Responding to an Overdose
This section describes the steps, tools, and strategies you can use to revive someone suffering from an opioid—or other drug overdose. Trying to help someone who is overdosing can be a scary and stressful experience, even for people who have responded to many overdoses or experienced overdose themselves. The first thing to keep in mind, though, is that if handled properly the great majority of overdoses will not be fatal or cause lasting harm. Don’t panic! There are simple steps you can take that will be effective in most situations. To some extent, every overdose is unique and what happens during an overdose will depend on what drug(s) the person has taken, whether that person is on any medications that might impact the overdose, their general state of health, and other factors that were previously discussed in the Risks and Prevention section. However, because the most dangerous kinds of overdose will usually involve either opioid or stimulant drugs—and opioid and stimulant overdoses are different—the content below focus mainly on those kinds of overdose.
Step-by-Step: How to Respond to an Opioid Overdose
If you think someone is overdosing, then following these basic steps will allow you to respond effectively to most overdoses:
1. Rescue Breathing: If the person is breathing very little or not at all, the best and most important thing you can do is get oxygen into their lungs.
2. Call for Help: If possible, immediately call for an ambulance or medical personnel. Professionals are the best help in an overdose situation.
3. Use Naloxone if Available: Naloxone is an opioid overdose antidote. Make an intramuscular injection in the upper arm or thigh.
4. Evaluate the Situation: Is the person breathing yet? Do they still need rescue breathing or another shot of naloxone? Are they waking up? Keep monitoring the situation until the person is completely stable, and repeat steps if necessary.
>Step 1: Provide Rescue Breathing
If someone is suffering from overdose, especially opioid overdose, getting oxygen into their body until they can start breathing on their own again is the most important thing you can do. Even without the help of an ambulance or access to naloxone, you can effectively respond to most overdoses just by performing rescue breathing and monitoring the person.
The first step in making sure someone has enough oxygen is to check if there is something obstructing her breathing. Open the person’s mouth and make sure that there is no food or chewing gum in the way, or anything else she might choke on. If necessary, use your finger to get stuff out.
Next, you should put her body in a position that makes it easy to breathe. If you need to leave the person to call for help or any other reason, or if you are simply monitoring her, you should put her in the recovery position: the person is laid on their side, with one leg pulled up for support and the head tilted downward. In this position, the person’s face will face downward enough that she will be very unlikely to choke if she vomits, and will otherwise be unlikely to hurt herself.
Knowing when you need to perform rescue breathing is crucial. Everyone needs roughly 12 breaths per minute to get enough oxygen to survive—that’s about one breath every five seconds. If you are with someone who is not breathing at all, or is breathing very shallowly and infrequently, you can perform rescue breathing, also known as mouth-to-mouth resuscitation.
Follow These Steps to Perform Rescue Breathing:
1. Lay the person who is overdosing flat on his or her back.
2. Supporting the back of the head with one hand, tilt the head back and chin up. You want to create a straight line from the mouth down the windpipe to the lungs in order to make the best path for oxygen to get into the person.
3. Pinch the nose shut so that no air will escape.
4. Take a deep breath, and then place your own mouth over the other person’s mouth, making a tight seal with your lips. If available, you can also use a breathing mask, which is often distributed by harm reduction organizations through overdose programs.
5. Gently exhale completely into the other person’s mouth. If you are doing it correctly, you should be able to see his chest rise as the air goes into him.
6. Breathe every three to four seconds, and repeat at least five times before taking a break to assess whether he is now breathing on his own.
You should repeat these steps until the person is breathing on his own, even if you use naloxone. If the person’s lips or fingers have turned blue, you should see them returning to normal color as you perform rescue breathing. You are keeping him alive until the overdose passes or help arrives.
>Step 2: Call for Help
As soon as the person suffering from an overdose is stabilized with rescue breathing, or if someone else is helping you respond, call an ambulance to provide professional medical attention. Emergency medical workers will be able to provide the best care, especially if the person overdosing is suffering other kinds of complications. If you are able to call for an ambulance, there are a few strategies you can use which may help:
> When calling an ambulance, you don’t necessarily need to say it’s an overdose: Just say that you’re with a friend who isn’t breathing. In many places, emergency services will prioritize such calls. When the ambulance arrives, however, it’s very important to be clear and precise about what’s happened and what drugs the person took. If you feel safe enough to tell the truth, this will help the ambulance workers respond better. The responding fire department and paramedics have no desire to get anyone into trouble with the police and will not disclose the fact that they are responding to an overdose so in order to help them help the person overdosing, be completely honest with them…it could potentially save a life.
> If you’re worried about the police coming, dispose any illegal drugs or paraphernalia in order to reduce the likelihood of arrest or other problems.
>Remember, if you must leave the person who is overdosing, even for a minute to make a phone call, be sure to put him in the recovery position. If you must leave altogether because of fear of police or other problems, be sure to call for help first, leave the person in the recovery position, and leave the door open so that help can get in.
>Step 3: Administer Naloxone if Available
If you know or suspect that someone has overdosed on heroin or other opiate drugs, injecting the person with naloxone as part of your response to the situation is an extremely effective way to reverse the overdose. First used by emergency medical personnel in the 1960s, naloxone has become more common as a medicine distributed by harm reduction organizations as a means of preventing overdose fatalities. Naloxone can be administered by intramuscular or intravenous injection, and can also be absorbed by mucous membranes in the nose (among other places). It usually takes one to five minutes to work. It cannot get you high and has no potential for abuse. Consequently, naloxone is not a controlled substance, though in most countries it does require a doctor’s prescription.
