Drug overdose

Last updated
Drug overdose
Other namesOverdose, OD, Hotshot, Wasted, Intoxication, Gassed, Medicinal Poisoning
DrugOverdose.jpg
Specialty Toxicology
Symptoms Depends on the drug and the amount used
Complications Brain death, coma, neurological damage, heart failure, suicide
Causes Addiction, depression, anxiety, suicidal ideation, Physical pain
Risk factors Trauma, physical abuse, sexual abuse, child abuse, bullying
Medication Activated charcoal, stomach pump

A drug overdose (overdose or OD) is the ingestion or application of a drug or other substance in quantities greater than are recommended. [1] [2] Typically it is used for cases when a risk to health will potentially result. [1] An overdose may result in a toxic state or death. [2]

Contents

Classification

Timeline of US drug overdose death rates by race and ethnicity. Rate per 100,000 population. Timeline. US drug overdose death rate by race and ethnicity.gif
Timeline of US drug overdose death rates by race and ethnicity. Rate per 100,000 population.

The word "overdose" implies that there is a common safe dosage and usage for the drug; therefore, the term is commonly applied only to drugs, not poisons, even though many poisons as well are harmless at a low enough dosage. Drug overdose is sometimes used as a means to commit suicide, as the result of intentional or unintentional misuse of medication. Intentional misuse leading to overdose can include using prescribed or non-prescribed drugs in excessive quantities in an attempt to produce euphoria.

Usage of illicit drugs, in large quantities, or after a period of drug abstinence can also induce overdose. Cocaine users who inject intravenously can easily overdose accidentally, as the margin between a pleasurable drug sensation and an overdose is small. [4] Unintentional misuse can include errors in dosage caused by failure to read or understand product labels. Accidental overdoses may also be the result of over-prescription, failure to recognize a drug's active ingredient or unwitting ingestion by children. [5] A common unintentional overdose in young children involves multi-vitamins containing iron.

The term 'overdose' is often misused as a descriptor for adverse drug reactions or negative drug interactions due to mixing multiple drugs simultaneously.

Signs and symptoms

Toxidrome [6]
Symptoms Blood
pressure
Heart rate Respiratory
rate
Temperature Pupils Bowel
sounds
Diaphoresis
Anticholinergic ~
[ clarification needed ]
up~updilateddowndown
Cholinergic ~~unchangedunchangedconstrictedupup
Opioid downdowndowndownconstricteddowndown
Sympathomimetic upupupupdilatedupup
Sedative-hypnotic downdowndowndown~downdown

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

Symptoms of opioid overdoses include slow breathing, heart rate and pulse. [7] Opioid overdoses can also cause pinpoint pupils, and blue lips and nails due to low levels of oxygen in the blood. A person experiencing an opioid overdose might also have muscle spasms, seizures and decreased consciousness. A person experiencing an opiate overdose usually will not wake up even if their name is called or if they are shaken vigorously.

Causes

The drugs or toxins that are most frequently involved in overdose and death (grouped by ICD-10):

Diagnosis

The substance that has been taken may often be determined by asking the person. However, if they will not, or cannot, due to an altered level of consciousness, provide this information, a search of the home or questioning of friends and family may be helpful.

Examination for toxidromes, drug testing, or laboratory test may be helpful. Other laboratory test such as glucose, urea and electrolytes, paracetamol levels and salicylate levels are typically done. Negative drug-drug interactions have sometimes been misdiagnosed as an acute drug overdose, occasionally leading to the assumption of suicide. [8]

Prevention

The distribution of naloxone to injection drug users and other opioid drug users decreases the risk of death from overdose. [9] The Centers for Disease Control and Prevention (CDC) estimates that U.S. programs for drug users and their caregivers prescribing take-home doses of naloxone and training on its utilization are estimated to have prevented 10,000 opioid overdose deaths. [10] Healthcare institution-based naloxone prescription programs have also helped reduce rates of opioid overdose in the U.S. state of North Carolina, and have been replicated in the U.S. military. [11] [12] Nevertheless, scale-up of healthcare-based opioid overdose interventions is limited by providers' insufficient knowledge and negative attitudes towards prescribing take-home naloxone to prevent opioid overdose. [13] Programs training police and fire personnel in opioid overdose response using naloxone have also shown promise in the U.S. [14]

Management

Activated carbon is a commonly used agent for decontamination of the gastrointestinal tract in overdoses. CharcoalPO.jpg
Activated carbon is a commonly used agent for decontamination of the gastrointestinal tract in overdoses.

