International Drug Overdose Awareness Day: how to identify overdose and deal with it

When a person ingests more than the medically recommended amount of a drug, be it legal or illegal, it is termed as an overdose. Even if the drug is a prescribed medication, taking more than the recommended amount is bound to have a harmful effect on the body and its functions.

Overdose can have various health implications, including death. The consequences of overdose depend upon the kind of drug that was taken and its quantity. They also closely depend upon the medical, physical as well as mental history of the person who has been overdosed.

One thing to note here is that the distinction between overdosing on a prescription drug and overdosing on a psychoactive substance taken for pleasure is a blurry one, at best. Take the example of opium. Opium-based or opioid drugs are depressants that are sometimes used to dull pain in conditions like fibromyalgia and after surgery. Morphine, an opioid painkiller, has been in use since the 16th century. However, opium can also be a habit-forming drug that people take to get high—heroin, a derivative of opium, is one of the most widely used psychoactive substances by addicts in India. The symptoms and treatment of overdose in both cases would naturally be the same.

The first thing to do, of course, is to know the signs of overdose. These may vary from person to person, but some universal symptoms of an overdose include:

• Hallucinations
• Delusions (read more: Delusional disorders)
• Drowsiness 
• Trouble breathing
• Difficulty walking
• Agitation and aggression 
• Dilated pupils
• Tremors and convulsions

Specific symptoms according to a certain class of drugs have been classified below:

• Central nervous system (CNS) depressants: Shallow breathing, weak pulse, clammy skin, coma, death from respiratory arrest.
• Inhalants: Marked CNS depression, loss of consciousness, stupor or coma, arrhythmia (irregular heartbeat). Might lead to sudden death.
• Hallucinogens: Psychotic features and agitation
• Marijuana: Profound drowsiness, unsteady gait, vomiting, tachycardia (fast heartbeat), agitation, psychosis
• Opioids: Depressed level of consciousness, respiratory depression/arrest, cold skin, bluish skin, constricted pupils, dilated pupils in case of anoxic brain injury.
• Stimulants: Hyperthermia, high pulse rate, increased blood pressure, arrhythmia, agitation, hallucinations and other psychotic features, seizures, cardiovascular emergencies

An overdose can occur intentionally or unintentionally. It can also occur through a combination of medicines—that's why your doctor always asks if you are taking any medicines before writing you a new prescription.

What to do in case of a drug overdose

Call the doctor if you have taken medication and feel any of the symptoms mentioned above, or if a loved one starts showing these symptoms and you are worried they may have taken something. Next,

• Make a note of the symptoms, so you can share them with the paramedics as soon as they arrive.
• Remove any objects around that could hurt the patient if they fall, bump into things, etc.
• If you are trained in giving cardiopulmonary resuscitation, be prepared to give CPR if the patient stops breathing
• If the patient faints before medical help arrives, turn them on one side with the hand of the arm that's on top tucked under their cheek (palm down) and the knee of the top leg bent. This will prevent them from choking on anything and help them breathe more easily.

What not to do in case of a drug overdose

• Do not try to induce vomiting, as this may be a choking hazard at this time.
• Do not let the patient sleep.
• Do not give the patient coffee, as it could worsen the dehydration.
• Do not leave the patient alone until help arrives.

Much like the symptoms, the treatment for overdose also varies depending upon the same factors that have been discussed above. Even though information regarding the class of drug and its amount is pivotal to decide the course of treatment, it is not always available to the medical practitioner. Below is the method that is followed:

• Activated charcoal is given to the patient. This absorbs the drug by acting in the digestive tract.
• Inducing vomiting to remove the remnants of the drug
• Giving plenty of fluids intravenously (fluid therapy) to speed up the body’s process of excretion of drugs through the urinary system. 
• The medical practitioner may need to facilitate breathing if the patient is unable to breathe properly on their own. Depending on the patient's condition, this may be done using an oxygen cylinder and nasal cannula or by intubating the patient.

Do not try any of these steps at home, as they need to be performed by a trained medical practitioner after a thorough examination of the patient's symptoms. The best help you can provide once the patient is in the ambulance or clinic is to give a detailed account of what the patient took, how much they took and the signs and symptoms you notice.

Most often, people who overdose have a history of substance abuse and/or addiction. That being said, people can also overdose the first time they use a substance, in which case they may not necessarily meet the criteria for addiction. Hence, these people might not require the full range of addiction treatment services. Educating them about the consequences and the incidence of overdosage should be deterrent enough.

However, in those who constantly engage in addictive behaviour, a thorough treatment that includes detox and therapy is extremely beneficial. The ideal course of treatment must also address the underlying reasons, including mental health issues, that led to substance abuse in the first place.

Overdoses can be prevented in many ways, such as: 

• Use prescription drugs only as directed by your doctor.
• It's a good idea to not combine any medications without first asking your doctor if it’s safe.
• Alcohol consumption must be avoided in case you are on prescription medication, in order to prevent any unwanted reaction. 
• If you have kids at home, keep medication out of the reach of children in order to prevent accidental overdose. 
• If you or someone you know is misusing drugs and feel like they cannot quit, approach your doctor or a counsellor for help. Various therapy and detox programmes are available for you.

In many cases of substance overdose, immediate treatment can save lives. It is also important to understand that the stigma surrounding drug abuse and related mortality is an active deterrent for anyone who is trying to seek help. Being informed and disseminating information is the best way to fight drug abuse and prevent substance overdose—and that is why International Overdose Awareness Day is so important in this day and age.