Download Overdose By Tb1
Dorthea Seate
A drug overdose (overdose or OD) is the ingestion or application of a drug or other substance in quantities much greater than are recommended.[2][3] Typically it is used for cases when a risk to health will potentially result.[2] An overdose may result in a toxic state or death.[3]
The word "overdose" implies that there is a common safe dosage and usage for the drug; therefore, the term is commonly applied only to drugs, not poisons, even though many poisons as well are harmless at a low enough dosage. Drug overdose is sometimes used as a means to commit suicide, as the result of intentional or unintentional misuse of medication. Intentional misuse leading to overdose can include using prescribed or non-prescribed drugs in excessive quantities in an attempt to produce euphoria.
Usage of illicit drugs, in large quantities, or after a period of drug abstinence can also induce overdose. Cocaine and opioid users who inject intravenously can easily overdose accidentally, as the margin between a pleasurable drug sensation and an overdose is small.[5] Unintentional misuse can include errors in dosage caused by failure to read or understand product labels. Accidental overdoses may also be the result of over-prescription, failure to recognize a drug's active ingredient or unwitting ingestion by children.[6] A common unintentional overdose in young children involves multivitamins containing iron.
Signs and symptoms of an overdose vary depending on the drug or exposure to toxins. The symptoms can often be divided into differing toxidromes. This can help one determine what class of drug or toxin is causing the difficulties.
Symptoms of opioid overdoses include slow breathing, heart rate and pulse.[8] Opioid overdoses can also cause pinpoint pupils, and blue lips and nails due to low levels of oxygen in the blood. A person experiencing an opioid overdose might also have muscle spasms, seizures and decreased consciousness. A person experiencing an opiate overdose usually will not wake up even if their name is called or if they are shaken vigorously.
Masking undesired taste may impair judgement of the potency, which is a factor in overdosing. For example, lean is usually created as a drinkable mixture, the cough syrup is combined with soft drinks, especially fruit-flavored drinks such as Sprite, Mountain Dew or Fanta, and is typically served in a foam cup.[9][10] A hard candy, usually a Jolly Rancher, may be added to give the mixture a sweeter flavor.[11]
The substance that has been taken may often be determined by asking the person. However, if they will not, or cannot, due to an altered level of consciousness, provide this information, a search of the home or questioning of friends and family may be helpful.
Examination for toxidromes, drug testing, or laboratory test may be helpful. Other laboratory test such as glucose, urea and electrolytes, paracetamol levels and salicylate levels are typically done. Negative drug-drug interactions have sometimes been misdiagnosed as an acute drug overdose, occasionally leading to the assumption of suicide.[12]
The distribution of naloxone to injection drug users and other opioid drug users decreases the risk of death from overdose.[13] The Centers for Disease Control and Prevention (CDC) estimates that U.S. programs for drug users and their caregivers prescribing take-home doses of naloxone and training on its utilization are estimated to have prevented 10,000 opioid overdose deaths.[14] Healthcare institution-based naloxone prescription programs have also helped reduce rates of opioid overdose in the U.S. state of North Carolina, and have been replicated in the U.S. military.[15][16] Nevertheless, scale-up of healthcare-based opioid overdose interventions is limited by providers' insufficient knowledge and negative attitudes towards prescribing take-home naloxone to prevent opioid overdose.[17] Programs training police and fire personnel in opioid overdose response using naloxone have also shown promise in the U.S.[18]
Supervised injection sites (also known as overdose prevention centers) have been used to help prevent drug overdoses by offering opioid reversal medications such as naloxone, medical assistance and treatment options. They also provide clean needles to help prevent the spread of diseases like HIV/AIDS and hepatitis.[19][20][21][22]
Stabilization of the person's airway, breathing, and circulation (ABCs) is the initial treatment of an overdose. Ventilation is considered when there is a low respiratory rate or when blood gases show the person to be hypoxic. Monitoring of the patient should continue before and throughout the treatment process, with particular attention to temperature, pulse, respiratory rate, blood pressure, urine output, electrocardiography (ECG) and O2 saturation.[23] Poison control centers and medical toxicologists are available in many areas to provide guidance in overdoses both to physicians and to the general public.