Stabilization of the victim's airway, breathing, and circulation (ABCs) is the initial treatment of an overdose. Ventilation is considered when there is a low respiratory rate or when blood gases show the person to be hypoxic. 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. [15] Poison control centers and medical toxicologists are available in many areas to provide guidance in overdoses both to physicians and to the general public.

Antidotes

Specific antidotes are available for certain overdoses. For example, naloxone is the antidote for opiates such as heroin or morphine. Similarly, benzodiazepine overdoses may be effectively reversed with flumazenil. As a nonspecific antidote, activated charcoal is frequently recommended if available within one hour of the ingestion and the ingestion is significant. [16] Gastric lavage, syrup of ipecac, and whole bowel irrigation are rarely used. [16]

Epidemiology and statistics

1,015,060 US residents died from drug overdoses from 1968 to 2019. 22 people out of every 100,000 died from drug overdoses in 2019 in the US. [17] From 1999 to Feb 2019 in the United States, more than 770,000 people have died from drug overdoses. [18]

In the US over 92,000 died in the 12 month period ending in November 2020. [19] 70,630 people died from drug overdoses in 2019. [20] The U.S. drug overdose death rate has gone from 2.5 per 100,000 people in 1968 to 21.5 per 100,000 in 2019. [17]

The National Center for Health Statistics reports that 19,250 people died of accidental poisoning in the U.S. in the year 2004 (eight deaths per 100,000 population). [21]

In 2008 testimony before a Senate subcommittee, Leonard J. Paulozzi, [22] a medical epidemiologist at the Centers for Disease Control and Prevention said that in 2005 more than 22,000 American lives were lost due to overdoses, and the number is growing rapidly. Paulozzi also testified that all available evidence suggests unintentional overdose deaths are related to the increasing use of prescription drugs, especially opioid painkillers. [23] However, the vast majority of overdoses are also attributable to alcohol. It is very rare for a victim of an overdose to have consumed just one drug. Most overdoses occur when drugs are ingested in combination with alcohol. [24]

Drug overdose was the leading cause of injury death in 2013. Among people 25 to 64 years old, drug overdose caused more deaths than motor vehicle traffic crashes. There were 43,982 drug overdose deaths in the United States in 2013. Of these, 22,767 (51.8%) were related to prescription drugs. [25]

The 22,767 deaths relating to prescription drug overdose in 2013, 16,235 (71.3%) involved opioid painkillers, and 6,973 (30.6%) involved benzodiazepines. Drug misuse and abuse caused about 2.5 million emergency department (ED) visits in 2011. Of these, more than 1.4 million ED visits were related to prescription drugs. Among those ED visits, 501,207 visits were related to anti-anxiety and insomnia medications, and 420,040 visits were related to opioid analgesics. [26]

See also

Related Research Articles

Heroin Opioid drug primarily used recreationally

Heroin, also known as diacetylmorphine and diamorphine among other names, is an opioid used as a recreational drug for its euphoric effects. Medical grade diamorphine is used as a pure hydrochloride salt which is distinguished from black tar heroin, a variable admixture of morphine derivatives—predominantly 6-MAM (6-monoacetylmorphine), which is the result of crude acetylation during clandestine production of street heroin. Diamorphine is used medically in several countries to relieve pain, such as during childbirth or a heart attack, as well as in opioid replacement therapy.

Naloxone opioid receptor antagonist

Naloxone, sold under the brand name Narcan among others, is a medication used to block the effects of opioids. It is commonly used to counter decreased breathing in opioid overdose. Naloxone may also be combined with an opioid, to decrease the risk of opioid misuse. When given intravenously, effects begin within two minutes, and when injected into a muscle within five minutes. Another route it can be given is by spraying it into a person's nose. The effects of naloxone last from about 30 seconds to 24 hours. Multiple doses may be required, as the duration of action of most opioids is greater than that of naloxone.

