Opioid Overdose

Opioids are drugs that are often used to treat pain. Opioids include illegal drugs, such as heroin, as well as prescription pain medicines, such as codeine, morphine, hydrocodone, and fentanyl.

An opioid overdose happens when you take too much of an opioid. An overdose may be intentional or accidental and can happen with any type of opioid.

The effects of an overdose can be mild, dangerous, or even deadly. Opioid overdose is a medical emergency.

What are the causes?

• Taking too much of an opioid on purpose.
• Taking too much of an opioid by accident.
• Using two or more substances that contain opioids at the same time.
• Taking an opioid with a substance that affects your heart, breathing, or blood pressure. These include alcohol, tranquilizers, sleeping pills, illegal drugs, and some over-the-counter medicines.

• A health care provider who prescribes a medicine.
• The pharmacist who fills the prescription.

What increases the risk?

• Children. They may be attracted to colorful pills. Because of a child's small size, even a small amount of a medicine can be dangerous.
• Older people. They may be taking many different medicines. Older people may have difficulty reading labels or remembering when they last took their medicines. They may also be more sensitive to the effects of opioids.
• People with chronic medical conditions, especially heart, liver, kidney, or neurological diseases.
• People who take an opioid for a long period of time.
• People who take opioids and use illegal drugs, such as heroin, or other substances, such as alcohol.
• People who:
  • Have a history of drug or alcohol abuse.
  • Have certain mental health conditions.
  • Have a history of previous drug overdoses.
• People who take opioids that are not prescribed for them.

What are the signs or symptoms?

• Sleepiness or difficulty waking from sleep.
• Confusion.
• Slurred speech.
• Slowed breathing and a slow pulse (bradycardia).
• Nausea and vomiting.
• Abnormally small pupils.

• Cold, clammy, and pale skin.
• Blue lips and fingernails.
• Vomiting.
• Gurgling sounds in the throat.
• A pulse that is very slow or difficult to detect.
• Breathing that is very irregular, slow, noisy, or difficult to detect.
• Inability to respond to speech or be awakened from sleep (stupor).
• Seizures.

How is this diagnosed?

• About all of the opioids that you took.
• When you took the opioids.
• Whether you were drinking alcohol or using marijuana, cocaine, or other drugs.

• Checking and monitoring your heart rate and rhythm, breathing rate, temperature, and blood pressure.
• Measuring oxygen levels in your blood.
• Checking for abnormally small pupils.

You may also have blood tests or urine tests. You may have X-rays if you are having severe breathing problems.

How is this treated?

This condition requires immediate medical treatment and hospitalization. Reversing the effects of the opioid is the first step in treatment. If you have a Narcan kit or naloxone, use it right away. Follow your health care provider's instructions. A friend or family member can also help you with this.

• Giving salts and minerals (electrolytes) along with fluids through an IV.
• Inserting a breathing tube (endotracheal tube) in your airway to help you breathe if you cannot breathe on your own or you are in danger of not being able to breathe on your own.
• Giving oxygen through a small tube under your nose.
• Passing a tube through your nose and into your stomach (nasogastric tube, or NG tube) to empty your stomach.
• Giving medicines that:
  • Increase your blood pressure.
  • Relieve nausea and vomiting.
  • Relieve abdominal pain and cramping.
  • Reverse the effects of the opioid (naloxone).
• Monitoring your heart and oxygen levels.
• Ongoing counseling and mental health support if you intentionally overdosed or used an illegal drug.

Follow these instructions at home:

Medicines

• Take over-the-counter and prescription medicines only as told by your health care provider.
• Always ask your health care provider about possible side effects and interactions of any new medicine that you start taking.
• Keep a list of all the medicines that you take, including over-the-counter medicines. Bring this list with you to all your medical visits.

General instructions

• Drink enough fluid to keep your urine pale yellow.
• Keep all follow-up visits. This is important.

How is this prevented?

• Read the drug inserts that come with your opioid pain medicines.
• Take medicines only as told by your health care provider. Do not take more medicine than you are told. Do not take medicines more frequently than you are told.
• Do not drink alcohol or take sedatives when taking opioids.
• Do not use illegal or recreational drugs, including cocaine, ecstasy, and marijuana.
• Do not take opioid medicines that are not prescribed for you.
• Store all medicines in safety containers that are out of the reach of children.
• Get help if you are struggling with:
  • Alcohol or drug use.
  • Depression or another mental health problem.
  • Thoughts of hurting yourself or another person.
• Keep the phone number of your local poison control center near your phone or in your mobile phone. In the U.S., the hotline of the National Poison Control Center is (800) 222-1222.
• If you were prescribed naloxone, make sure you understand how to take it.

Contact a health care provider if:

• You need help understanding how to take your pain medicines.
• You feel your medicines are too strong.
• You are concerned that your pain medicines are not working well for your pain.
• You develop new symptoms or side effects when you are taking medicines.

Get help right away if:

• You or someone else is having symptoms of an opioid overdose. Get help even if you are not sure.
• You have thoughts about hurting yourself or others.
• You have:
  • Chest pain.
  • Difficulty breathing.
  • A loss of consciousness.

These symptoms may represent a serious problem that is an emergency. Do not wait to see if the symptoms will go away. Get medical help right away. Call your local emergency services (911 in the U.S.). Do not drive yourself to the hospital.

• Call your local emergency services (911 in the U.S.).
• Call a suicide crisis helpline, such as the National Suicide Prevention Lifeline at 1-800-273-8255 or 988 in the U.S. This is open 24 hours a day in the U.S.
• If you’re a Veteran:
  • Call 988 and press 1. This is open 24 hours a day.
  • Text the Veterans Crisis Line at 838255.

Summary

• Opioids are drugs that are often used to treat pain. Opioids include illegal drugs, such as heroin, as well as prescription pain medicines.
• An opioid overdose happens when you take too much of an opioid.
• Overdoses can be intentional or accidental.
• Opioid overdose is very dangerous. It is a life-threatening emergency.
• If you or someone you know is experiencing an opioid overdose, get help right away.