Drug Overdose: Signs, Symptoms, & Treatment

What Is an Overdose?

A drug overdose occurs when someone consumes toxic amounts of medication or drugs. During a drug overdose, the severity and specific symptoms experienced can depend on the specific drug(s) they took, as well as the amount and duration of use.

Short-term effects of a drug overdose can include confusion, breathing difficulties, nausea and vomiting, seizures, and loss of consciousness. In severe cases, drug overdoses can lead to brain damage, coma, and death. Long-term effects of a drug overdose may include chronic health problems, mental illness, and the potential for future overdoses. It is critical to seek medical attention immediately if an overdose is suspected, as prompt treatment can prevent serious long-term effects.

What Happens in the Body During a Drug Overdose?

During a drug overdose, the body cannot process the excess amount of drugs consumed.  Depending on the type of drug, this can lead to various overdose symptoms and effects on the body. For example, an overdose of a stimulant drug like cocaine or amphetamines can cause high blood pressure, seizures, and rapid heart rate. An overdose of an opioid like heroin or prescription painkillers can cause weak or impaired breathing, decreased heart rate, and loss of consciousness.

A drug overdose can cause the body’s systems to become overwhelmed and may lead to organ failure, particularly in the heart, liver, and kidneys. Overdoses can also lead to chemical imbalances in the brain, which may cause seizures or other life-threatening conditions if not properly treated. It is essential to seek medical attention immediately if you or someone you know is experiencing signs of a drug overdose.

Types of Substances That Can Cause an Overdose

It is a misconception that only illegal drugs and prescription drugs cause overdoses.  Illegal drugs like cocaine and heroin are often abused in high quantities and can have dangerous effects on the body, with overdose being a distinct possibility. Additionally, prescription drugs(including painkillers, sedatives, and stimulants) can lead to an overdose if too much is taken or if the drugs are taken improperly, and sometimes even when taken as prescribed. Lastly, over-the-counter (OTC) drugs can also lead to an overdose if taken in high quantities or combined with other substances like alcohol or prescription medications.

According to the National Institute of Health, over 106,000 people died from a drug overdose in the US in 2021, whether from illicit drugs or prescription medications.¹

The substances most commonly associated with overdose are:

• Opioids (fentanyl, heroin, prescription painkillers)
• Benzodiazepines (Xanax, Valium)
• Cocaine
• Alcohol
• Methamphetamine
• Methadone
• Amphetamines (such as Adderall)
• Ecstasy (MDMA)
• Synthetic cannabinoids (such as Spice or K2)
• Ketamine

What Are the Symptoms of an Overdose?

Symptoms of an overdose can vary depending on the substance taken, the amount which has been ingested, and the individual’s body chemistry and tolerance. For example, restlessness, nervousness, rapid heartbeat, agitation, confusion, and tremors are symptoms of caffeine overdose. These are common symptoms and most likely have been experienced by most individuals throughout their lifetime. However, these symptoms also describe a cocaine overdose. One is more life-threatening than the other.  Nevertheless, it is vital to educate yourself on overdose symptoms to facilitate recognition as early as possible.

Symptoms of a drug overdose include:

• Slowed or stopped breathing (respiratory arrest)
• Blue lips or nails
• Loss of consciousness
• Uncontrollable muscle movements
• Seizures
• Nausea and vomiting
• Chest pain and/or irregular heartbeat
• Dilated or constricted pupils

One of the more dangerous symptoms to recognize is respiratory arrest. Respiratory arrest occurs as a complication due to an overdose of a depressant (opioid, benzodiazepines, alcohol). Depressants slow down and can stop a person’s breathing. Respiratory arrest requires immediate medical intervention, which may include supplemental oxygen, mechanical ventilation, CPR, or in some cases, medical intervention like naloxone.

The length of time someone can go without oxygen before experiencing brain damage or death can depend on several factors such as the individual’s age, overall health, and degree of oxygen deprivation. In general, the brain starts to suffer damage within a few minutes of reduced oxygen supply. This damage can be irreversible in as little as 5 minutes without oxygen.² The speed of returning oxygen is vital. Often, individuals experiencing respiratory arrest may not even look like they are in obvious distress. Instead, they may look peacefully asleep. The importance of careful monitoring of potential overdoses cannot be overstated.

Risk Factors & Causes

Risk factors may increase the risk of overdose when taking certain substances. For example, drug tolerance increases the potential for the body to become accustomed to its effects, thereby increasing the amount needed to achieve the desired high and elevating the chance of an overdose.

Other risk factors which may contribute to a drug overdose include:

• Combining substances (Polydrug use): Combining multiple substances can increase the risk of an overdose as the substance can interact with each other, leading to unpredictable effects.
• Method of administration: Certain routes of administration, like smoking, injecting, or snorting, can facilitate rapid delivery of a substance to the brain and increase the likelihood of overdose.
• Mixing with prescription drugs: Some prescription drugs, when combined with recreational drugs, can be lethal. Remember, just because a trusted physician prescribes it does not mean it’s safe, especially if it is not administered as directed.
• Co-occurring medical conditions: Individuals with underlying medical conditions such as heart, liver, or kidney problems may be unable to efficiently eliminate drugs from the body, leading to a higher risk of overdose.
• Returning to the same amount of drug after tolerance is depleted: When a person takes a drug regularly over time, their body builds up a tolerance. If a person stops using the drug for a period of time, their tolerance decreases, and their body may no longer be able to handle the same amount of the drug as before.