Opioid Psychoactive chemical

Opioids are substances that act on opioid receptors to produce morphine-like effects. Medically they are primarily used for pain relief, including anesthesia. Other medical uses include suppression of diarrhea, replacement therapy for opioid use disorder, reversing opioid overdose, suppressing cough, as well as for executions in the United States. Extremely potent opioids such as carfentanil are approved only for veterinary use. Opioids are also frequently used non-medically for their euphoric effects or to prevent withdrawal.

Opioid use disorder Medical condition

Opioid use disorder (OUD) is a substance use disorder relating to the use of an opioid. Any such disorder causes significant impairment or distress. Signs of the disorder include a strong desire to use opioids, increased tolerance to opioids, difficulty fulfilling obligations, trouble reducing use, and withdrawal symptoms with discontinuation. Opioid withdrawal symptoms may include nausea, muscle aches, diarrhea, trouble sleeping, agitation, and a low mood. Addiction and dependence are components of a substance use disorder. Complications may include opioid overdose, suicide, HIV/AIDS, hepatitis C, and problems at school, work, or home.

Toxidrome Syndrome caused by a dangerous level of toxins

A toxidrome is a syndrome caused by a dangerous level of toxins in the body. The term was coined in 1970 by Mofenson and Greensher. It is often the consequence of a drug overdose. Common symptoms include dizziness, disorientation, nausea, vomiting, and oscillopsia. A toxidrome may indicate a medical emergency requiring treatment at a poison control center. Aside from poisoning, a systemic infection may also lead to a toxidrome. "Classic" toxidromes are presented below, but they are often variable or obscured by the co-ingestion of multiple drugs.

Drug-related crime

A drug-related crime is a crime to possess, manufacture, or distribute drugs classified as having a potential for abuse. Drugs are also related to crime as drug trafficking and drug production are often controlled by drug cartels, organised crime and gangs.

Opioid overdose Medical condition

An opioid overdose is toxicity due to excessive consumption of opioids, such as morphine, heroin, fentanyl, tramadol, and methadone. This preventable pathology can be fatal if it leads to respiratory depression, a lethal condition that can cause hypoxia. Other symptoms include insufficient breathing, small pupils, and unconsciousness, however its onset can depend on the method of ingestion, the dosage and individual risk factors. Although there were over 110,000 deaths in 2017 due to opioids, individuals who survived also faced adverse complications, including permanent brain damage.

Benzodiazepine overdose Medical condition

Benzodiazepine overdose describes the ingestion of one of the drugs in the benzodiazepine class in quantities greater than are recommended or generally practiced. The most common symptoms of overdose include central nervous system (CNS) depression, impaired balance, ataxia, and slurred speech. Severe symptoms include coma and respiratory depression. Supportive care is the mainstay of treatment of benzodiazepine overdose. There is an antidote, flumazenil, but its use is controversial.

A coma cocktail is a combination of substances administered in an emergency to comatose individuals when the cause of the coma has not yet been determined. The intention is to work against various causes of a coma seen in an emergency setting including drug overdoses and hypoglycemia.

Buprenorphine/naloxone

Buprenorphine/naloxone, sold under the brand name Suboxone among others, is a fixed-dose combination medication that includes buprenorphine and naloxone. It is used to treat opioid use disorder, and reduces the mortality of opioid use disorder by 50%. It relieves cravings to use and withdrawal symptoms. Buprenorphine/naloxone is available for use in two different forms, under the tongue or in the cheek.

Opioid epidemic in the United States ongoing drug crisis

The opioid epidemic refers to the extensive overuse of opioid medications, both from medical prescriptions and from illegal sources. The epidemic began in the United States in the late 1990s, when opioids were increasingly prescribed for pain management and resulted in a rise in overall opioid use throughout subsequent years.

