Responding To Overdose
In the context of these guidelines, an overdose is when someone ingests a drug that leads to a significant risk to their physical health. The likelihood of this occurring for a person using drugs is dependent on the dose and purity of the drug, interactions with other substances consumed, method of administration, body weight, age, biological sex, genetics and consumption of food and water. Drug overdoses can be caused by many different types of drugs, including stimulants, depressants, opioids, dissociatives and psychedelics, as well as the combination of different types.
Providing Support
If you suspect a drug overdose is occuring, seek immediate medical attention from medics or emergency services. Put the person in the stable side (recovery) position if they lose consciousness, and do not leave the person alone and continue to provide first aid until medical staff advise that it is safe to do so. If left untreated, overdoses can result in permanent brain damage, coma and death within minutes.
When to call for medical help (medical team/ambulance)
Overdoses most commonly present as either:
Depressant overdoses. Depressants are drugs that slow down body functions, such as alcohol, benzos, GHB/GBL, ketamine and opioids, e.g. tramadol, codeine, morphine, heroin, fentanyl, nitazene.
Stimulant overdoses (‘overamping’). Stimulants are drugs that speed up body functions, such as MDMA, cocaine and methamphetamine.
Call 111 if you spot someone who has these signs of a depressant overdose:
Is not completely awake or is totally unresponsive
Is breathing slowly or not at all (they may be making choking, gurgling or snoring sounds)
Has blue lips, tongue and hands. Their skin may be cool and pale.
Has pinpoint pupils
And if you spot someone who has these signs of a stimulant overdose (also known as overamping):
Has a very high temperature (may be sweating a lot)
Difficulty breathing
Extreme agitation or confusion
Chest pains
Seizure, convulsions or tremors
Loss of consciousness
Naloxone is a medication that can temporarily reverse an opioid overdose. If you or someone you know is using opioids, carry naloxone with you. Let people know you have it and show them how to use it. If someone is overdosing on opioids, give them naloxone and call 111 immediately.
Info on specific types of overdose
This can occur when someone has drunk a dangerous amount of alcohol, usually over a short period of time. Drinking too much alcohol too quickly can be especially impactful on breathing, heart rate, body temperature and gag reflex.
Common symptoms include:
Confusion
Vomiting
Low body temperature, shivering, goosebumps and/or cold, clammy skin
Blue lips and/or fingernails (cyanosis)
Drowsiness and/or loss of consciousness
Seizures
Slowed, irregular and/or stopped breathing, loud snoring, ‘death rattle’ or gasping for air.
Slurred speech
Serotonin Syndrome
This can occur when a drug(s) excessively increases the production or release of serotonin in the brain, or decreases its reabsorption. The use of MDMA with tramadol or other drugs like SSRI’s are some of the most common causes, and can significantly impact brain function.
Common symptoms include:
Seizures
Unconsciousness
Irregular heartbeat
Extreme agitation and/or restlessness
High body temperature, fever, overheating and/or sweating
Loss of muscle coordination, twitching muscles and/or rigidity
High blood pressure and/or heart rate
Dilated (large) and/or shaking pupils
Other symptoms include:
Insomnia
Confusion
Shivering
Stomach pain, nausea and/or vomiting
Diarrhoea
Headaches
This can occur when opioids start to negatively affect the part of the brain that regulates breathing. It is usually caused by opioids/opiates like heroin, fentanyl, nitazines, tramadol, morphine and codeine, or by combining them with other depressants such as alcohol, benzodiazepines or other opioids and opiates.
Naloxone (nyxoid) is an antidote that can temporarily reverse the effects of an opioid overdose long enough for them to receive medical attention. It is very important to have this on hand, and have at least one staff member who is trained to administer it. If someone is overdosing on opioids, give them naloxone and call 111 immediately.
Common symptoms include:
Stomach pain, nausea and/or vomiting
Limp body
Small (constricted) pupils
Low body temperature and/or cold, clammy skin
Low blood pressure and/or heart rate
Snoring and/or gurgling sounds
‘The nod’ - appearing to dose off before jerking awake
Blue lips and/or fingernails (cyanosis)
Drowsiness and/or loss of consciousness
Seizures
Slowed, irregular and/or stopped breathing, loud snoring, ‘death rattle’ or gasping for air.
This can occur when someone takes a high dose of ketamine, or combines it with other drugs (especially depressants). It can be a significantly disorienting and psychologically distressing experience, and primarily poses a risk to a person’s breathing through vomiting and blocked airways. Keep in mind that a ‘k-hole’ (high intoxication on ketamine) may be a desired effect for a lot of people experienced with the drug, and only pose a risk if they are left unsupervised, not in the recovery position or if combined with other drugs, especially alcohol.
Common symptoms include:
Confusion
Blue lips and/or fingernails (cyanosis)
Drowsiness and/or loss of consciousness
Seizures
Slowed, irregular and/or stopped breathing, loud snoring, ‘death rattle’ or gasping for air.
Slurred speech
Resources
The Level: Overdoses - What to Watch Out for
The Level: How and When to Use Nyxoid Nasal Spray to Respond to an Opioid Overdose
The Level: How to Use Naloxone Ampoules
Australian Alcohol and Drug Foundation: Drug Wheel