| Drug overdose | |
|---|---|
| Other names | Overdose, OD, hotshot, wasted, intoxication, gassed, medicinal poisoning |
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| A photograph showing a person who had overdosed | |
| Specialty | Toxicology |
| Symptoms | Vary depending on the drug and the amount used |
| Complications |
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| Causes |
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| Risk factors | |
| Differential diagnosis | |
| Treatment | |
Adrug overdose (overdose orOD) is theingestion or application of adrug or other substance in quantities much greater than are recommended.[2][3] Typically the term is applied for cases when a risk to health is a potential result.[2] An overdose may result in atoxic state ordeath.[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, notpoisons, even though many poisons as well are harmless at a low enough dosage. Drug overdose is sometimes used as a means to commitsuicide, as the result of intentional or unintentional misuse ofmedication. Intentional misuse leading to overdose can include using prescribed or non-prescribed drugs in excessive quantities in an attempt to produceeuphoria.
Usage ofillicit drugs, in large quantities, or after a period of drugabstinence can also induce overdose.Cocaine and opioid users whoinject intravenously can easily overdose accidentally, as the margin between a pleasurable drug sensation and an overdose is small.[4] 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.[5] A common unintentional overdose in young children involvesmultivitamins containingiron.
The term 'overdose' is often misused as a descriptor foradverse drug reactions or negativedrug interactions due tomixing multiple drugs simultaneously.
Signs and symptoms of an overdose vary depending on the drug or exposure totoxins. The symptoms can often be divided into differingtoxidromes. This can help one determine what class of drug or toxin is causing the difficulties.
Symptoms ofopioid overdoses include slow breathing, heart rate and pulse.[6] Opioid overdoses can also cause pinpoint pupils, and blue lips and nails due to low levels ofoxygen in the blood. A person experiencing anopioid 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 they are shaken vigorously.
Thedrugs ortoxins that are most frequently involved in overdose and death (grouped byICD-10):
Masking undesired taste may impair judgement of thepotency, 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 asSprite,Mountain Dew orFanta, and is typically served in afoam cup.[7][8] A hard candy, usually aJolly Rancher, may be added to give the mixture a sweeter flavor.[9]
The substance that has been taken may often be determined by asking the person. However, if they will not, or cannot, due to analtered level of consciousness, provide this information, a search of the home or questioning of friends and family may be helpful.
Examination fortoxidromes, drug testing, or laboratory test may be helpful. Other laboratory test such asglucose,urea andelectrolytes,paracetamol levels andsalicylate levels are typically done. Negative drug-drug interactions have sometimes been misdiagnosed as an acute drug overdose, occasionally leading to the assumption ofsuicide.[10]
| Symptoms | Blood Pressure | Heart rate | Respiratory Rate | Temperature | Pupils | Bowel Sounds | Diaphoresis |
|---|---|---|---|---|---|---|---|
| Anticholinergic | ~ [clarification needed] | up | ~ | up | dilated | down | down |
| Cholinergic | ~ | ~ | unchanged | unchanged | constricted | up | up |
| Opioid | down | down | down | down | constricted | down | down |
| Sympathomimetic | up | up | up | up | dilated | up | up |
| Sedative-hypnotic | down | down | down | down | ~ | down | down |
The distribution ofnaloxone toinjection drug users and otheropioid drug users decreases the risk of death from overdose.[12] TheCenters 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.[13] Healthcare institution-based naloxone prescription programs have also helped reduce rates of opioid overdose in theU.S. state of North Carolina, and have been replicated in the U.S. military.[14][15] 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.[16] Programs training police and fire personnel in opioid overdose response using naloxone have also shown promise in the U.S.[17]
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 likeHIV/AIDS andhepatitis.[18][19][20][21]
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 whenblood gases show the person to behypoxic. 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.[22]Poison control centers andmedical toxicologists are available in many areas to provide guidance in overdoses both to physicians and to the general public.
Specificantidotes are available for certain overdoses. For example,naloxone is the antidote foropiates such asheroin ormorphine. Similarly,benzodiazepine overdoses may be effectively reversed withflumazenil. As a nonspecific antidote,activated charcoal is frequently recommended if available within one hour of the ingestion and the ingestion is significant.[23]Gastric lavage,syrup of ipecac, andwhole bowel irrigation are rarely used.[23]
 | The examples and perspective in this sectionmay not represent aworldwide view of the subject. You mayimprove this section, discuss the issue on thetalk page, or create a new section, as appropriate.(December 2022) (Learn how and when to remove this message) |
The UN gives a figure of 300,000 deaths per year in the world through drug overdose.
