Managing overdoses
An overdose means that the body is unable to process the drugs in the system. Depending on the drug taken, the signs of an overdose can look different. Opioid overdoses are the most common and account for the most deaths. It can be difficult to tell the difference between someone who is under the influence and someone who has overdosed. If you are unsure, it is always best to treat it as an overdose.
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Overdose management
Signs of opioid overdose (e.g. Heroin, Fentanyl, Methadone):
- Unconscious
- No or slow or snoring breathing
- Not responding to calls
- Gray/blue lips and nails
Signs of stimulant overdose (e.g. cocaine, amphetamine, Tina, E):
- epileptic seizure
- High pulse
- Chest pain
- Sweating and headaches
- Anxiety, paranoia, hallucinations
Managing an overdose, step by step:
- Is the person conscious?
Yes: Talk to the person calmly and keep them awake until medical staff arrive.
No: Try to wake the person by calling their name, pinching their arm or rubbing their knuckles against their sternum. If the person does not wake up, tilt the head back and make sure airways are clear.
If the person is unconscious, do not give them food or water!
Epileptic seizures: Put something soft under the person's head, don't hold the person down and don't put anything in their mouth.
- Is the person breathing?
Look, listen and feel for breathing. Is there air coming from your mouth and nose? Does the chest rise and fall? Put a mirror or phone in front of your mouth and see if it fogs up.
Yes: If the person is unconscious but breathing, place them in a stable side position and call 112. Give Naloxone.
No: If the person has no pulse or breathing, start CPR and call 112. Give Naloxone.
- Give Naloxone
If Naloxone is available, give it immediately. Spray 1 time in one nostril or inject into the thigh.
If no effect is noticed after 2 minutes, spray once more in the other nostril.
- Call 112
Call 112 if the person is not breathing or is unconscious. It is best to let paramedics determine the situation and guide you through CPR. Tell them where you are calling from, whether the person is breathing or not, if naloxone was given and if it worked. Inform what drug the person has taken if you know.
If you are worried that police may accompany you, remember that the most important thing is to save lives.
- Cardiopulmonary resuscitation
If the person is not breathing, start CPR.
Alternate between 30 chest compressions and 2 breaths. Repeat until medical staff are on site.
Remember that it is better to do something than nothing.
- Stable lateral position
If the person is breathing, place them in a stable side position. Avoid having the person choke, vomit or tongue or anything else that may be in the mouth.
- Aftercare
Do not leave the person alone, talk to them calmly if they wake up and wait for medical staff.
If there is no improvement, you can give Naloxone again, sometimes several doses are needed before it takes effect. Give Naloxone again after about 30 minutes.
Other
Naloxone
Naloxone reverses opioid overdoses (e.g. fentanyl and heroin) and is completely safe to administer. It is available as a nasal spray and injection. Naloxone cannot prevent overdoses of other drugs but is completely safe and should therefore be given at the slightest suspicion of an opioid overdose.
If Naloxone is available, give it immediately. Spray 1 time in one nostril or inject into the thigh. If no effect is seen after 2 minutes, spray again in the other nostril.
Naloxone is cleared from the body after about 30-90 minutes, faster than opioids, and should therefore be given again after 30 minutes to prevent the person from overdosing again. Naloxone can be given several times without risk if the person overdoses again.
Cardiopulmonary resuscitation
CPR can keep the person alive until medical personnel arrive. Start CPR if the person is not breathing, has weak or irregular breathing. Lay the person on their back and do the following:
chest compressions: Put your hands together and press hard with straight arms in the middle of the person's chest, every second for 30 seconds; press down about 5 cm with each press.
Injections: Tilt the person's head back, hold the nose and blow air into the person's mouth with a steady pressure.
Repeat until paramedics are on the scene. If there are several of you, you can take turns.
Stable lateral position
Stable lateral position ensures that an unconscious person does not suffocate. Lay the person on their side with one arm under their head. Bend one of the knees so that the person does not fall over on their stomach. The head should be on its side to prevent vomit or tongue from getting stuck in the throat.
Overdose on stimulant drugs
An overdose on stimulant drugs (such as amphetamines, cocaine, mephedrone or MDMA) can be very unpleasant and in some cases life-threatening. The main risks are cardiac arrest, stroke or extreme overheating, but pure overdoses are more often fatal with recreational drugs than with stimulants.
Common symptoms of an overdose include seizures, epileptic fits, severe anxiety, paranoia, hallucinations or anxiety attacks.
Here's how you can help:
- Stay with the person and talk calmly.
- Always call 112 if the person becomes unconscious, has convulsions or cannot be contacted.
- If the heart stops: alert 112 immediately and start CPR.
- Help the person to drink water, but not too much.
- If overheated: cool with a wet towel or paper. Avoid ice-cold baths, as they can shock the body.
Naloxone has no effect on stimulant drugs, but it is safe to give. If you are unsure what has been taken - always give naloxone and call 112.
Overdose on GHB
The line between desired effect and overdose on GHB/GBL is very small, the strength between doses can also vary. Be careful to measure the dose with a pipette and always start with a smaller dose, especially if it is a new batch.
GHB/GBL overdose often results in slurred speech, lack of motor skills, difficulty staying awake, unconsciousness and shallow breathing. If someone becomes unconscious or falls asleep, stay with them, call 911 immediately and place them in a stable side position. If the person stops breathing, start CPR.
Drug mixtures and overdoses
Mixing different drugs to enhance or alter the high is not uncommon, but it can produce unpredictable effects and carries a high risk of overdose. Drugs can also be mixed with other substances without the user's knowledge - in Sweden, fentanyl has been found mainly in counterfeit tablets and some powders, making the risk of accidental overdose particularly high.
Different drugs break down differently in the body. This can lead to imbalances where one type of drug 'masks' the effects of another. For example, cocaine can give a strong high that temporarily masks the downward effect of opioids. When the cocaine quickly leaves the body, the opioid can kick in with full force, causing respiratory arrest or overdose.
Mixed overdoses can also be more difficult to recognize, as symptoms are less clear when several substances are involved.
Naloxone can reverse an opioid overdose and is safe to use even if it is a different drug. Always give naloxone if you suspect opioids - even if you are not sure - and always call 112.
