Overdose

General Information

If you think you or a friend is overdosing, seek immediate medical attention. When in doubt, it is better to contact emergency services than to be responsible for bodily harm or death.

Furthermore, it is important not to misrepresent your situation to paramedics. Tell the paramedics and emergency personnel the truth about what you have ingested. A majority of overdose situations are caused by unsafe drug combinations; when considering a drug combination, check for any Drug Combinations, avoid dangerous combinations and start with a lower dose of each drug.

If someone is refusing contact with emergency medical services due to fear of legal consequences they should be reminded that most regions have some sort of Good Samaritan law where legal immunity is offered to reduce a bystanders' hesitation to assist in the event of an emergency.

The difference between a panic attack and a seizure

When a person has taken mind altering substances, especially with a history of anxiety, they may become hysterical and believe they are having a seizure. It can be difficult to diagnose a seizure for physicians because often it is over before the patient can be seen. Panic attacks however can present similarly to seizures and confirmation must be done through an EEG to confirm if there was in fact a seizure.

Seizures can commonly be caused by alcohol withdrawal, Benzodiazepine withdrawal, cocaine usage, MDMA usage, or even infection secondary to improper/unsanitary drug usage such as using old used needles.

• Sometimes partial seizures present themselves as panic attacks
• Some seizures are caused by conditions such as low blood sugar (hypoglycaemia) or a temporary change to the way the heart is working.

What seizures depending on their origin and type commanly can be sudden, short, and cause a change in the person’s awareness of where they are, what they are doing, what they are thinking or what they are feeling and even cause memory loss. It is also possible for stroke symptoms to present after a seizure in what is called the "post ictal" phase.

A concern when dealing with seizures is status epilepticus. Status epilepticus (SE) is an epileptic seizure of greater than five minutes or more than one seizure within a five-minute period without the person returning to normal between them

Benzodiazepines are indicated as treatment for seizures as they raise the seizure threshold and reduce the electrical activity occurring in the brain do not attempt to administer benzodiazepines yourself ; Contact Emergency medical services

The difference between a panic attack and a heart attack

• Panic attacks are again usually triggered by something
• Panic attacks and heart attacks can feel frighteningly similar: shortness of breath, palpitations, chest pain, dizziness, vertigo, feelings of unreality, numbness of hands and feet, sweating, fainting, and trembling.

Physical symptoms of a panic attack are triggered by an offset in breathing (usually hyperventilation). Your heart isn’t being strained; it’s being thrown into a natural fight or flight response. Also, your heart isn’t what’s causing the panic attack – your mind is. During a panic attack, chest pain is localized over the heart and described as "sharp, and comes and goes. The pain usually intensifies with breathing in and out, and pressing on the center of the chest. Panic attack may cause nausea, but vomiting is very rare. If tingling is present, the entire body tingles. Hyperventilation almost always precedes panic attack symptoms. If the location of the pain moves to the center of the chest, doesn't go away within 10 minutes, is accompanied by more than one incident of vomiting or diarrhea, or goes away and returns a few minutes later, you should immediately get medical attention.

Heart attacks, also known as Acute Myocardial Infarctions or AMI's are extremely deadly and anyone suspecting an AMI should err on the side of caution.

A heart attack can be caused my multitudes of things and the chance of something being a heart attack versus a panic attack can possibly be narrowed down through medical history current drug use and risk factors but the two can be hard to distinguish at times.

Classic signs of a heart attack include

• Sweating profusely
• Chest pain (squeezing tight pain is typical, usually severe as well, but not all heart attacks present the same way)
• Cold skin
• Pale skin
• heart rate below 60 or above 100 beats per minute
• Difficulty breathing
• Pain radiating to the left shoulder or left arm (due to the heart being on the left side of the body)
• Pain radiating to the jaw or neck or chin
• Rapid breathing, possibly shallow as well
• Altered mental status
• Pain lasting longer than 20 minutes not relieved by rest!

If you suspect you are having a heart attack do not hesitate to contact emergency services

How To Check Your Heartrate and Pulse

http://onlineheartrate.com/ A normal resting heart rate for adults ranges from 60 to 100 beats a minute.

Tips to lower heartrate

To do the valsalva maneuver, after taking a deep breath, strain the muscles in your abdomen the same way you would to give a bowel movement. Hold the pressure for five seconds, and then let go. You may have to do this multiple times to get the desired effect.

Serotonin Syndrome

Serotonin syndrome is a potentially life threatening drug reaction that causes the body to have too much serotonin, a chemical produced by nerve cells. Serotonin syndrome can happen as the result of taking many different drugs and taking different types of drugs together, including psychedelics, anti-depressants, CNS stimulants, opiods, 5-HT1 antagonists. some herbs, and others.

