Substance abuse is a serious problem, not just in the United States but all over the world. The Centers for Disease Control and Prevention (CDC) reports that, among people ages 12 and older, about 10.2 percent have abused any illicit drug – such as marijuana, heroin, or LSD – in the past month; among that same group, 2.5 percent abused a therapeutic drug for a nonmedical reason. Between 2008 and 2011, there were 1.1 million admissions to the emergency room for drug poisoning of any kind. Those who overdosed and were sent to the ER were most commonly between 20 and 34 years old. About one-quarter of those admissions resulted in longer-term hospital admission.
Drug Overdoses in the US
Among those admissions, almost 25 percent of drug poisonings involved heroin, methadone, and other related narcotics. Over 27 percent of admissions involved tranquilizers, sedatives, and sedative-hypnotics. The remaining 48.3 percent of admissions involved other substances, including meth, cocaine, or bath salts. Several of them involved drug combinations, such as mixing benzodiazepines and opioids, which can be deadly.
To give a person the best chance of surviving a drug overdose, emergency medical attention is needed, so call 911 immediately when witnessing an overdose or a suspected overdose. Symptoms of drug overdoses vary widely but affect all major organ systems, especially the brain. Heart rate and breathing rates change; the person may vomit; they may stumble because they cannot control their limbs; or they could pass out or fall into a stupor, in which they are not aware of their surroundings but appear conscious.
Emergency responders may use some overdose medications to treat the individual onsite, but for too many drugs, there are no medicines that can stop the overdose.
The Most Dangerous Drugs
- Opioids: Between 1999, when the prescribing practices around opioid drugs were loosened, and 2015, the CDC found that 183,000 people died from overdosing on prescription narcotics. This category includes potent drugs like OxyContin and fentanyl, but it does not include illicit narcotics like heroin, which is being abused more as people are unable to easily acquire prescription analgesics. Between 2014 and 2015, heroin overdose deaths increased 20.6 percent. This may be due to an increase in lacing heroin with other narcotics, especially fentanyl and more potent, new, and untested versions of fentanyl.
- Fentanyl: Since 2013, law enforcement laboratories have encountered more instances of fentanyl in illicit substances. This is tied to an increase in fentanyl overdoses and related deaths. In 2015, eight states reported over 500 encounters with fentanyl in illicit drug seizures. The drug is often mixed into substances like heroin or sold instead of illicit prescription narcotics. Without knowing what they are taking, people overdose on fentanyl because they do not understand how to dose this potent drug, which is between 50 and 100 times more potent than morphine and about 80 times more potent than heroin.
- Fentanyl analogs: The death rate from synthetic opioids, including tramadol and fentanyl, has increased by 72 percent between 2014 and 2015. Since 2015, more synthetic opioids more potent than fentanyl have appeared on the market. These include carfentanil, which was developed as a tranquilizer for large animals like elephants and is so dangerous that inhaling a small amount by accident can cause an overdose; U-47700, or “pink”, a research chemical opioid that is being made in illicit drug labs with no regulation; and gray death, a strange mixture of several potent opioid drugs, which is 10,000 times more potent than heroin.
- Acetaminophen poisoning:
Acetaminophen is a nonsteroidal anti-inflammatory drug (NSAID), which is in many over-the-counter and prescription drugs. It can be taken by itself, but it is also found in cold and flu medicines to ease pain. It is also an additive in prescription opioids like Vicodin and Percocet. People who abuse these opioid drugs put themselves at risk of acetaminophen overdose in addition to opioid overdose.
Symptoms of opioid overdoses include vomiting, passing out, and depressed or stopped breathing. The leading cause of death when a person overdoses on opioids is oxygen deprivation.
Opioid overdoses kill 91 people in the US every day, so many lawmakers and medical professionals are pushing for wider acceptance of Good Samaritan Laws, which decriminalize reporting an overdose, and easier access to naloxone to the general public. Naloxone is an opioid antagonist that has been used in hospital settings for years, and it temporarily reverses opioid overdoses. The drug has a shorter half-life than most opioid drugs, so if the person does not get immediate medical attention after naloxone has been administered, they will likely begin to overdose again.
Naloxone does not have any known side effects, unless the person is allergic to the drug, and it is not addictive. A recent nasal spray version, which is easy to administer, is becoming the focus of many laws that allow caregivers and friends of people with opioid painkiller prescriptions or who are struggling with addiction to easily access this medicine.
- Benzodiazepines: These anti-anxiety medicines, including Valium, Xanax, and Klonopin, are very addictive, and the body rapidly develops a tolerance to them. However, overdoses and deaths involving benzodiazepines rarely occur with just that substance in the person’s body; often, the drug is used in combination with other drugs, particularly opioids and alcohol.
The Drug Abuse Warning Network (DAWN) Report found that, between 2005 and 2011, there were almost 1 million admissions to the ER due to an overdose involving benzodiazepines: 89,310 of those admissions were benzodiazepines alone; 50,561 of them were a combination of benzodiazepines and opioids; 27,452 were alcohol and benzodiazepines; and 8,229 were benzodiazepines, opioids, and alcohol. While many people struggle with benzodiazepine abuse, these drugs are more often combined with other substances, which dramatically increases the risk of overdosing.