A take-home naloxone program is a governmental program that provides naloxone drug kits to those that are at risk of an opioid overdose. Naloxone is a medication that was created to reverse opioid overdoses. As an opioid antagonist, it binds to the μ-opioid receptors blocking the opioid's effects. Naloxone quickly restores normal respiration. The ongoing opioid epidemic has caused many public health authorities to expand access to naloxone.

Opioid epidemic Type of drug epidemic

The opioid epidemic, also referred to as the opioid crisis, is the phrase used to describe the overuse, misuse/abuse, and overdose deaths attributed either in part or in whole to the class of drugs opiates/opioids, and the significant medical, social, psychological, and economic consequences of both the medical and the non-medical or recreational use of these medications.

United States drug overdose death rates and totals over time

The United States Centers for Disease Control and Prevention has data on drug overdose death rates and totals. 1,015,060 US residents died from drug overdoses from 1968 to 2019. 22 people out of every 100,000 died from drug overdoses in 2019 in the US.

When authorized medical personnel prescribe two or more medications together for the same condition or disease to the same patient, it is known as co-prescribing. When clinicians prescribe the opioid overdose drug naloxone to patients in conjunction with the patient's opioid prescriptions, or to patients at risk for opioid overdose, it is called a naloxone co-prescription. Due, in part, to the opioid epidemic in the United States, there are currently both a state-level and nation-wide movement in the medical and public policy fields to encourage, and sometimes require, naloxone co-prescribing. The U.S. government has issued guidelines recommending co-prescribing naloxone along with opioids. Some co-prescribing, e.g., the practice of co-prescribing benzodiazepines and certain opioid medications to patients, has been cause for concern due to the high risk of opioid overdose.

The New Jersey “Opioid Antidote Prescription” bill is legislation sponsored in the New Jersey State Senate. The bill, numbered NJ S. 2323, requires a co-prescription of an opioid overdose agent, such as naloxone, with prescriptions for opioid medications for patients who have a high risk of overdosing and tightens restrictions on the dispensing of opioid medications in New Jersey.

The Illinois “Opioids-Covid-19-Naloxone” Resolution is legislation sponsored in the Illinois State Senate. The bill, numbered IL SR 1184, prompts the state of Illinois to examine the rise in opioid overdoses due to the COVID-19 pandemic. The bill also urges the state to improve and increase access to naloxone, an opioid overdose reversal drug.

The New York mandatory opioid antagonist prescription bill is legislation sponsored in the New York State Senate and Assembly. The Senate bill, numbered NY S. 5150-B, sponsored by state Senator Pete Harckham, will require prescribers to co-prescribe an opioid antagonist with the first opioid prescription of the year for certain high-risk patients to combat accidental overdoses.

The South Carolina opioid overdose prevention bill is legislation sponsored in the South Carolina state legislature. The bill, numbered SC H.B. 4711 and sponsored by state Representative Russell Fry, would require prescribers to offer a prescription for naloxone to patients at high risk of an opioid overdose.

The California naloxone requirement bill is legislation passed by the California legislature and signed into law in 2018. The bill, numbered AB 2760 and sponsored by state Assembly member Jim Wood, requires medical prescribers to offer a prescription for naloxone to certain populations at higher risk of overdosing from opiate drugs.

References

  1. 1 2 Definitions Archived 2011-02-27 at the Wayback Machine Retrieved on 20 September 2014.
  2. 1 2 "Stairway to Recovery: Glossary of Terms" Archived 2011-07-09 at the Wayback Machine . Retrieved on 19 March 2021
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  4. Study on fatal overdose Archived 2012-01-19 at the Wayback Machine in New-York City 1990-2000, visited May 11, 2008,
  5. "What to do with leftover medicines". Medicines Talk, Winter 2005. Available at "Archived copy". Archived from the original on 2009-10-24. Retrieved 2010-01-06.CS1 maint: archived copy as title (link)
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  17. 1 2 Data is from these saved tables from CDC Wonder at the Centers for Disease Control and Prevention, National Center for Health Statistics. The tables have totals, rates, and US populations per year.
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Further reading

Classification
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