An overdose occurs when a person takes an excessive amount of a drug, medication, or a combination of substances. It can cause confusion, vomiting, slowed breathing, seizures, or cardiac arrest.
An overdose may be accidental or intentional. It happens when the amount taken is so high that the body cannot eliminate the substance before dangerous effects develop.
An overdose is a serious medical emergency. Immediate evaluation and treatment can help prevent complications such as organ failure, impaired brain function, and death.
Overdose symptoms
The main symptoms of an overdose include:
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Confusion;
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Excessive sleepiness;
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Irregular, rapid, or slow breathing;
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Difficulty breathing;
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A rapid or slow heartbeat;
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Vomiting;
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Cold, clammy, pale, blue, or gray skin;
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Blue or purple lips and nails.
Other symptoms may include loss of consciousness, unresponsiveness, seizures, hallucinations, psychosis, delirium, tremors, chest pain, or cardiopulmonary arrest.
Symptoms can vary depending on the type of substance taken. For this reason, people who use drugs or medications should be aware of the possible effects associated with those substances.
What to do in case of an overdose
In case of an overdose, especially if the person appears likely to faint or is losing consciousness:
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Call the person by name and try to keep them awake;
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Call 911 for an ambulance and follow the emergency dispatcher’s first-aid instructions;
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Check whether the person is breathing;
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If the person is conscious and breathing: place them in the most comfortable position possible until medical help arrives;
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If the person is unconscious but breathing: place them on their side in the recovery position to help prevent choking if they vomit;
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If the person is unconscious and not breathing: begin CPR, including chest compressions, and continue until medical help arrives;
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Do not induce vomiting;
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Do not give the person food or drinks;
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Stay with the person until the ambulance arrives, checking that they continue to breathe and that their overall condition does not get worse.
Whenever possible, take the drug, medication, or packaging suspected of causing the overdose to the emergency department. This may help the medical team identify the cause and determine the appropriate treatment.
When an opioid overdose involving a substance such as heroin, codeine, or morphine is suspected and naloxone nasal spray is available, administer it while waiting for emergency medical help. Naloxone rapidly reverses the effects of an opioid overdose and is available in FDA-approved prescription and over-the-counter products in the United States.
How to use naloxone for an opioid overdose
Naloxone, commonly sold under brand names such as Narcan, is a medication that can reverse the effects of opioids on the brain.
This medication is especially important during an opioid overdose and may save the person’s life within minutes.
To administer a single-dose naloxone nasal spray:
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Place the person on their back;
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Remove the device from its packaging;
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Hold the device with your thumb on the bottom of the plunger and two fingers on either side of the nozzle;
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Insert the nozzle into one nostril until your fingers touch the bottom of the person’s nose;
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Press the plunger firmly to release the entire dose into that nostril;
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Call 911 immediately if this has not already been done;
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Place the person on their side after administering the dose;
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If the person does not respond, wakes up and then becomes unresponsive again, or continues to have trouble breathing, administer another dose with a new device every 2 to 3 minutes until emergency help arrives.
Each single-dose device contains one complete dose and should not be divided between the nostrils.
Naloxone is often provided to people who regularly use prescription opioids for severe pain. It may also be provided to people who use illicit opioids, such as heroin, as well as to their family members, friends, or caregivers.
Narcan 4 mg naloxone nasal spray was the first naloxone product approved by the FDA for over-the-counter use. Other prescription, generic, and over-the-counter naloxone products are also available in the United States.
Main causes
The main causes of an overdose include:
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Alcoholic beverages;
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Cannabis;
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Opioids, such as fentanyl, morphine, or heroin;
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Stimulants, such as amphetamine, methamphetamine, cocaine, or crack cocaine;
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Synthetic or recreational drugs, such as ecstasy, LSD, or ketamine;
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Sedatives, such as alprazolam, diazepam, or clonazepam;
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Barbiturates, such as phenobarbital;
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Ayahuasca.
Other possible causes include excessive amounts of ibuprofen, antihistamines, or toxic plants such as aconite, Atropa belladonna, oleander, or foxglove.
An overdose can also be caused by excessive acetaminophen use and may lead to drug-induced hepatitis.
How treatment is performed
Overdose treatment is provided at a hospital and depends on the type of substance involved, the amount taken, the symptoms present, and how much time has passed since the substance or combination of substances was used.
To reduce the amount of a substance in the body, doctors may perform gastric or intestinal decontamination, administer activated charcoal to bind to the substance and reduce its absorption, use an appropriate antidote, or administer other medications to control the symptoms of the overdose.
Overdose antidotes
The main medications used as overdose antidotes include:
Doctors may also use medications such as deferoxamine, calcium gluconate, or atropine, depending on the specific substance involved.
Naloxone is FDA-approved for the emergency treatment of a known or suspected opioid overdose. N-acetylcysteine, also called acetylcysteine, is FDA-approved to prevent or reduce liver injury following a potentially toxic acetaminophen ingestion.
Flumazenil is FDA-approved for the complete or partial reversal of the sedative effects of benzodiazepines and may be used in certain overdose situations. However, it is an adjunct to appropriate supportive care rather than a substitute for standard overdose management, and its use may be inappropriate in some patients because it can trigger seizures or withdrawal reactions.
How to prevent an overdose
The best way to prevent an overdose is to avoid drug misuse, including misuse of legally available substances such as alcohol, tobacco products, and medications. Medications should only be taken according to a healthcare provider’s instructions or the directions on the product label.
People who regularly use drugs should be aware that a period of abstinence can reduce the body’s tolerance. As a result, an amount that was previously tolerated may later cause an overdose.
Drugs should never be used alone. If an overdose occurs, another person should be present to call 911, administer naloxone when appropriate, and provide immediate assistance.
