictly adhering to prescribed dosages, and properly disposing of unused or expired medications to prevent misuse. Additionally, harm reduction techniques, such as providing access to naloxone and fostering environments where individuals feel comfortable seeking help without stigma, play a critical role in minimizing the chances of an overdose.

Finding Help and Support

For those struggling with substance use, finding help and support is a crucial step towards recovery. Numerous resources are available, ranging from local community support groups to professional treatment facilities offering tailored recovery programs. National helplines and websites also provide confidential advice and can direct individuals and their loved ones to appropriate services. Engaging with these resources can pave the way for healing and help prevent the devastating consequences of overdoses.

Key Takeaways

• Overdoses are tragic and on the rise, especially for opioids such as fentanyl.

• The specific effects of an overdose can vary widely depending on the substance involved, the amount taken, and the individual’s body chemistry.

• Overdoses can involve a range of substances, including prescription medications, over-the-counter drugs, alcohol, and illicit substances.

• The consequences of an overdose can be severe and life-threatening.

• Awareness and education about factors contributing to overdoses are key components of a broader strategy to reduce the prevalence of overdoses and save lives.

• The ability to recognize the signs of an overdose is critical, as quick and informed responses can save lives.

• The ability to recognize the signs of an overdose is critical, as quick and informed responses can save lives.

• When faced with a suspected overdose, swift and informed action can be the difference between life and death. 

• Overdose prevention is a multifaceted approach that involves both individual and community efforts to reduce the risks associated with substance use. 

Sources

Los Angeles County Department of Public Health. Nov. 2023. Data Report. Fentanyl Overdoses in Los Angeles County.