What Is a Drug Overdose?
Overdoses of drugs or chemicals can be either accidental or intentional. Drug overdoses occur when a person takes more than the medically recommended dose of a prescription or over-the-counter drug. However, some people may be more sensitive to certain medications so that the high end of the therapeutic range of a drug may be toxic for them.
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 5 years) and among teenagers to those in their mid-30s.
- In 2014, there were 47,055 drug overdose deaths in the U.S. Overdose deaths from opioids, including prescription opioids and heroin, killed more than 28,000 people that same year. More than half of those deaths were from prescription opioids.
What Causes a Drug Overdose?
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 elderly persons 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 5 years (especially 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.
What Are Risk Factors for Drug Overdose?
Risk factors for drug overdose are those that would make someone more likely to abuse drugs, or more likely to accidentally take the incorrect medication or take the wrong dose of a medication.
Risk factors for accidental drug overdose include the following:
- Age: Young children and the elderly are at risk.
- Taking many different medications
- Mental illness
Risk factors for drug overdose in drug abusers include the following:
- Gender: Men are more likely to abuse drugs.
- Age: For example, people 45-54 years of age are more likely to abuse opioids, while people 25-34 years of age are more likely to abuse heroin.
- Low income
- Mental illness
- High daily dosage of medications
- Doctor shopping
- Injection drug use
- Mixing alcohol with drugs
- Using multiple drugs
- History of overdose
- Use of street drugs
- Using drugs alone
What Are the Signs and Symptoms of Drug Overdose?
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.
Signs and Symptoms of a Drug Overdose
- 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 are common and can be dangerous if the person breathes vomit into the lungs (aspiration).
- Skin can be cool and sweaty, or hot and dry.
- Seizures (convulsions) may occur.
- 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.
Overdose of Narcotics
- Any person suspected of narcotic overdose requires immediate medical attention and must be taken to a hospital's emergency department.
- The main physical signs of narcotic overdose are small pupils and respiratory depression (shallow breathing) that can lead to decreased oxygen in the blood, coma, and death.
- Street methods of overdose resuscitation, such as packing the person in ice or injecting milk or saliva, do not work.
When Should Someone Seek Medical Care for a Suspected Drug Overdose?
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, call 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 potential overdose or cannot call the Poison Control Center (800-222-1222), 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 the law enforcement community. 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.
What Specialists Treat a Drug Overdose?
An emergency-medicine specialist in a hospital's emergency department treats a drug overdose. A medical toxicologist may be consulted on some individuals. If a child overdoses, depending on the circumstances, Child Protective Services personnel may be involved. If a suicide attempt was the reason for the overdose, psychiatry services may need to be consulted.
If you have a problem with drug abuse, you may see an addiction specialist and a counselor to help deal with your addiction.
What Exams and Tests Do Physicians Use to Diagnose a Drug Overdose?
A history and physical examination to look for evidence of drug poisoning will be performed. The doctor may order laboratory tests based on the organ systems that can be harmed by the specific drug overdose to make a diagnosis.
- 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, with analysis of the urine and/or blood may also be done.
What Is the Treatment for a Drug Overdose?
If a person is suspected of overdosing on drugs, call 911 immediately.
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.
- 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 activated charcoal so that the person more quickly evacuates stool from his or her bowels.
- Agitated or violent people 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.
Are There Home Remedies for a Suspected Drug Overdose?
Home care and home remedies should not be done without first consulting a doctor or poison expert. Call Poison Control 800-222-1222 (U.S.) even if the person has no symptoms but overdose is suspected.
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. The phone number 800-222-1222 will get you through to a poison specialist.
- 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 successful suicide. The sooner you intervene, the better the success of avoiding suicide.
Is Follow-up Necessary After a Drug Overdose?
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 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.
How Can People Prevent a Drug Overdose?
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 solved 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 the age of 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.
What Is the Prognosis for a Drug Overdose?
The prognosis for drug overdose can vary. In many cases, a person who overdoses generally recovers completely and without lasting physical disability.
- Some serious drug overdoses are fatal, even with appropriate and timely treatment.
- 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 two organ systems at high risk.
- Brain damage resulting from suppression of lung and heart function is generally permanent.
- If the mental health problems that led to an intentional overdose are not addressed, then the person remains at risk for repetitive 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.
Reviewed on 11/21/2017
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Stolbach, Andrew, and Robert S. Hoffman. "Acute opioid intoxication in adults." UpToDate.com. Jan. 25, 2016.
United States. Centers for Disease Control and Prevention. "Injury Prevention & Control: Opioid Overdose." Mar. 14, 2016. <http://www.cdc.gov/drugoverdose/data/
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