Overdose

The term drug overdose (or simply overdose or OD) describes the ingestion or application of a drug or other substance in quantities greater than are recommended or generally practiced. An overdose is widely considered harmful and dangerous as it can result in death.

 

Classification

The word "overdose" implies that there is a safe dosage; therefore, the term is commonly only applied to drugs, not poison. Drug overdoses are sometimes caused intentionally to commit suicide or as self-harm, but many drug overdoses are accidental and are usually the result of either irresponsible behavior or the misreading of product labels. Drug overdose often happens as a result of the use of multiple drugs with counter indications simultaneously (for instance, heroin / certain prescription pain medications and cocaine / amphetamines / alcohol.) Usage of illicit drugs that are of unexpected purity, in large quantities, or after a period of abstinence can also induce overdose. Cocaine users that inject intravenous can overdose accidentally as the margin between an optimal flash and an overdose is small.

A common unintentional overdose in young children involves multi-vitamins containing iron. Iron is a component of the hemoglobin molecule in blood, used to transport oxygen to living cells. When taken in small amounts, iron allows the body to replenish hemoglobin, but in large amounts it causes severe pH imbalances in the body. If this overdose is not treated with chelation therapy, it can lead to death or permanent coma.

Signs and symptoms

Signs and symptoms of an overdose varies depending on the drug or toxin exposure. The symptoms can often be divided into differing toxidromes. This can help one determine what class of drug or toxin is causing the difficulties.

Causes

The drugs or toxins most frequently involved in overdose and death:

 

    * Among Barbiturates

          o Amobarbital

          o Secobarbital

          o Pentobarbital

    * Among Benzodiazepine overdose

          o Temazepam

          o Nitrazepam

          o Triazolam

          o Nimetazepam

    * Among Opioid overdose

          o Heroin

          o Morphine

          o Methadone

          o Hydromorphone

          o Codeine

          o Propoxyphene

    * Among Stimulants

          o Amphetamine overdose

          o Cocaine

          o Methamphetamine

    * Uncategorized sedative-hypnotics

          o Ethyl Alcohol

          o Methaqualone

          o GHB

          o Ketamine

          o Glutethimide (Doriden)

          o Ethchlorvynol (Placidyl)

    * Other Drugs

          o Aspirin

          o Paracetamol toxicity

          o Tricyclic antidepressant overdose

          o Anticholinergic toxicity

    * Industrial toxins

          o Organophosphate poisoning

    * Drug "cocktails" (Speedballs), or a combination of numerous drugs

Diagnosis

Diagnosis of an overdosed patient is generally straightforward if the drug is known. However, it can be very difficult if the patients cannot (or refuse to) state what drug they have overdosed on. At times, certain symptoms and signs exhibited by the patient, or blood tests, can reveal the drug in question. Even without knowing the drug, most patients can be treated with general supportive measures.

 

In some instances, antidotes may be administered if there is sufficient indication that the patient has overdosed on a particular type of medication.

Treatment

Once in hospital, establishing a stable airway, breathing rate and circulatory system is an essential first step. Ventilation is considered when there is a low respiratory rate or when blood gases show the person to be hypoxic. The next necessary step is to treat for shock. Investigations should be carried out in labs to help identify the drug(s) at hand such as glucose, urea and electrolytes, paracetamol levels and salicylate levels. Monitoring of the patient should continue before and throughout the treatment process, with particular attention to temperature, pulse, respiratory rate, blood pressure, urine output, electrocardiography (ECG) and O2 saturation.

Specific treatment

Specific measures vary between the causative agents used. Blood plasma toxicology will depend upon the suspected agent such as measuring paracetamol levels in unconscious patients, or those suspected otherwise to have overdosed on the drug. Specific antidotes for common agents include:

 

* Benzodiazepines – Flumazenil.

* β-Blockers - Atropine, but glucagon and dextrose if atropine fails. If unresponsive, consider aortic balloon pumps.

* Carbon monoxide - 100% oxygen and monitoring.

* Anticoagulants - If major bleed is present, treat with vitamin K and provide prothrombin complex concentrate.

* Opiates - Naloxone (Narcan), but high-dose opiate abusers may require methadone to combat withdrawal.

Prevention

    * Refrain from mixing depressant drugs like alcohol, barbiturates, benzodiazepines, and opiates together.

    * Start with small amounts, in order to estimate the potency of a drug.

    * Be careful when taking a drug after a period of abstinence, as your tolerance may be drastically lowered.

    * If you have a pharmaceutical chemical, make sure it is not expired. Toxicity can increase drastically.

 

If you need help with substance abuse you can apply for FREE to one of our Teen Challenge Centers today. You will need to complete an online application form to get help. One of our Support Workers or Centre Manager will then contact you to arrange an interview.

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