Dr. Leonard is a Doctor of Medical Science and a clinical anatomist. He achieved his bachelor’s degree in human biology from the University of Miami. He received his Master of Science in anatomy from Barry University’s School of Podiatric Medicine, he then achieved his Master of Medical Science from Nova Southeastern University, and lastly, he achieved his doctor of medical science from Lincoln Memorial University’s DeBusk College of Osteopathic Medicine. He has practiced in both internal and emergency medicine at the University of Florida medical system. He has published several, peer-reviewed scientific articles, as well as a medical book chapter.
Since 1999, close to 850,000 U.S. citizens have lost their lives due to fatal overdoses. That is more than every armed conflict going all the way back to World War I, over 100 years of combat. And the driving force behind the overdose epidemic that has been called the “worst public health crisis in American history” are opioids — prescription painkillers, heroin, and increasingly, powerful synthetics like fentanyl. In fact, every year, almost 70% of drug deaths involve at least one opioid.
Studies confirm that the country is in the midst of an opioid addiction epidemic. According to the National Institute on Drug Abuse, the number of overdoses in the United States has tripled since 2001. Illegal drugs and prescription medications are responsible for a large number of emergency room visits. Between 2001 and 2014, deaths caused by an overdose of prescription opioid painkillers increased three and a half times. As the epidemic worsens and the number of overdoses increases, it is important that individuals addicted to drugs and their loved ones recognize what happens to the body during an opioid overdose.
Despite the alarming increase in opioid-related overdoses, most people cannot describe exactly what occurs during the problem. A person on the verge of an overdose seldom realizes that a medical crisis is occurring. Recognizing an overdose quickly and summoning medical help is critical to saving someone’s life. This guide provides an overview of predisposing factors for overdose, potential symptoms, and steps to help the person.
“As the number of opioid overdoses and deaths increase at an alarming rate, we must take action. It’s time to call this what it is — an emergency. Most of us know someone impacted by substance abuse – our family, our friends, our neighbors. Our hearts ache for them, but that isn’t enough. We must do more.”
~ Arizona Governor Doug Ducey
In the midst of this continuing and worsening tragedy that affects all of us, most people lack a basic understanding of such topics as:
- Who is most at-risk for an opioid overdose?
- What does an opioid overdose look like?
- How should you respond during an overdose emergency?
- What should happen after an overdose?
Knowing the answers to these and other related questions can and will save lives.
Overdose Risk Factors
Although there is no single factor that will cause the body to experience an overdose, there are certain issues that appear to place a person at greater risk. These include:
- Returning to drug use after detox
- Mixing opioids with alcohol or other sedatives – whether they are known or not
- A physical tolerance requiring higher doses to achieve the same effect
The body’s metabolism removes toxic substances in order to avoid harmful side effects. Once the threshold has been breached, the chemicals in your system overwhelm your body’s ability to process the drugs, which can result in physical and mental harm. When the body is overwhelmed by powerful drugs, an overdose will occur. The immediate symptoms of a nonfatal overdose can last from a few minutes to several hours. Tragically, an overdose can also kill the person within seconds. Factors determining the time that it takes for overdose symptoms to occur include:
- The specific drug or the drug combination taken
- The amounts and duration of abuse
- The method of use, such as injecting, smoking, snorting or swallowing
- Other coexisting physical illnesses
- The individual’s age
- The person’s body weight
What Happens to Your Body During an Opioid Overdose
The consequences of a nonfatal overdose can result in devastating, lifelong health problems. Whether you swallow a pill of inject the drug, the opioid travels throughout your body, including your brain, heart and lungs. As the opioid circulates through your system, the drug engages receptors responsible for triggering various mental and physical reactions.
When the opioid reaches your brain, it interacts with the region that produces the happiness brain chemical dopamine. The drug enables the brain to produce a larger than normal amount of dopamine. As the high tapers off, you may begin to fall asleep. Your head may begin to dip or jerk as you drift between sleep and consciousness. The drug also interacts with the portion of the brain that regulates breathing. During an opioid-related overdose, your breathing can slow down considerably or stop.
