Drug overdose

An overdose is when you take a toxic (poisonous) amount of a drug or medicine. Symptoms can come on rapidly, but sometimes they are delayed. Not all overdoses are fatal or life threatening; however, medical advice should always be sought if an overdose is suspected or has occurred.

An overdose is a medical emergency that requires immediate attention. Always call your local emergency number (for example 911 in the US and Canada, 112 across the EU and many countries, 999 in the UK, or 000 in Australia) if you know or think that someone has had an overdose.

Substances that people can overdose on include:

• alcohol
• prescription medications
• over-the-counter (non-prescription) medications
• illicit drugs
• some herbal remedies

Signs and symptoms#

A wide range of signs and symptoms can occur when a person overdoses, and everyone responds differently. What happens depends on factors such as which substance or substances were taken, how much was taken, the strength of the drug, how it was taken, the person’s age, and their general state of health.

Symptoms of a drug overdose (including alcohol poisoning) may include:

• nausea and vomiting
• severe stomach pain and abdominal cramps
• diarrhea
• chest pain
• dizziness, loss of balance or loss of coordination
• being unresponsive but awake, or a limp body
• drowsiness and confusion
• agitation, paranoia or hallucinations
• visual disturbances
• seizures (fitting)
• a slow or erratic pulse
• difficulty breathing; shallow, erratic or absent breathing
• choking, gurgling or deep snoring sounds
• blue fingernails or lips
• a pale or clammy face
• loss of consciousness

First aid for overdose#

If you think someone has taken an overdose:

• Try your best to stay calm.
• Call your local emergency number (for example 911 in the US and Canada, 112 across the EU and many countries, 999 in the UK, or 000 in Australia) for an ambulance.
• If the person is unconscious but breathing, gently place them on their side in the recovery position. Keep their airway open by tilting the head back and lifting the chin. This helps them breathe and stops them from choking if they vomit.
• Check their breathing and monitor their condition until help arrives.
• Do not try to make the person vomit.
• Do not give them anything to eat or drink.
• Keep any pill containers to take to the hospital.

An overdose can still be an emergency even if the person seems okay at first. If someone may have taken an overdose but has no symptoms and seems well, contact your local poisons information service for advice (available 24 hours a day). Knowing some basic first aid could mean the difference between life and death in an emergency, so consider doing a first-aid course.

Local health services can teach you how to prevent, recognize and respond to a drug overdose. Some can also supply free naloxone (a medication that can reverse opioid overdose) for you to carry if you are at risk of experiencing or witnessing an opioid overdose. Many people carry naloxone and have used it to reverse overdoses.

Paracetamol overdose#

Paracetamol is a common form of pain relief and is also used to reduce fever. It is usually bought over the counter without a prescription, and it is one of the most common medicines taken by young children in an accidental overdose. It is also commonly taken by people who intend to harm themselves.

Another name for paracetamol is acetaminophen (often known by a brand name such as Panadol®). There is only a small difference between the maximum daily dose of paracetamol and an amount that causes an overdose, which can damage the liver. Large amounts are very dangerous, but the effects often do not show until about 2 to 3 days after the tablets are taken.

Signs of paracetamol overdose can include nausea, vomiting and abdominal pain, and in serious cases drowsiness, seizures and coma. Treatment must start early to be effective, before the effects begin. Always seek treatment for a paracetamol overdose immediately, even if the person seems well.

Treatment for drug overdose#

Medical care for an overdose depends on the drug or drugs taken, when and how they were taken, what else they were taken with, and how the person has been affected, including any medical complications.

If you go to hospital for a suspected drug overdose, the healthcare team will typically:

• Perform a full assessment, which may include blood tests, observation and a psychological review.
• Remove the drug from your body where possible, for example by giving activated charcoal, which binds the drug so the body cannot absorb it.
• Administer an antidote when possible, for example naloxone hydrochloride (brand names Prenoxad®, Nyxoid®, Narcan®), a drug that can reverse opioid overdose.
• Admit you to hospital for further treatment if needed.

A follow-up appointment with your doctor is important for everyone who has had an overdose. Your doctor can monitor your recovery, advise on continued treatment if required, or arrange referral for further help.

Self-care after treatment with activated charcoal#

If you were given charcoal in hospital, you will pass it with a bowel motion in a day or two. Home care suggestions include:

• Follow all instructions given by the doctor.
• Drink plenty of water to avoid constipation.
• Be aware that charcoal can interfere with how well other medications work. For example, if you take the oral contraceptive pill, you will need to use another method of contraception until your next period.
• If you are unsure how charcoal may affect your other medications and what to do about it, ask your doctor.

Why an overdose might happen#

Sometimes it is unclear whether an overdose was accidental or intentional, and there may be elements of both. Whatever the reason, it is important to treat people who have had an overdose with care and dignity.

• Accidental overdose – when a person takes the wrong substance, or the wrong combination, amount or timing, without knowing it could harm them. This includes people who take a drug for a desired effect (for example, to feel “high” or to ease unpleasant emotions) but do not realize the strength or ingredients of what they are taking.
• Intentional overdose – when a person deliberately takes a harmful dose of a substance or combination of substances. This can be a sign of physical, emotional or inner distress, and points to a need for additional care and support.

People of any age may overdose. The risk is increased when more than one substance is taken at the same time, or when the body is not used to a particular substance.

Preventing overdose#

Some ways to help prevent an overdose include:

• Always read medication labels carefully.
• Take prescription medications only as directed.
• Keep all medications in their original packaging.
• Tell your doctor or other health professional if you have had an overdose before.
• Do not keep medications you no longer need; return them to a pharmacist.
• Keep all medicines, alcohol, drugs and poisons locked away in a safe, secure place, out of reach of children.
• Be careful when taking different substances (including alcohol) at the same time, as they can interact and increase your risk of overdose. Ask your doctor or pharmacist about any interactions you should be aware of.

Safer use#

There is no safe level of drug use; using any drug carries some risk. If you do choose to use a substance, the following can help keep you safer from overdose:

• Start low and go slow. If you have not used a drug (such as heroin) for a while, your tolerance is likely to be much lower than before, so take it slowly and start with a smaller amount.
• If you are using drugs from an unknown source or of unknown purity, have a smaller test amount first.
• If you have any unexpected or delayed reaction to a drug, do not take more.
• Make sure you are in a safe environment with people you trust.
• Try to avoid using alone. Let someone know where you are and what you are doing, or have a friend with you.
• Keep naloxone on hand if you are using opioid drugs such as heroin, morphine or oxycodone. It helps temporarily reverse the effects of opioids.
• Remember that false or contaminated drug products may be circulating, even if no warning has been issued about them. Check for any recent drug alerts in your area.

Free overdose training and naloxone may also be available from local health services.

Key points#

• Symptoms of an overdose can occur rapidly, but sometimes people experience a delay in symptoms
• A wide range of signs and symptoms can occur when a person overdoses, and everyone responds differently
• Signs and symptoms depend on a variety of factors, including the person’s age
• Symptoms of a drug overdose (including alcohol poisoning) may include loss of consciousness
• An overdose is a medical emergency, so always call your local emergency number if you suspect one

Where to get help#