Overdose

Overview

An overdose is a medical emergency. If you suspect someone has overdosed, call your local emergency number right away. In the United States, you can also call the Poison Control hotline at 1-800-222-1222 for guidance. Do not wait to see if symptoms improve.

An overdose happens when a person takes more of a drug or medicine than the body can safely process. It can involve prescription medicines, over-the-counter products, illegal drugs, alcohol, or a combination. Overdoses may be accidental, such as a child swallowing pills or a mix-up with doses, or intentional, as in self-harm. The effects range from mild to life-threatening, depending on the substance, the amount, the person, and how quickly help is given. Many overdoses can be treated successfully when help is sought immediately.

Symptoms and Warning Signs

Signs of an overdose vary widely with the substance, but warning signs that need emergency help include:

• Slow, shallow, irregular, or stopped breathing
• Extreme drowsiness, unresponsiveness, or loss of consciousness
• Confusion, agitation, or seizures
• Blue or grayish lips, fingertips, or skin (a sign of low oxygen)
• Vomiting, especially if the person is drowsy and may choke
• Very small or very large pupils
• A very slow, fast, or irregular heartbeat
• Cold, clammy skin or a very high temperature

With opioid overdose, slow or stopped breathing and pinpoint pupils are key signs. Any of these warning signs means calling emergency services without delay.

Common Causes

Many substances can cause an overdose. Some of the most common and dangerous include:

• Opioids: Prescription painkillers, heroin, and fentanyl, which can dangerously slow or stop breathing.
• Paracetamol (acetaminophen): Common in pain and cold remedies; excess amounts can seriously damage the liver, sometimes without early symptoms.
• Alcohol: Large amounts can suppress breathing and consciousness.
• Sedatives and sleeping pills: Especially dangerous when combined with alcohol or opioids.
• Stimulants: Such as cocaine or amphetamines, which can strain the heart.
• Everyday medicines: Including some heart, diabetes, and over-the-counter drugs in large amounts.

Combining substances greatly increases the danger, even at amounts that might be tolerated alone.

Risk Factors

• Substance use disorders, including opioid or alcohol use
• Taking several medicines, especially sedatives or opioids together
• Mental health conditions and thoughts of self-harm
• Young children with access to medicines or household products
• Older adults managing many medications
• Restarting a drug after a break, when tolerance has dropped
• Confusion about dosing or duplicate ingredients in combination products

Assessment

In an emergency, medical teams assess and treat at the same time. Assessment may include:

• History: What substance, how much, and when it was taken, from the person, bystanders, or pill bottles.
• Examination: Breathing, heart rate, consciousness, pupils, and temperature.
• Blood and urine tests: To measure levels of certain drugs (such as paracetamol) and check organ function.
• Heart tracing (ECG): Because many overdoses affect the heart's rhythm.

Poison control centers and emergency staff use this information to choose the right treatment.

Treatment

Treatment depends on the substance and how unwell the person is, and is given in an emergency setting:

• Support of breathing and circulation: Oxygen, help with breathing, and fluids as needed.
• Antidotes: Specific reversal treatments for some overdoses, such as naloxone for opioids (which can rapidly restore breathing) and a specific antidote for paracetamol poisoning.
• Reducing absorption: Activated charcoal in certain cases when given soon after ingestion, under medical guidance.
• Removing the drug: Occasionally measures such as dialysis for specific substances.
• Monitoring and supportive care: Close observation of the heart, breathing, and organs until the person recovers.
• Mental health support: If the overdose was intentional, assessment and support for the person's safety and wellbeing.

Naloxone is widely available and can save a life during an opioid overdose while waiting for emergency help; it is safe to give if opioids are suspected.

Prevention

• Take medicines only as prescribed and check labels for duplicate ingredients
• Store all medicines and household chemicals safely away from children
• Do not mix sedatives, opioids, or sleeping pills with alcohol
• Keep naloxone on hand if you or someone close uses opioids, and learn how to use it
• Dispose of unused medicines safely
• Seek help for substance use or thoughts of self-harm; support is available

When to Get Emergency Help

Call emergency services immediately if you suspect an overdose. Do not wait for symptoms to worsen. Call right away for any of the following:

• Slow, shallow, or stopped breathing
• Unresponsiveness or extreme drowsiness
• Seizures, confusion, or blue lips or skin
• Any known large or intentional overdose, even if the person seems okay

While waiting for help, stay with the person, keep them on their side if they may vomit, and give naloxone if an opioid overdose is suspected and it is available. If someone is having thoughts of harming themselves, treat it as an emergency and contact local emergency or crisis services. In the US, you can call or text 988 for the Suicide and Crisis Lifeline.

Related Topics

Frequently Asked Questions

References

1. Centers for Disease Control and Prevention (CDC). Drug overdose.
2. MedlinePlus, U.S. National Library of Medicine. Drug overdose.
3. American Association of Poison Control Centers. Poison Help.
4. Substance Abuse and Mental Health Services Administration (SAMHSA). Naloxone.