The drug also causes your heart rate to slow. Extremely slow breathing or extended pauses prevent your lungs from transferring oxygen to the blood. When oxygen levels fall, your heart may begin to beat erratically. These abnormal heart rhythms may cause you to experience cardiac arrest.
Because of the high level of opioids in your system, your brain stops receiving and sending the correct signals. The body will begin shutting down. Lack of oxygen-rich blood flow causes brain damage. Highly sensitive, the brain can be permanently damaged because of insufficient oxygen within as little as four minutes. CPR and colder temperatures during the overdose may reduce the amount of damage. The lack of oxygen from an opioid overdose can also cause seizures that damage your brain. The seizure may cause paralysis and impair your ability to speak.
Some people experiencing an overdose may foam at the mouth and choke on the secretions. The overdose may cause pulmonary edema, a condition that occurs when fluid enters the space surrounding the lungs. During an overdose, you may inhale liquid and choke because opioids interfere with the body’s natural gag reflex, the natural response that prevents secretions from entering your windpipe, or trachea. Inhaling liquid causes serious complications because this prevents the lungs from receiving oxygen and removing carbon dioxide. This situation can irreparable harm or kill the incapacitated individual.
Signs of an Overdose
Each person reacts differently depending upon the opioid that he or she took.
Common warning signs of an opioid overdose include:
- The person is unresponsive or unconscious
- The person is awake but cannot communicate
- The body is very limp
- You hear a deep snoring or shallow raspy-sounding breaths
- Breathing is very slow and shallow or absent
- The lips and fingernails are blue or gray
- The skin is clammy and sweaty
- Vomiting or foam at the mouth
If you are unsure, treat every situation as an overdose and call for emergency medical attention.
The Opioid Crisis in Arizona
“We’ve all heard the first-person stories of individuals who have been impacted by this crisis. Many here today have been personally impacted. But there are so many other stories we haven’t heard — because the individuals impacted didn’t survive. More than 800 just last year. This bill is for them,”
~ Governor Ducey, signing the Arizona Opioid Epidemic Act
According to statistics from the Arizona Department of Health Services, the opioid crisis has created a real and pressing need for intervention and treatment services in Arizona. From June 15, 2017 to July 31, 2020 there were:
- 47,503 suspected opioid overdoses.
- 6,597 suspected opioid deaths.
- 2,123 infants born with neonatal abstinence syndrome.
As might be expected, the majority of opioid deaths in Arizona happen in Maricopa County, home to Phoenix, Mesa, Chandler, Scottsdale, and Glendale.
There is good news, however. The tragedy could have been much worse, if not for the timely administration of life-saving overdose reversal drugs. During that same time period:
- 89,266 doses of naloxone were dispensed.
- 27,423 doses of naloxone were administered to opioid overdose victims.
Naloxone use in Arizona is encouraging, and follows a national trend. In 2012, U.S. pharmacies only gave out 1,282 naloxone prescriptions. But by 2017, that number had increased to 271,000. And in the one-year period between 2017 and 2018, it doubled to 557,000 prescriptions dispensed.
As a direct result, drug deaths in the United States fell to under 68,000, decreasing for the first time since 1999.
Responding to an Opioid Overdose
“The epidemic of deaths involving opioids continues to worsen. Prescription opioid misuse and use of heroin and illicitly-manufactured fentanyl are intertwined and deeply troubling problems.”
~ Dr. Thomas Frieden, former Director of the Centers for Disease Control and Prevention
The Harm Reduction Coalition has released step-by-step guidelines advising what to do during an opioid overdose emergency:
First, quickly assess the situation, checking for:
- Is the person breathing? If not, call 911 and give a few rescue breaths.
- Are their skin, fingertips, or lips discolored?
- Can they speak?
- Do they respond when you call/yell their name or shake them?
