If you suspect someone is having an overdose, call 9-1-1 immediately.
Risk Factors for Overdose
Using alone – no one to intervene or call for help
Haven’t used recently – tolerance is lowered, so fewer drugs will get you higher
Unknown drug strength – can never really know with street drugs, but the risk is increased with a new dealer or supply
Mixing drugs – ex. Opioids and benzodiazepines
Signs and Symptoms of an Overdose
The signs and symptoms of an overdose differ depending on the drugs used.
When it comes to opioids such as fentanyl, heroin, hydromorphone, or morphine, for example, symptoms can include:
Tiny pupils
Slow, irregular breathing, and eventually no breathing
Blue or purple fingernails or lips – note that this does not occur in Black individuals; should check for a greyish color around the mucus membranes (lips, gums, eyes)
Unresponsive
Symptoms of an overdose related to stimulant use such as amphetamines or MDMA can include:
Rigid, jerking limbs, possibly seizures
In and out of consciousness
Tachycardia (a fast heart rate)
Chest pain
Agitation
Paranoia
Sweating
Naloxone
Naloxone / Narcan is an opioid antagonist. This means that it blocks the action of opioids, and thus reverses the signs and symptoms of an opioid overdose (Peri, 2020). It works in 1-5 minutes and lasts 30-90 minutes. In this time, you should see the return of breathing, normal skin color, and consciousness. However, many opioids last longer than this in the body, so the person can overdose again once the naloxone wears off. This makes it especially important that you stay with the person after administering naloxone. Note that naloxone does not work for non-opioid overdoses, but if opioids were taken with something else, naloxone still has the potential to help.
It is also important to note that naloxone can cause uncomfortable withdrawal feelings. Stay with the person to support them and encourage them not to use for another couple of hours, when the naloxone wears off, as this could result in another overdose (National Harm Reduction Coalition, n.d.).
Fortunately, naloxone is widely available in Canada. Many places also offer training. It is available in 2 different forms.
Nasal spray – won’t work as well if someone has a lot of scar tissue in their nose, like if they snort drugs OR if they’re experiencing wooden chest syndrome
Ampoule for intramuscular injection
Wooden Chest Syndrome (WCS): A rare complication of IV fentanyl that causes marked chest wall rigidity (Rosal et al, 2021). |
Steps in Responding to an Overdose (National Harm Reduction Coalition, n.d.)
Assessment – Is the scene safe for you to provide care? What symptoms present may indicate an overdose?
Try to wake the person up by shaking and shouting. If no response, rub your knuckles on their breast bone for 5-10 seconds.
If they don’t wake up and an overdose is suspected, call 9-1-1. Report the signs and symptoms you witnessed and state your location.
If you have naloxone and are comfortable administering it, do so now and repeat after 2-5 minutes. If someone else is available, they should begin rescue breaths while the naloxone is being prepared.
If you are trained, perform CPR or rescue breathing as applicable. Continue until help arrives.
Stay with the person and be ready to explain what happened. When they start breathing on their own, roll them into the recovery position.
Misconceptions or Barriers that Prevent People from Responding to Overdoses
Not knowing how to use naloxone – as discussed, training is widely offered and should be attended if you hope to respond to overdoses
Unsure if it is an opioid overdose – naloxone is an opioid antagonist so if there are no opioids in the system, they will not experience withdrawal and no harm is done (Marshall, 2021)
Fear of overdose by giving mouth to mouth – this is a myth, it is not possible to overdose in this way (del Pozo et al, 2021)
Fear of overdose through touch – this is also a myth, it is virtually impossible to overdose in this way, despite claims by police officers, which have since been deemed “factually incorrect” (Herman et al, 2020; Moss et al, 2017; del Pozo et al, 2021; Public Health Insider, 2022, Smith, 2021)
When sources refer to the fact that fentanyl can be absorbed through the skin, this refers to transdermal patches, which release fentanyl at a prescribed rate over several hours
Not having “fentanyl gloves” – these don’t exist, normal nitrile medical gloves that can be found in any naloxone kit are sufficient (CDC, 2011; CDC, 2020a)
Fear of HIV transmission – HIV transmission is not possible through saliva, it is spread through contact with blood, semen, vaginal fluid, anal fluid, and breast milk. Additionally, the virus dies very quickly on contact with air, so it must be transferred within the body (Centers for Disease Control and Prevention, 2020b)
Fear of getting in trouble with the law – The Good Samaritan Drug Overdose Act applies to anyone seeking emergency support during an overdose – it provides some protections to the person experiencing an overdose, the person seeking help, and anyone else at the scene (Government of Canada, 2021)
App Spotlight – The Brave App
The Brave App is a free overdose safety app made by people who use drugs for people who use drugs. It can be downloaded and used in the US and Canada. This app connects you with a peer to talk to if you’re using drugs alone.