(For more information regarding Naloxone (or Narcan) please see our post “Overdose Rescue Kit including Narcan”).
Naloxone is usually active in the body for 60–90 minutes, which is a much shorter period than most opioid drugs. Because of this, it’s possible that an overdose could return after the naloxone wears off. Fortunately, this seems to be very rare, but it is important to monitor someone who has overdosed for a couple hours afterward to make sure he or she is OK.
Aside from reversing opioid overdose, naloxone may cause mild-tosevere withdrawal symptoms for someone dependent on opiates, because it temporarily blocks opioid drugs from affecting the body. Naloxone does not, however, remove opiates from the body, and as the naloxone wears off, the person who has overdosed will start to feel comfortable again as the opiates still in her system are able to reach their receptors.
>Step 4: Evaluating the Situation
Because overdoses are unpredictable and many factors are involved, it’s important to monitor and support people who have suffered overdose until medical help has arrived or until you are absolutely sure the overdose has passed—for at least an hour or two if possible. This is especially important if you have used naloxone to revive the person, since the overdose might return after the naloxone wears off. If the overdose continues or comes back, repeat all the steps above until the person has recovered.
What about Chest Compressions (CPR)?
Many people think of rescue breathing being done in conjunction with chest compressions—cardiopulmonary resuscitation or CPR. In most cases of opioid overdose, heart failure will occur from prolonged lack of oxygen if the person is not breathing. Therefore, if you provide rescue breathing and the other steps described above, you should be able to keep the person alive (and his heart beating) until he recovers. For someone whose heart has stopped, chest compressions help pump blood (and oxygen) through the body to keep him alive, and may help the heart start beating again on its own. However, it can sometimes be dangerous to give chest compressions to someone whose heart is still beating, and it is possible to fracture someone’s ribs by doing so.
How to Respond to a Stimulant Overdose
As noted, there is often some confusion about whether someone is experiencing a stimulant overdose as opposed to the physical and behavioral symptoms resulting from prolonged or intensive stimulant use without sleep or a sufficient break.
A stimulant overdose leads to seizure, heart attack, or stroke resulting from dangerously elevated body temperature, pulse and blood pressure, and from dehydration and other causes. Other signs that a person may have taken too much of a stimulant drug— including extreme agitation, shaking or chest pains—may be signs of an impending overdose and the person should be monitored and encouraged to discontinue use, and to eat and sleep.
With the exception of naloxone injection, which has no effect on stimulant drugs, all of the steps described in the section on “How to Respond to an Opioid Overdose” will help you respond to a stimulant overdose. In addition, you can use the following directions depending on the situation.
If Someone has a Seizure, Heart Attack, or Stroke
Always call for an ambulance, because any of these conditions may result in death and it can be difficult for people without medical training to respond. If a person is having a seizure, protect his or her head from bumping into walls, furniture, or the floor. You do not need to put a spoon or other object into the mouth. If someone’s heart has stopped beating because of stimulant overdose, he could die very quickly. In this case, the American Heart Association, the leading authority on heart health in the United States, now recommends that witnesses to someone having a heart attack perform “hands-only CPR”—that is, CPR using only chest compressions, without rescue breathing. Unlike with an opioid overdose where breathing is the most important issue, providing chest compressions after someone’s heart has stopped may more than double their chance of survival. Hands-only CPR has also recently been shown to be as effective as conventional CPR including rescue breathing.
>To provide chest compressions:
1. Place the person flat on her back
2. Put your hands, one over the other, in the center of the person’s chest on the sternum—the bone where the ribs comes together.
3. Push hard and fast in the center of the chest, without interruption, until medical help arrives or the person has revived.
You should try to provide up to 100 chest compressions per minute—or a little more than 15 every 10 seconds. Compressions should be relatively deep: about 40mm (1.5 inches).
If someone’s heart has stopped, calling for help and providing chest compressions immediately is the best thing to do. If possible, seek professional CPR training from your local Red Cross or Red Crescent so that you are able to respond as effectively as possible.
If Someone is Feeling Extremely Agitated, Nervous or Sick
This is probably the result of heavy stimulant use over a period of many hours or days. Although these symptoms may not be life threatening, they are a sign that the person should slow down. Because stimulant drugs increase body temperature, lead to dehydration, and keep people awake, the best things you can do to make someone feel better and avoid more serious consequences are to respond to these symptoms.
>If someone is overheated, put cool, damp washcloths on the back of his neck and/or under his armpits. Make sure the person drinks plenty of cool water in order to stay hydrated. Drinks like cola (which contains caffeine) or alcohol are not a good idea, since they will actually make the person more dehydrated and may make it harder to go to sleep.
>If the person is very agitated, try to talk to him calmly, and make him feel comfortable and more relaxed. Open a window to let in fresh air. If the person is upset, try gently touching him—a little bit of human contact will often interrupt the worst feelings.
>If the person has not slept in a very long time, she may benefit from a small dose of a mild sedative, such as Valium or Xanax. It’s not necessary for the person to use a large dose— the body wants to go to sleep, and a small dose will help a lot. It’s NOT a good idea for someone who has been using stimulants for a prolonged period to take heroin or other strong depressants, which could cause overdose or other dangerous complications.