Drug Overdose Overview
Drug overdoses can be accidental or intentional. They occur when a person takes more than the medically recommended dose. However, some people may be more sensitive to certain medications, so the low (more dangerous) end of a drug may be toxic for them; a dose that is still within the range of acceptable medical use may be too much for their bodies to handle.
Illicit drugs, used to get high, may be taken in overdose amounts when a person's metabolism cannot detoxify the drug fast enough to avoid unintended side effects.
Exposure to chemicals, plants, and other toxic substances that can cause harm are called poisonings. The higher the dose or the longer the exposure, the worse the poisoning. Two examples are carbon monoxide poisoning and mushroom poisoning.
- People respond differently to a drug overdose. Treatment is tailored to the individual's needs.
- Drug overdoses can involve people of any age. It is most common in very young children (from crawling age to about age 5) and among teenagers to those in their mid-30s.
Drug Overdose Causes
The cause of a drug overdose is either by accidental overuse or by intentional misuse. Accidental overdoses result from either a young child or an adult with impaired mental abilities swallowing a medication left within their grasp. An adult (especially seniors or people taking many medications) can mistakenly ingest the incorrect medication or take the wrong dose of a medication. Purposeful overdoses are for a desired effect, either to get high or to harm oneself.
- Young children may swallow drugs by accident because of their curiosity about medications they may find. Children younger than age 5 (especially age 6 months to 3 years) tend to place everything they find into their mouths. Drug overdoses in this age group are generally caused when someone accidentally leaves a medication within the child's reach. Toddlers, when they find medications, often share them with other children. Therefore, if you suspect an overdose in one child while other children are around, those other children may have taken the medication, too.
- Adolescents and adults are more likely to overdose on one or more drugs in order to harm themselves. Attempting to harm oneself may represent a suicide attempt. People who purposefully overdose on medications frequently suffer from underlying mental health conditions. These conditions may or may not have been diagnosed before.
Drug Overdose Symptoms
Drugs have effects on the entire body. Generally, in an overdose, the effects of the drug may be a heightened level of the therapeutic effects seen with regular use. In overdose, side effects become more pronounced, and other effects can take place, which would not occur with normal use. Large overdoses of some medications cause only minimal effects, while smaller overdoses of other medications can cause severe effects, possibly death. A single dose of some medications can be lethal to a young child. Some overdoses may worsen a person's chronic disease. For example, an asthma attack or chest pains may be triggered.
- Problems with vital signs (temperature, pulse rate, respiratory rate, blood pressure) are possible and can be life threatening. Vital sign values can be increased, decreased, or completely absent.
- Sleepiness, confusion, and coma (when someone cannot be aroused) are common and can be dangerous if the person breathes vomit into the lungs (aspirated).
- Skin can be cool and sweaty, or hot and dry.
- Chest pain is possible and can be caused by heart or lung damage. Shortness of breath may occur. Breathing may get rapid, slow, deep, or shallow.
- Abdominal pain, nausea, vomiting, and diarrhea are possible. Vomiting blood, or blood in bowel movements, can be life threatening.
- Specific drugs can damage specific organs, depending on the drug.
When to Seek Medical Care
Your doctor, your local poison center, or the emergency department of your local hospital may be able to help determine the seriousness of a suspected drug overdose. Development of any symptoms after drug overdose requires immediate and accurate information about the specific name of the drug, the amount of the drug ingested, and the time when the drug was taken. Often, the bottle the drug came in will have the information needed.
- Some doctors' offices are equipped to handle overdoses; others are not. Some doctors' offices advise their patients to go to a hospital's emergency department. In life-threatening circumstances, an ambulance should usually be summoned by calling 911.You are not expected to know when a drug overdose is serious. If you cannot reach a qualified professional by telephone to discuss the overdose, it would be prudent for you to take the overdosed person to the nearest hospital's emergency department or medical facility.
Take appropriate caution when dealing with drug overdose. Each person responds differently, and reactions are hard to predict. Many people who are directed to go to the emergency department may not develop any physical signs of poisoning. Others will become quite ill.
- A person unwilling to go to the hospital may need persuasion by trained professionals in emergency medical services (paramedics and ambulance personnel) or law enforcement officials. You may call 911 for these services. Family members are also often helpful in persuading the person to seek medical care.
- Anyone who is with a person who overdoses on drugs can assist by finding all medication or chemical containers and bringing them to the emergency department doctor.
Exams and Tests
A history and physical exam to look for evidence of poisoning will be performed. The doctor will order lab tests based on the organ systems that can be harmed by the specific drug overdose.
- Family members and associates are an important source of information. They can assist in providing the doctor with names of drugs, amounts taken, and timing of overdose.
- Specific drug levels in the blood may be measured, depending on the drug taken and the reason for the overdose.
- Drug screening may also be done.
