Recognizing the Signs of Overdose

Overdoses, whether from drugs or other substances, are one of the top killers in the country, affecting people from childhood to adulthood. In 2022, drug overdoses claimed more than 107,000 lives in the United States alone, making it the deadliest year on record for overdose deaths. 

Being able to recognize the signs of an overdose is necessary for providing immediate help and preventing tragedy. In this blog, we explore the signs someone is overdosing so that you can feel confident taking action, should this situation ever occur.

Behavioral and Physical Signs

The signs of an overdose are inevitably going to vary depending on the substance ingested but there are common behavioral and physical indicators that can help you identify when someone is experiencing an overdose. These signs are:

• Unresponsiveness: One of the most obvious signs of an overdose is unresponsiveness. If the person is not waking up or responding to stimuli, this is a major red flag.
• Slow or Shallow Breathing: Pay attention to the person’s breathing. Slow, irregular, or shallow breathing can indicate an overdose. In some cases, it may even lead to complete cessation of breathing.
• Skin Changes: Look for changes in the person’s skin color. Bluish or pale skin, particularly around the lips and fingertips, is a sign of oxygen deprivation and a possible overdose.
• Confusion or Disorientation: People experiencing an overdose usually exhibit confusion, disorientation, or even agitation. They may not make sense when they speak or might be unable to answer simple questions.
• Vomiting and Nausea: Nausea and vomiting are common symptoms of overdose. If the person is vomiting uncontrollably, it can be a sign that their body is rejecting the substance. This is a good sign, as they may be able to purge some of the deadly drugs.
• Seizures: Some overdoses can lead to seizures, which are a danger of their own. If the person starts convulsing or having muscle spasms, it’s a critical emergency. Turn them on their side to avoid choking.
• Loss of Coordination: Difficulty in maintaining balance and coordination can be indicative of an overdose. The person may stumble, fall, or have trouble standing.
• Altered Level of Consciousness: Overdose might result in altered states of consciousness, whether they seem to be out of it. The person may be in and out of consciousness or appear extremely drowsy and difficult to rouse.

Specific Symptoms for Different Substances

Recognizing the signs of overdose becomes even more important when considering the specific symptoms associated with different substances. Here are some key points to keep in mind:

Opioids (Heroin, Fentanyl, Prescription Painkillers)

• Pinpoint pupils (extremely constricted)
• Extreme drowsiness or inability to stay awake
• Loss of consciousness
• Slow, shallow breathing

Stimulants (Cocaine, Methamphetamine)

• Agitation and paranoia
• Rapid, irregular heart rate
• Elevated body temperature
• Severe anxiety or panic

Sedatives (Benzodiazepines)

• Drowsiness and confusion
• Slurred speech
• Muscle weakness
• Slow or shallow breathing

Alcohol

• Slurred speech
• Impaired coordination
• Vomiting or choking
• Confusion

Drug Interactions That Can Lead to Overdose

• Inhibition of metabolism: Some drugs can inhibit the metabolism of other drugs, leading to increased blood levels of the affected drug. This is often the case with certain medications that are metabolized by the cytochrome P450 system in the liver. Grapefruit juice is a known inhibitor of this system and can affect the metabolism of several medications.
• Competition for elimination: When two drugs are eliminated from the body through the same metabolic pathways, they compete for elimination. This can lead to higher blood levels of one or both drugs. For example, NSAIDs and certain antibiotics compete for elimination with methotrexate, leading to methotrexate toxicity.
• Synergistic effects: Some drug combinations can produce synergistic effects, where the combined impact is greater than the sum of the individual effects. For instance, combining central nervous system depressants like opioids and sedative-hypnotics can lead to severe respiratory depression and overdose.
• Decreased tolerance: If a person regularly takes a particular drug and then stops for a period, their tolerance to the drug may decrease. If they resume taking the same dose as before, it can lead to overdose. This is especially common with opioids.
• Accidental duplication: Taking multiple medications with similar active ingredients without realizing it can lead to overdose. For example, taking multiple over-the-counter pain relievers that contain the same active ingredient, like acetaminophen, can result in unintentional overdose.
• Altered drug metabolism due to underlying medical conditions: Certain medical conditions can affect the metabolism of drugs. As an example, liver disease can slow down the metabolism of many drugs, leading to increased drug levels in the body and a higher risk of overdose.
• Additive effects of alcohol: Combining alcohol with drugs, particularly central nervous system depressants, has additive effects. Drinking alcohol while taking sleeping pills or benzodiazepines can lead to dangerous sedation, which many people are unaware of.

What to Do If You Suspect an Overdose

If you suspect someone is overdosing, taking immediate action is crucial. Every second counts in these situations. Here’s what you should do:

• Call 911: The first step should always be to call emergency services, regardless of the citation specifics. When you call, give them a thorough description of the situation, including your suspicion of an overdose.
• Stay with the Person: Do not leave the person alone for even a moment. Stay by their side and try to keep them conscious and responsive while you wait for the ambulance to arrive.
• Perform CPR if Necessary: If the person is not breathing, or their breathing is dangerously slow, try performing CPR if you are trained to do so. If not, it is not recommended to try as it could cause further harm.
• Naloxone (for Opioid Overdoses): If you happen to have access to naloxone, administer it as directed. Naloxone is an opioid antagonist that can reverse the effects of opioid overdose. 
• Provide Comfort and Support: Keep the person as comfortable as possible while waiting for emergency responders. During this time, reassure them and try to keep them calm.

Final Thoughts

Knowing the signs of overdose can be a matter of life and death. When you understand the common behavioral and physical indicators associated with different substances, you can help save lives. Overdose deaths are continuing to climb, year after year, and your ability to identify an overdose and act can make a difference.

New Dimensions Can Help!

New Dimensions specializes in helping adolescents and adults overcome substance abuse. Sometimes family members will set up an intervention to get their loved one help.   A drug addiction intervention is a structured process where family members, friends, and other concerned individuals confront the addict about the consequences of their addiction and the impact that it has had on their lives. If you have a family member who would benefit from an intervention, call 800-685-9796.  To learn more about the intensive and partial day treatment programs at New Dimensions, visit our website at www.nddtreatment.com or call 800-685-9796. 

References

• https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates
• Brady, J.E., Giglio, R., Keyes, K.M. et al. Risk markers for fatal and non-fatal prescription drug overdose: a meta-analysis. Inj. Epidemiol. 4, 24 (2017). https://doi.org/10.1186/s40621-017-0118-7
• O’Donnell J, Gladden RM, Mattson CL, Hunter CT, Davis NL. Vital Signs: Characteristics of Drug Overdose Deaths Involving Opioids and Stimulants – 24 States and the District of Columbia, January-June 2019. MMWR Morb Mortal Wkly Rep. 2020 Sep 4;69(35):1189-1197. doi: 10.15585/mmwr.mm6935a1. PMID: 32881854; PMCID: PMC7470457.
• Schiller EY, Goyal A, Mechanic OJ. Opioid Overdose. [Updated 2023 Jul 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470415/