How to Help Someone Experiencing a Drug Overdose

A drug overdose is a medical emergency and will require professional medical intervention, such as calling 911. While waiting for emergency services to arrive, there are ways help those experiencing an overdose.

After calling 911, other ways to help someone experiencing an overdose are:

• Administer CPR if trained
• Administer Naloxone
• Monitor breathing
• Prevent choking by putting them on their side
• Stay present until emergency responders arrive
• Try to figure out what they took and the quantity
• Try to keep the person awake
• Comfort the person

Conversely, there are certain things to avoid when someone is experiencing an overdose, such as:

• Delayed medical attention
• Poor or inadequate ventilation
• Being alone during the overdose

What Does Drug Overdose Treatment Look Like?

Drug overdose treatment typically depends on the type of drug involved and the severity of the overdose. When emergency services arrive at the scene, they will evaluate the person’s condition to develop an appropriate treatment plan. Initially, emergency responders will assess the airway, breathing, and circulation. If breathing has decreased or stopped, the emergency responders may establish an emergency airway. Emergency responders will then administer appropriate medications, such as naloxone, when necessary.

Next, responders will initiate treatment to stabilize the person’s condition. Intravenous therapy may be utilized to deliver fluids and medications, which may increase the heart rate and blood pressure. Continuous monitoring will be utilized to ensure the effectiveness of the treatment and to detect any complications. After the person has been stabilized, it may be necessary to seek counseling, whether to the person, friends, or family, to examine the events which led up to the overdose and provide resources to deal with any underlying problem.

It may be possible that police or other legal response will arrive with emergency services. This may lead to complications in ensuring appropriate treatment due to several issues, such as fear of arrest. To mitigate these complications, overdose prevention programs, and treatment centers are increasingly adopting policies prioritizing medical care over incrimination. A confidentiality policy laying out specific guidelines for patient treatment and police involvement can help make people more willing to assist in distress or trauma, improving health outcomes and saving lives.

Therapeutic Interventions

After stabilization, therapeutic intervention should be discussed with the survivor. If the drug overdose results from an addiction or a drug of abuse, further treatment may be necessary for a full recovery. Mental health therapy, whether individual or group, can provide a place for individuals to process their near-death experiences. One factor which can impact the success of the process is when one decides to find the right therapist.

Certain types of therapeutic interventions can be tailored towards the individual experiencing the substance use disorder:

• Cognitive Behavioral Therapy (CBT): CBT is based on the understanding that thoughts, actions, and feelings influence behavior. Understanding these three facets allows individuals to target inaccurate and self-destructive beliefs which impact addiction.
• Exposure Therapy: Exposure therapy allows individuals to gradually confront triggering situations contributing to a person’s addictive behaviors. As a result, sufferers understand how to identify, manage, and increase tolerance to triggers.
• Dialectical Behavioral Therapy (DBT): DBT aims to bring mindfulness, emotional regulation, distress tolerance, and interpersonal effectiveness together to help individuals over addiction. Individuals aim to experience greater mood, self-respect, and psychosocial functioning to cope better.
• Motivational Interviewing: Motivational interviewing encourages change by enhancing intrinsic motivation. Building a non-judgemental, understanding, and supportive environment for the individual can help improve self-esteem and self-worth within the perceptions of their substance use disorders.
• Group Therapy: Addiction often leads to isolation. Group therapy helps individuals increase their peer support and learn techniques with non-judgemental feedback and support.

Intensive Outpatient Treatment

Intensive outpatient treatment (IOP) is a structured outpatient treatment program providing structure and support for addiction patients. These programs are designed to have participants examine all components of their addiction, from triggers to underlying origins. IOP attempts to provide flexibility with a schedule along with social support, customizable treatment, group therapy, and post-recovery coping mechanisms. Timelines for treatment can vary from 2 to 12 weeks.  The costs of IOP can vary depending on the program, intensity, and duration.  Many IOPs accept insurance and can provide personalized services depending on individual needs.

Rehab

Depending on the severity of the addiction, rehabs can provide inpatient or outpatient rehab.  It will be up to the individual and their treatment team to determine the appropriateness of Inpatient vs. outpatient rehab.

Rehab options include:

• 30 to 60-day residential treatment facilities
• Outpatient rehab
• Intensive outpatient & partial hospitalization
• Medical detox
• Dual-diagnosis treatment
• 12-Step programs
• Individual counseling

In My Experience

The first thing I tell clients after they overdose is how lucky they are to be alive.  I do everything in my power to drive this point home.  Although beneficial and life-saving, interventions such as CPR and Narcan often cannot reverse even mild overdoses. Individuals revived with CPR usually suffer broken ribs from the chest compressions. I have worked with clients who were in the best shape of their life, only not to survive an overdose. Remember when I mentioned that irreversible brain damage can occur after 5 minutes? Now consider how long emergency services take to arrive after being first alerted. It is most likely emergency services will not arrive until at least one-half hour after breathing stops.

I advise all overdose survivors to participate in an inpatient rehabilitation program. Period. If you know someone that suffers from an addiction to opioids, strongly consider enrolling yourself in a Narcan training course, and have Narcan readily available. When it comes to life or death, individuals suffering from addiction deserve the best possible shot at recovery, and this often requires a prolonged and honest inventory of self.