If they do not wake up or respond, try direct pain stimulation:
- Vigorously rub/dig your knuckles into their sternum. Do the same on their upper lip.
If they respond to any of your efforts, try to get them to wake up fully and focus. Talk to them to see if they are confused.
If they complain of shortness of breath or tightness, pressure, or pain in their chest, call 911. DO NOT let them go back to sleep.
If they do NOT respond, this is a medical emergency – call 911 right away. Do not worry about being arrested, even if you were doing drugs with them. Arizona has a “Good Samaritan” law in place to protect people who try to help overdose victims.
If they are not breathing and you know CPR, administer it until they start breathing or until help arrives.
While you wait for the paramedics, place the person in the “recovery position” – move them on their side, with one knee bent for support. This position helps keep their airway clear and prevents them from aspirating and choking on their own vomit.
If you have an opioid overdose reversal drug such as Narcan, follow the instructions and administer it now.
Emergency Treatment During an Overdose
While waiting for medical help to arrive with medications like NARCAN® to reverse the effects of the opioid overdose, take the following steps.
- Try to wake the person.
- Make sure that the airway is clear and open. If there is something in the person’s mouth, remove it and extend the neck forward to open the airway as much as possible.
- Check for breathing and pulse.
- Perform CPR as needed.
- Loosen restrictive clothing
- Place the individual on his or her side with one knee draped forward to prevent vomit from blocking the airway.
- Keep the person warm.
- Do not give the person any fluids.
- Stay with the person until help arrives.
- Inform first responders what drug, how much and when it was taken if possible.
What You Need to Know About Naloxone
“Addiction to heroin and other opiates – including certain prescription painkillers – is impacting the lives of Americans in every state, in every region, and from every background and walk of life – and all too often, with deadly results. Used in concert with Good Samaritan laws, which provide immunity from criminal prosecution to those seeking medical help for someone experiencing an overdose, naloxone can save lives.”
~ Eric Holder, former U.S. Attorney General
Naloxone is the generic name for the brands Narcan and Evzio. It is an emergency opioid overdose reversal medication that is available as a nasal spray or an injection. When used properly and promptly, it quickly restores normal breathing, usually within 2-3 minutes.
Naloxone binds directly to the brain’s opioid receptors, blocking the uptake of any opioid molecules for the next 90 minutes. More importantly, it dislodges any opioid molecules currently in place, reversing the overdose and restoring normal breathing.
Because it totally blocks all opioid effects, naloxone also immediately triggers severe opioid withdrawal. The symptoms are not dangerous, but they are extremely unpleasant:
- Painful, throbbing headache
- Runny nose
- Excessive sweating
- Muscle pain and cramps
Naloxone will NOT reverse other types of overdoses, such as benzodiazepines, cocaine, or barbiturates. But if you are unsure of the substance, ALWAYS administer naloxone anyway. If the drug causing the overdose IS an opioid, naloxone will reverse the overdose and save the person’s life. If it is NOT an opioid, naloxone has no adverse effect.
Naloxone will block ANY opioid –
- Natural – opium, morphine, codeine
- Semi-synthetic – heroin, oxycodone (OxyContin, Percodan, Percocet), hydromorphone (Dilaudid), hydrocodone (Vicodin), buprenorphine
- Synthetic – fentanyl, carfentanil, Gray Death, U-47700, Pink
When stronger opioids like fentanyl or other synthetics are involved, multiple doses of naloxone may be required.
Frequently Asked Questions About Opioid Overdose
What Causes People to Overdose on Opioids?
People overdose on opioids much too frequently. But the question is, why do they do it? There are a few different reasons:
- Many people overdose because they want to take an opioid drug to get high. They may be using a drug that is new to them and so, they are not familiar with its effects. Taking too much at one time can result in an overdose.
- A lot of opioid overdoses happen because the person took an extra dose or they took an additional dose before it was time. This can be done either on purpose or completely by accident.
