Stimulant Overdose: Signs and Emergency Response

What to do right now

1. Call 911. Many US states have Good Samaritan laws that protect people who call for help during an overdose.
2. Stay with the person and keep the area calm, quiet and dim. Speak slowly and reassuringly.
3. Keep them safe: move dangerous objects away; do not restrain them, which can raise temperature and cause cardiac arrest.
4. Cool them down if hot: remove extra clothing, apply cool wet cloths, fan them, move to a cool place.
5. If breathing slows or stops or they will not wake: give naloxone (nasal spray) in case fentanyl is involved; it is harmless if no opioid is present. Start CPR if there is no normal breathing.
6. If they have a seizure: clear the space, cushion the head, turn them on their side after it stops, do not put anything in their mouth.
7. Do not give other drugs, alcohol or coffee, or try to make them vomit.
8. Tell responders what was taken, how much and when.

Signs of a stimulant overdose

Body

• fast or irregular heartbeat
• high blood pressure
• chest pain or tightness
• very high body temperature, heavy sweating or hot, dry skin
• dilated pupils
• rapid breathing
• tremor, muscle twitching, teeth grinding
• seizures
• nausea and vomiting
• severe headache

Mind and behavior

• extreme agitation, restlessness or anxiety
• paranoia, hallucinations, delusions
• aggression or violent behavior
• confusion, disorientation
• panic

Life-threatening complications

• heart attack and dangerous heart rhythms
• stroke (bleeding or blocked arteries)
• aortic dissection
• extreme hyperthermia (above 40 °C or 104 °F) leading to organ failure
• rhabdomyolysis: muscle breakdown causing kidney failure
• serotonin syndrome with MDMA or when combined with some antidepressants
• low sodium and brain swelling with MDMA and heavy water drinking
• cardiac arrest

Substances involved

Fentanyl or other opioids are often present in the illicit stimulant supply, so a stimulant overdose can turn into an opioid overdose with slowed breathing.

Hospital treatment

• benzodiazepines (such as lorazepam or diazepam) to calm agitation, lower heart rate and blood pressure, and stop seizures; the cornerstone of treatment
• rapid cooling for hyperthermia: ice packs, cooling blankets, cold IV fluids
• IV fluids for dehydration and muscle breakdown
• ECG and heart monitoring, troponin tests for heart damage
• blood pressure control with medicines suited to stimulant toxicity
• CT scan for stroke or bleeding
• treatment of chest pain as for a possible heart attack
• naloxone and breathing support if opioids are involved
• observation until symptoms resolve, which can take many hours for methamphetamine

After an overdose

A stimulant overdose is a turning point to seek support:

• treatment for stimulant use disorder: contingency management and cognitive behavioral therapy are the most effective approaches
• harm reduction: never use alone, carry naloxone, use fentanyl test strips, avoid mixing substances, stay cool and hydrated without overdrinking
• see stimulant use disorder for more

Frequently asked questions

What are the signs of a stimulant overdose?

Signs include a racing or irregular heartbeat, chest pain, very high body temperature, heavy sweating, extreme agitation, paranoia, hallucinations, confusion, seizures and collapse. Slowed breathing or unresponsiveness may mean opioids such as fentanyl are also involved.

What should I do if someone is overdosing on stimulants?

Call 911, keep the person calm and safe, cool them if they are hot, and stay with them. If they stop breathing normally or will not wake, give naloxone and start CPR. Do not restrain them or give other substances.

Does naloxone work for a stimulant overdose?

Naloxone reverses opioids, not stimulants. But because many stimulants are contaminated with fentanyl, naloxone can save the life of someone whose breathing slows during a stimulant overdose. It is safe to give if you are unsure.

What happens if a child swallows ADHD medicine?

Even one or two pills can cause a fast heart rate, agitation, vomiting or seizures in a small child. Call Poison Control at 1-800-222-1222 immediately, or 911 if the child has symptoms. Store medicines locked and out of reach.

Can you die from a stimulant overdose?

Yes. Stimulant overdoses can cause heart attacks, strokes, dangerous heart rhythms, extreme overheating and organ failure. Deaths involving stimulants, often combined with fentanyl, have risen sharply in the US. Fast emergency treatment saves lives.