Drug Overdose Treatment
Treatment will be dictated by the specific drug taken in the overdose. Information provided about amount, time, and underlying medical problems will be very helpful.
- On rare occasions, the stomach may be washed out by gastric lavage (stomach pumping) to mechanically remove unabsorbed drugs from the stomach.
- Activated charcoal may be given to help bind drugs and keep them in the stomach and intestines. This reduces the amount absorbed into the blood. The drug, bound to the charcoal, is then expelled in the stool. Often, a cathartic is given with the charcoal so that the person more quickly evacuates stool from his or her bowels.
- Agitated or violent people may need physical restraint and sometimes sedating medications in the emergency department until the effects of the drugs wear off. This can be disturbing for a person to experience and for family members to witness. Medical professionals go to great lengths to use only as much force and as much medication as necessary. It is important to remember that whatever the medical staff does, it is to protect the person they are treating. Sometimes the person has to be intubated (have a tube placed in the airway) so that the doctor can protect the lungs or help the person breathe during the detoxification process.
- For certain overdoses, other medicine may need to be given either to serve as an antidote to reverse the effects of what was taken or to prevent even more harm from the drug that was initially taken. The doctor will decide if treatment needs to include additional medicines.
Self-Care at Home
Home care should not be done without first consulting a doctor or poison expert.
- For some accidental drug overdoses, the local poison control center may recommend home therapy and observation. Because of the potential for problems after some overdoses, syrup of ipecac or other therapies should not be given unless directed by a medical professional.
- Most people have telephone access to a local poison control center. Locate the closest one to you through the American Association of Poison Control Centers (www.aapcc.org) or by calling 1-800-222-1222.
- Anyone who has small children at home should have the "poison line" telephone number readily available near the telephone.
- People who take a drug overdose in an attempt to harm themselves generally require psychiatric intervention in addition to poison management. People who overdose for this purpose must be taken to a hospital's emergency department, even if their overdose seems trivial. These people are at risk for eventually achieving a completed suicide. The sooner you intervene, the better the success of avoiding suicide.
The FDA has approved a prescription treatment that can be used by family members or caregivers to treat a person known or suspected to have had an opioid overdose. Opioids include various prescription pain medications and illicit street drugs. An overdose is characterized by slowed breathing and heart rate and a loss of consciousness. Evzio (naloxone hydrochloride injection) rapidly delivers a single dose of the drug naloxone via a hand-held auto-injector that can be carried in a pocket or stored in a medicine cabinet. Although Evzio can counter overdose effects within minutes, professional medical help is still needed.
Next Steps Follow-up
Everyone who suffers an overdose needs to be seen by his or her doctor for follow-up. In part, this is to ensure that there are no delayed injuries to any organ system. It is also to make sure that prevention against a recurrence is in place.
- After an intentional drug overdose has been managed and the person is out of immediate medical danger, psychiatric care needs to be provided. The abuser of illicit drugs should also be considered for a mental health evaluation. Finding a support group for a psychiatric or substance abuse problem can be very helpful.
- For children, the experience of being treated for an overdose may have been frightening. They need help in coping with the trauma as well as learning from the mistake. Following up with their pediatrician can reduce anxiety and also be a good learning experience. The same is true for their parents. Do not point fingers or assign guilt. Use the follow-up visit to discuss prevention and safety.
To prevent accidental overdoses, medications, even over-the-counter pain relievers and vitamins, must be kept in a safe, secure place. Intentional overdoses are harder to prevent, unless the underlying problems are addressed. Unintentional, illicit drug overdose is a serious problem best avoided by getting the person away from access to the illicit drug (see Drug Dependence and Abuse).
- People with certain mental illnesses need the help of family and friends to assist with medication therapy and to lend social support. Drug abusers also need this same support in order to stay clean and safe.
- Poison prevention and injury prevention in children is an important task for parents, grandparents, and others who take care of small children. Make your home safe so children do not have access to medications. Accidental poisoning is a leading cause of death in children from ages 6 months to 5 years.
- Make sure elderly people understand how to take their medication and can recognize one medicine from another. It may be safest to provide some sort of supervision for seniors in taking medication. Pills can be sorted into small containers and labeled to show the time they are to be taken. Some containers come with clocks that have audible alarms as a reminder to take medications at specific times. Other containers can be filled a week at a time.
Depending on which substances are taken in an overdose, many people can recover successfully and without lasting physical disability.
- Some drugs can cause transient damage to certain organ systems. Improvement is noted first in the hospital and then at home. However, some overdoses can cause permanent damage to certain organ systems. The liver and the kidneys are organ systems at high risk.
- Brain damage resulting from suppression of lung and heart function can be permanent.
- If the mental health problems that led to an intentional overdose are not addressed, the person remains at risk for subsequent drug overdoses. Multiple overdoses can have a cumulative effect on some organ systems and lead to injury and organ failure. Sometimes, this effect is not recognized until later in the person's life.