- Sometimes people will mix opioids with other drugs, such as alcohol or illegal substances like cocaine or heroin. Both can result in augmented effects from the opioids, which can lead to an overdose. Also, they should never be mixed with benzodiazepines like Xanax and Valium. That type of combination has proven to be potentially fatal.
- Many opioid overdoses occur because the individual took a medication that was not prescribed to them. The majority of teens who overdose on these drugs say that they got them from someone else; most likely a family member. But the same is true for adults as well.
- Some opioid overdoses take place as the result of a relapse. The person was previously taking an opioid drug like Vicodin or heroin and they decided to quit. What they do not realize is that their tolerance level has dropped, and if they take their usual dose, it ends up being too much.
Who is at Risk for an Opioid Overdose?
It makes sense that people who use illegal opioid drugs like heroin would be more at risk for an overdose that someone who takes prescription painkillers. But the same is true for people who combine them with other medications or alcohol. If people decide to increase their dosages on their own, that also increases their risk.
People with some medical conditions also have a higher risk of overdosing on opioids. This is true for people with reduced liver or kidney functions as well as for people with sleep apnea.
How Can People Prevent More Opioid Overdose Deaths?
Everyone can do their part to help prevent more people from dying from opioid overdoses. Education is so critical, and the more people know about the dangers of these drugs, the better.
If a loved one is addicted to opioids, they may not be aware of the risk of overdosing. Their family can make a big difference in their life by talking to them about those risks and even considering staging an intervention to assist them in getting help.
Is Overdosing on Opioids a Sign That it is Time to Consider Getting Professional Help?
Overdoses are scary, life-threatening situations. When a person survives an opioid overdose, it should be seen as a cry for help, even if they do not want to stop using. At that point, it is obvious that their drug use has gotten out of control.
If the person refuses to get help, the family can step in and stage a professional intervention. We stress the word professional because this should never be done without some type of oversight. An interventionist who understands the best ways to address this issue with the addict and the family is often the best option.
Avoiding Overdose: Opioid Addiction Treatment in Arizona
“The sharp increases and variations across states and counties indicate the need for better coordination to address overdose outbreaks spreading across county and state borders.”
~ The Centers for Disease Control and Prevention
Even if it is not fatal, experiencing or witnessing an opioid overdose should be a life-changing wakeup call that things need to change. It is the “one more chance” that too many struggling addicts never get.
Overdose reversal drugs like Narcan are not free passes that allow you to continue engaging in dysfunctional and self-destructive behaviors. Rather, they are resources that give you the time to get the help and support you need.
As one of the top drug rehabs Scottsdale has to offer, Springboard Recovery is your first and best option when you are ready to begin your own personal sober journey. By using a treatment approach that uses both evidence-based strategies and holistic therapies, Springboard Recovery gives you the tools to safely and successfully regain your long-term sobriety.
To get immediate help, contact Springboard Recovery TODAY.
- Vox: https://www.vox.com/policy-and-politics/2017/6/6/15743986/opioid-epidemic-overdose-deaths-2016
- CNN: https://www.cnn.com/2014/02/04/health/how-heroin-kills/index.html
- Webmd: https://www.webmd.com/mental-health/addiction/drug-overdose#2-3
- Arizona Opioid Epidemic Act: https://azgovernor.gov/sites/default/files/opioidepidemicactweb_0.pdf
- Arizona Department of Health Services: https://www.azdhs.gov/prevention/womens-childrens-health/injury-prevention/opioid-prevention/index.php
- State of Reform: https://stateofreform.com/news/2018/12/arizona-governor-doug-ducey-releases-policy-primer-on-opioid-epidemic/
- Centers for Disease Control and Prevention: https://www.cdc.gov/mmwr/volumes/68/wr/mm6831e1.htm?s_cid=mm6831e1_w%22
- National Harm Reduction Coalition: https://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/responding-to-opioid-overdose/
- Narcan: https://www.narcan.com/
- Medline Plus: https://medlineplus.gov/opioidoverdose.html
- Centers for Disease Control and Prevention: https://www.cdc.gov/drugoverdose/index.html