Symptom onset is usually rapid, often occurring within minutes. Serotonin syndrome encompasses a wide range of clinical findings. Mild symptoms may only consist of increased heart rate, shivering, sweating, dilated pupils,myoclonus (intermittent tremor or twitching), as well as overresponsive reflexes. Moderate intoxication includes additional abnormalities such as hyperactive bowel sounds, high blood pressure and hyperthermia; a temperature as high as 40 °C (104 °F) is common in moderate intoxication.

The combination of MAOIs, alcohol or other serotonin agonists or precursors pose a particularly severe risk of a life-threatening serotonin syndrome.

Treatment consists of discontinuing medications which may contribute and in moderate to severe cases administering a serotonin antagonist. An important adjunct treatment includes controlling agitation with benzodiazepine sedation.

If you think you have serotonin syndrome, it is best to seek medical advice.

Opioid overdose

Naloxone is an opioid antagonist drug developed by Sankyo in the 1960s. Naloxone is a drug used to counter the effects of opioid overdose, for example heroin or morphine overdose. Naloxone is specifically used to counteract life-threatening depression of the central nervous system and respiratory system. Always have naloxone on you if you plan on taking opiates; many ambulances and hospitals also carry the drug.

Stimulant overdose

In case of amphetamine psychosis

Antipsychotics such as Risperidone; or Haldol (Haloperidol lactate)

Benzodiazepines such as Lorazepam, Diazepam (EMS uses often), Midazolam

Benzodiazepines also raise the seizure threshold and are the drug class of choice in stimulant, primarily cocaine, overdose including if there is a cocaine or stimulant induced seizure

As mentioned above seizures may also occur due to stimulant usage, primarily with cocaine or MDMA

The use of cocaine is associated with the occurrence of seizures frequently, up to 40% in some case studies

Amphetamines and related drugs rarely induce epileptic seizures at therapeutic doses, but seizures may occur after the first dosing. 

Caffeine at high doses may induce epileptic seizures because of its adenosine receptor-antagonizing properties.

Marijuana, at variance with other psychostimulants, owing to its serotonin-mediated anticonvulsant action, could have a medical use for the treatment of epilepsy.

Psychedelic compounds rarely induce epileptic seizures, but the most common clinical CNS complication after ingestion of ecstasy is the occurrence of. seizures

Possible hospitalisation

Seroquel (2x 50mg, 200mg max) If seroquel were to be used for a stimulant overdose it should be noted that benzodiazepine treatment of acute stimulant overdose will be amplified by seroquel. This drug interaction may cause CNS depression.

Depressant Overdose

Depressants slow the central nervous system, and depress breathing and heart rate. In the case of an overdose caused by excess consumption or combination of depressants, effects can range from unrousable consciousness to possible coma or death.

Symptoms:

• Shallow breathing
• Unresponsive, unrousable unconsciousness
• Low body temperature
• Blue tinged skin, particularly on the fingertips or lips

In the case of these symptoms, it is important to seek medical attention immediately. In general, such overdoses must be treated in a hospital by supplementing oxygen, or through manual respiration. Certain drugs, such as opioids (mentioned above), may respond to individual treatments to reverse the depressant effects.

Dissociative Overdose

Dissociative overdose can have long lasting psychological effects.

With an overdose of dissociatives, emergency care, such as 911, should be contacted immediately. There is no antidote for ketamine. Overdose situations with ketamine are treated with symptomatic and supportive care in the hospital setting. Benzodiazepines may be used if needed for seizures or excitation. Respiratory support is rarely needed, but assisted ventilation or supplemental oxygen may be required.

'Tussin syrup may contain potentially deadly active ingredients such as paracetamol (acetaminophen), chlorpheniramine, and phenylephrine. Never take more than 4g of acetaminophen in a day, which may cause liver damage. In case of overdose, you will want to see medical attention.

Combining dissociatives with stimulants can cause a dangerous rise in blood pressure and heart rate. CNS depressants such as ethanol (drinking alcohol) will have a combined depressant effect, which can cause a decreased respiratory rate.

Combining dextromethorphan with other serotonergic drugs could possibly cause serotonin toxicity, an excess of serotonergic activity in the central nervous system (CNS) and peripheral nervous system (PNS).

Psychedelic Overdose

Most psychedelics are relatively safe, and won't put a user in a physically endangered state through psychedelic actions alone. However, many psychedelics are also stimulating and serotonergic, so overdoses may result in issues with stimulant overdose or serotonin syndrome.

In case of a NBOMe overdose, seek medical attention immediately.

Other

Many Over The Counter drugs also contain APAP (acetaminophen/paracetamol). Never take more than 4g of acetaminophen in a day. Overdoses of APAP take place over several days with a slow onset, and damage the liver - possibly causing liver failure or death. In the case of such an overdose, seek medical attention.

Emergency numbers

USA Emergencies: 911 Poison Control Hotline 1-800-222-1222

Australia Emergencies: 000 (112 from cell phones) Poison Control: 13 11 26

United Kingdom Emergencies: 999 Poison Control: 0845 4647 NHS non-emergency: 111

Germany Emergencies: 112 49 30 3068 6711

Most of Europe: Emergencies: 112