- Methamphetamines: While these drugs are decreasing in popularity in the US, they are extremely potent and poisonous. Since meth is a stimulant, an overdose involves increased heart rate, rapid and shallow breathing, extreme paranoia and delusions, hallucinations, hyperthermia, and seizures. People who overdose on meth are likely to suffer extensive damage to their brains and bodies, so they need emergency medical assistance immediately. Call 911.
- Cocaine: After declining for several years, cocaine overdoses are on the rise in the US. Between 2010 and 2015, the Monitoring the Future (MTF) survey found that there was a 1.6-fold increase in cocaine overdose deaths. As a stimulant like meth, cocaine overdoses are characterized by hallucinations, paranoia, delusions, confusion, hyperthermia, rapid heartbeat, increased breathing rate, and seizures. There were 505,224 emergency department admissions in 2011 alone for cocaine overdoses.
- With alcohol: Cocaine is a drug used socially in many cases, which means it is often mixed with alcohol. Combining these two drugs causes the liver to produce cocaethylene, a poisonous chemical that is toxic to the liver and can also cause a heart attack. People who mix cocaine and alcohol are more likely to experience toxic, overdose-like effects.
This is a combination of cocaine and heroin or sometimes other opioid drugs. Negative side effects from mixing these two drugs include lack of sleep, incoherence, confusion, paranoia, and stupor. Cocaine has a shorter half-life than heroin, so if a large amount of both drugs were taken, the person may experience a heroin overdose and stop breathing when the cocaine wears off.
- Bath salts: This name for a type of synthetic cathinones has become a slang term for these intense, dangerous drugs. There is essentially no way to take a synthetic cathinone and not experience an overdose; the stimulant drugs are completely unregulated, made with any available chemicals in a clandestine lab, and difficult to dose because the potency is constantly changing.
Calls to poison control centers about bath salts, flakka, and other synthetic cathinones peaked in 2012, with about 2,697 calls. Over 20,000 people have reportedly been admitted to the ER because of synthetic cathinone poisoning. These drugs are rapidly absorbed into the body when orally ingested; the rush peaks at 1.5 hours, but the full experience takes 6-8 hours. If a person takes more to try to hit the cathinone peak again, they are extremely likely to overdose. Symptoms include hyperthermia, paranoid delusions, self-harm or violence toward others, heart attacks, and seizures.
- Drug Abuse among Doctors
- Drug Tolerance and Dependency
- Overview on Drug Abuse
- Addiction among First Responders
- Addiction among Inmates
- The Failed Drug Wars
- Health Risks of Prolonged Drug Use
- Drug Withdrawal Symptoms
Preventing a Drug Overdose
The only surefire way to prevent an overdose is to get help overcoming substance abuse. However, some ways to prevent an accidental overdose, as recommended by the Food and Drug Administration (FDA) and the National Institute on Drug Abuse (NIDA), include:
- Read the directions on the medicine bottle; both over-the-counter and prescription drugs will have information on appropriate doses and dosing times.
- Follow the prescribing doctor’s and pharmacist’s instructions for prescription medicines, as these may differ slightly from the bottle.
- Only take as much of the substance as is safe; for example, OTC drugs containing acetaminophen have information about how much is safe to consume in one day and how much can safely be consumed every hour or two.
- Use the dosage delivery device (e.g., dropper, spoon, etc.) that comes with the medicine, if appropriate. These devices help to accurately measure the dose size.
- Do not take medicines as needed unless this is how they are prescribed or intended to be taken in the case of OTC medicines.
- Do not consume drugs from containers that have been damaged or opened before purchase.
- Check the expiration date of the medication, and appropriately dispose of drugs after they have passed their expiration date.
- If prescription medicines remain after treatment has ended, find a safe disposal site. Many pharmacies, doctors’ offices, and drugstores offer these programs.
- Keep medicine in a safe place, out of reach of children.
- Never take someone else’s prescription medications.
- Never switch or change prescription medication without consulting a doctor.
- Do not mix drugs unless a doctor has okayed multiple prescriptions and explained how these drugs interact. Mixing any prescription or OTC drug with alcohol, for example, can lead to an overdose.
Treating a Drug Overdose
When a person is suffering an overdose, there are some steps to take to help them after calling 911. There is no such thing as home treatment for a drug overdose; the person suffering from the overdose needs emergency medical attention immediately.
- If the individual is conscious but stumbling, incoherent, very confused, or in a stupor, make sure they do not consume any more drugs or alcohol. Keep them awake until EMS arrives and stay with them so they do not wander away.
- If the person is unconscious and breathing, and they have not vomited, place them in the recovery position. This helps keep their airway clear if they do vomit while unconscious.
- If they are not breathing, perform CPR or find someone who can.
- Keep track of their vital signs, like breathing and heart rate, until EMS arrives.
- If it is possible to find out which substances were consumed, find out; getting that information to EMS will help them treat the person appropriately.
When the person gets to the hospital, they will likely receive IV fluids and any relevant overdose reversal drugs like naloxone or flumazenil. They will get blood tests, head and chest scans, and other procedures to determine the extent of harm. They will then get appropriate emergency treatment and may remain in the hospital for several hours or days.