Specific antidotes are available for certain overdoses. For example, naloxone is the antidote for opiates such as heroin or morphine. Similarly, benzodiazepine overdoses may be effectively reversed with flumazenil. As a nonspecific antidote, activated charcoal is frequently recommended if available within one hour of the ingestion and the ingestion is significant.[24] Gastric lavage, syrup of ipecac, and whole bowel irrigation are rarely used.[24]
In 2008 testimony before a Senate subcommittee, Leonard J. Paulozzi,[31] a medical epidemiologist at the Centers for Disease Control and Prevention said that in 2005 more than 22,000 American people died due to overdoses, and the number is growing rapidly. Paulozzi also testified that all available evidence suggests unintentional overdose deaths are related to the increasing use of prescription drugs, especially opioid painkillers.[32] However, the vast majority of overdoses are also attributable to alcohol. It is very rare for a victim of an overdose to have consumed just one drug. Most overdoses occur when drugs are ingested in combination with alcohol.[33]
Their regular non-medical use, prolonged use, misuse and use without medical supervision can lead to opioid dependence and other health problems. Opioid dependence is a disorder of regulation of opioid use arising from repeated or continuous use of opioids. The characteristic feature of dependence is a strong internal drive to use opioids, which manifests itself by impaired ability to control use, increasing priority given to use over other activities and persistence of use despite harm or negative consequences. Physiological features of dependence may also be present, including increased tolerance to the effects of opioids, withdrawal symptoms following cessation or reduction in use, or repeated use of opioids or pharmacologically similar substances to prevent or alleviate withdrawal symptoms (1).
Worldwide, about 600 000 deaths were attributable to drug use in 2019. Close to 80% of these deaths are related to opioids, with about 25% of those deaths caused by opioid overdose. According to WHO estimates, approximately 125 000 people died of opioid overdose in 2019. Opioid overdoses that do not lead to death are several times more common than fatal overdoses.
The number of opioid overdoses has increased in recent years in several countries, in part due to the increased availability of opioids used in the management of chronic pain, and also due to increasing use of highly potent opioids appearing on the illicit drug market. In the United States of America (USA) the number of people dying from drug overdose amounted to 70 630 in 2019, and approximately half of these deaths involved synthetic opioids. From 2013 to 2019, the age-adjusted synthetic opioid death rates in the United States increased by 1040% (3). During the COVID-19 pandemic, a further substantial increase in drug overdose deaths was reported in the USA, primarily driven by rapid increases in overdose deaths involving synthetic opioids (4).
Death following opioid overdose is preventable if the person receives basic life support and the timely administration of the drug naloxone. Naloxone is an antidote to opioids that will reverse the effects of an opioid overdose if administered in time. Naloxone has virtually no effect in people who have not taken opioids.
Access to naloxone is generally limited to health professionals. In many countries there is still limited availability of naloxone even in medical settings, including in ambulances. On the other hand, some countries have already made naloxone available in pharmacies without prescription. Several countries (Australia, Canada, Italy, the United Kingdom of Great Britain and Northern Ireland and Ukraine) have introduced naloxone as over-the-counter medication and have also started proactive dissemination in communities.
In recent years, a number of programmes around the world have shown that providing naloxone to people likely to witness an opioid overdose, in combination with training on the use of naloxone and on the resuscitation of people following an opioid overdose, could substantially reduce the number of deaths resulting from opioid overdose. This is particularly relevant for people with opioid use disorders and leaving prison, as they have very high rates of opioid overdose during the first four weeks after release.
The gap between recommendations and practice is significant. Only half of countries provide access to effective treatment options for opioid dependence and less than 10% of people worldwide in need of such treatment are receiving it (5).
WHO continues to monitor several fentanyl analogues through its surveillance system for new psychoactive substances, alerting countries to the potential dangers associated with these substances. Collection of such data is important as information about the patterns of use, misuse and non-medical use of opioids is very limited.
WHO recommends that naloxone be made available to people likely to witness an opioid overdose, as well as training in the management of opioid overdose. In suspected opioid overdose, first responders should focus on airway management, assisting ventilation and administering naloxone. After successful resuscitation following the administration of naloxone, the level of consciousness and breathing of the affected person should be closely observed until full recovery has been achieved.