It is anonymous, so you don’t need an account to use, but have the option to create an account to save your emergency response plan details; users are encouraged to do what makes them most comfortable.
The only information the app accepts are details to help your supporter carry out your emergency response plan per your instruction. Even then, that information is only shared if either (1) you choose to reveal it or (2) your supporter thinks you might be overdosing. The app is all about your preferences – you can set it up so that they will call 911 if an overdose is suspected, they can contact a roommate with naloxone, or can do both.
Learn more at https://www.thebraveapp.com/.
Until next time,
Raquel
References
Centers for Disease Control and Prevention. (2011). Fentanyl. Retrieved from https://www.cdc.gov/niosh/ershdb/emergencyresponsecard_29750022.html
Centers for Disease Control and Prevention. (2020a). Preventing emergency responders’ exposures to illicit drugs. Retrieved from https://www.cdc.gov/niosh/topics/fentanyl/risk.html
Centers for Disease Control and Prevention. (2020b). HIV transmission. Retrieved from https://www.cdc.gov/hiv/basics/transmission.html#:~:text=Most%20people%20who%20get%20HIV,can%20help%20prevent%20HIV%20transmission.
del Pozo, B., Sightes, E., Kang, S. et al. (2021). Can touch this: Training to correct police officer beliefs about overdose from incidental contact with fentanyl. Health Justice, 9(34). https://doi.org/10.1186/s40352-021-00163-5
Government of Canada. (2021). About the Good Samaritan drug overdose act. Retrieved from https://www.canada.ca/en/health-canada/services/opioids/about-good-samaritan-drug-overdose-act.html
Herman, P. A., Brenner, D. S., Dandorf, S., Kemp, S., Kroll, B., Trebach, J., … Stolbach, A. I. (2020). Media reports of unintentional opioid exposure of public safety first responders in North America. Journal of Medical Toxicology, 16(2), 112–115. https://doi.org/10.1007/s13181-020-00762-y.
Marshall, H. (2021). Side effects of Narcan: What you need to know. Healthline. Retrieved from https://www.healthline.com/health/drugs/narcan-side-effects
Moss, M. J., Warrick, B. J., Nelson, L. S., McKay, C. A., Dubé, P.-A., Gosselin, S., … Stolbach, A. I. (2018). ACMT and AACT position statement: Preventing occupational fentanyl and fentanyl analog exposure to emergency responders. Clinical Toxicology, 56(4), 297–300. https://doi.org/10.1080/15563650.2017.1373782.
National Harm Reduction Coalition. (n.d.). Responding to opioid overdose. Retrieved from https://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/responding-to-opioid-overdose/
Peri, C. (2020). Treating a drug overdose with naloxone. WebMD. Retrieved from https://www.webmd.com/mental-health/addiction/drug-overdose-naloxone
Public Health Insider. (2022). It’s safe to give help: Questions and answers about secondhand and fentanyl exposure. Retrieved from https://publichealthinsider.com/2022/04/05/its-safe-to-give-help-questions-and-answers-about-secondhand-fentanyl-exposure/
Rosal, N. R., Thelmo Jr, F. L., Tzarnas, S., DiCalvo, L., Tariq, S., & Grossman, C. (2021). Wooden chest syndrome: A case report of fentanyl-induced chest wall rigidity. Journal of Investigative Medicine High Impact Case Reports. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8312149/#:~:text=Fentanyl%2Dinduced%20chest%20wall%20rigidity%2C%20otherwise%20known%20as%20wooden%20chest,with%20sedatives%20for%20intubated%20patients.
Smith, P. A. (2021). A myth that lingers on: Casual contact with fentanyl causes overdoses. The Washington Post. Retrieved from https://www.washingtonpost.com/outlook/fentanyl-police-overdose-myth-san-diego-video/2021/08/13/5be44ec0-fbb3-11eb-8a67-f14cd1d28e47_story.html
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