1,015,060 US residents died from drug overdoses from 1968 to 2019. 22 people out of every 100,000 died from drug overdoses in 2019 in the US.[25] From 1999 to Feb 2019 in the United States, more than 770,000 people have died from drug overdoses.[26]
In the US around 107,500 people died in the 12-month period ending August 31, 2022, at a rate of 294 deaths per day.[27] 70,630 people died from drug overdoses in 2019.[28] The U.S. drug overdose death rate has gone from 2.5 per 100,000 people in 1968 to 21.5 per 100,000 in 2019.[25]
TheNational Center for Health Statistics reports that 19,250 people died of accidental poisoning in the U.S. in the year 2004 (eight deaths per 100,000 population).[29]
In 2008 testimony before a Senate subcommittee, Leonard J. Paulozzi,[30] a medical epidemiologist at theCenters 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, especiallyopioid painkillers.[31] However, the vast majority of overdoses are also attributable toalcohol. 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.[32]
Drug overdose was the leading cause of injury death in 2013. Among people 25 to 64 years old, drug overdose caused more deaths than motor vehicle traffic crashes. There were 43,982 drug overdose deaths in the United States in 2013. Of these, 22,767 (51.8%) were related to prescription drugs.[33]
The 22,767 deaths relating to prescription drug overdose in 2013, 16,235 (71.3%) involved opioid painkillers, and 6,973 (30.6%) involvedbenzodiazepines. Drug misuse and abuse caused about 2.5 million emergency department (ED) visits in 2011. Of these, more than 1.4 million ED visits were related to prescription drugs. Among those ED visits, 501,207 visits were related to anti-anxiety and insomnia medications, and 420,040 visits were related to opioid analgesics.[34]
New CDC data in 2024 demonstrates U.S. drug overdose deaths have significantly declined, marking the potential for the first year with fewer than 100,000 fatalities since 2020.[35] The CDC data shows a nearly 17% drop in reported overdose deaths during the 12 months ending in June, totaling 93,087.[36] This is a notable decrease from the 111,615 deaths recorded in the same period ending in June 2023. While the opioid crisis continues to take a heavy toll, fentanyl remains a major driver, contributing to the majority of these fatalities.[37]
![U.S. yearly overdose deaths from all drugs.[28]](/mt/?noimg=&dark=on&url=http%3a%2f%2fen.wikipedia.org%2fwiki%2fFile%3aUS_timeline._Number_of_overdose_deaths_from_all_drugs.jpg)
![US yearly overdose deaths, and the drugs involved. Among the 70,200 deaths in 2017, the sharpest increase occurred among deaths related to fentanyl and fentanyl analogs (synthetic opioids) with 28,466 deaths.[28]](/mt/?noimg=&dark=on&url=http%3a%2f%2fen.wikipedia.org%2fwiki%2fFile%3aUS_timeline._Drugs_involved_in_overdose_deaths.jpg)
![U.S. yearly overdose deaths involving benzodiazepines.[28]](/mt/?noimg=&dark=on&url=http%3a%2f%2fen.wikipedia.org%2fwiki%2fFile%3aUS_timeline._Benzodiazepine_deaths.jpg)
![U.S. yearly overdose deaths involving cocaine.[28]](/mt/?noimg=&dark=on&url=http%3a%2f%2fen.wikipedia.org%2fwiki%2fFile%3aUS_timeline._Cocaine_deaths.jpg)
![U.S. yearly deaths involving prescription opioids. Non-methadone synthetics is a category dominated by illegally acquired fentanyl, and has been excluded.[28]](/mt/?noimg=&dark=on&url=http%3a%2f%2fen.wikipedia.org%2fwiki%2fFile%3aUS_timeline._Prescription_opioid_pain_reliever_deaths.jpg)
![U.S. overdose deaths involving all opioids. Deaths per 100,000 population.[38]](/mt/?noimg=&dark=on&url=http%3a%2f%2fen.wikipedia.org%2fwiki%2fFile%3aTimeline._Overdose_death_rates_involving_opioids%2c_by_type%2c_United_States.gif)
![U.S. yearly overdose deaths involving heroin.[28]](/mt/?noimg=&dark=on&url=http%3a%2f%2fen.wikipedia.org%2fwiki%2fFile%3aTimeline_of_US_overdose_deaths_involving_heroin%2c_by_other_opioid_involvement.jpg)
![Timeline of US drug overdose death rates by race and ethnicity.[39] Rate per 100,000 population.](/mt/?noimg=&dark=on&url=http%3a%2f%2fen.wikipedia.org%2fwiki%2fFile%3aTimeline._US_drug_overdose_death_rate_by_race_and_ethnicity.gif)
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