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Overdose Awareness Day

Overdose Awareness Day

 OPIOIDS OVERDOSE

Opioids are narcotics which are either derived from opium (called opiates) or share a similar chemical structure but are manufactured without opium (1). Some examples of opiates are Fentanyl, Methadone, Morphine and Heroin.

Recent data published by the government of Canada (2) in the national report indicate that 2458 deaths in 2016 were opioid related. The rate was 8.8 per 100.000 people. The highest rates of 10.0 per 100.000 population was in western Canada. In a similar direction, the National Institute on Drug Abuse in United States published in their website more than 90 Americans die per day after overdosing on opioids (3). From the American population, prescribed opioids were abused by two million people and heroin by 591,000. Prescription drug misuse alone cost to the nation $78.5 billion in healthcare, law enforcement, and lost productivity in 2015 (3).

 

Opioids are narcotics which are either derived from opium (called opiates) or share a similar chemical structure but are manufactured without opium (1). Some examples of opiates are Fentanyl, Methadone, Morphine and Heroin.

Recent data published by the government of Canada (2) in the national report indicate that 2458 deaths in 2016 were opioid related. The rate was 8.8 per 100.000 people. The highest rates of 10.0 per 100.000 population was in western Canada. In a similar direction, the National Institute on Drug Abuse in United States published in their website more than 90 Americans die per day after overdosing on opioids (3). From the American population, prescribed opioids were abused by two million people and heroin by 591,000. Prescription drug misuse alone cost to the nation $78.5 billion in healthcare, law enforcement, and lost productivity in 2015 (3).

 

What is overdose and what are the consequences?

The use of excessive amounts or combination of drug(s) leads to a life-threatening reaction or death. There are many reasons leading to overdose including misuse of a prescription, prescriber miscalculation of the dose indicated, individual decreased tolerance.

The overdose signs and symptoms can vary according the substance used. Clinical signs and symptoms of opioid overdose lead to an emergent situation, typically manifested by decreased or absent respirations, pin point pupils, central nervous system depression /unconsciousness and cardiopulmonary arrest. The major consequence of abusing legal or illegal drugs combined or not with alcohol or benzodiazepines is respiratory depression and eventually death. Therefore, lack of consciousness in a person using opioids or other illicit drugs is a medical emergency.

Who is at risk for opioid overdose?

Anyone who receive long-term opioid medication, legitimate medical need for analgesia in an individual with substance use disorder, discharge from the hospital for opioid intoxication. Mandatory opioid detoxification or abstinent for a period of time (incarceration, hospital, rehab center), use of illegal opioids or mixing drugs (4).

What to do in case of opioid overdose?

STEP 1: If the person is unconscious or not breathing: CALL 911

Describe the clinical situation and provide the location address.

STEP 2: CHECK FOR SIGNS OF OPIOID OVERDOSE

  • Inability to awake upon sternal rub.
  • Pinpoint pupils.
  • Slow to shallow breathing.

STEP 3: SUPPORT THE PERSON’S BREATHING

Patients should be ventilated with oxygen prior to administration of naloxone. In situations where oxygen is not available, rescue breathing can be very effective in supporting respiration. Rescue breathing for adults involves the following steps:

  • Be sure the person’s airway is clear.
  • Place one hand on the person’s chin, tilt the head back and pinch the nose closed.
  • Place your mouth over the person’s mouth to make a seal and give 2 slow breaths.
  • The person’s chest should rise.
  • Follow up with one breath every 5 seconds.

STEP 4: MEDICAL TREATMENT

Naloxone should be administered intravenously immediately if opioids overdose is suspected. If the patient is unconscious, the Naloxone should reverse the effect. The unconscious patient should be restrained before administering naloxone because the recovery from unconsciousness lead to agitation, delirium and combativeness.

STEP 5: MONITOR THE PERSON’S RESPONSE

All patients should be monitored for recurrence of signs and symptoms of opioid toxicity for at least 4 hours from the last dose of naloxone or discontinuation of the naloxone infusion. The response to spontaneous breathing generally occurs within 3 to 5 minutes of naloxone administration.  It is essential to get the person to an emergency department as quickly as possible, even if he or she revives after the initial dose of naloxone and seems to feel better (4).

 ALCOHOL OVERDOSE

Drinking alcohol is part of many cultures around the world and is widely used in social celebrations, relax-time. It has also been suggested that the moderated use of alcohol has been associated with benefits in health (5).  The abuse or dependence to alcohol (Alcohol Use Disorder; AUD), however, has been a problem for many decades. From 1990 to 2010, the use of alcohol increased from the sixth to the third leading risk factor for death and disability (6). Approximately 886,000 individuals above the age of 15 had AUD in Canada (7) causing 2546 deaths related to car accidents in the context of alcohol use (8). A recent study (6) estimated that there were 5,082 alcohol-attributable deaths in 2015 in Canada.

In the United States of America, more than15 million adult people had an AUD and 1.315.000 adults received treatment for AUD at a specialized facility in 2015 (9).  An estimated 623,000 adolescents between the ages of 12–17 had AUD and 37.000 received treatment in a specialized facility (9).
An estimated of 88,000 people die annually, making alcohol the fourth leading preventable cause of death in the United States. In 2014, alcohol-impaired driving fatalities accounted for 9,967 deaths (31 percent of overall driving fatalities) (10).

 

What is alcohol overdose what are the consequences?

Increased alcohol blood levels above 250 mg/dl, may lead to progressive state starting with confusion (inability of estimate real time, place and identity), depression, sedation, slow breathing, blue tinged or pale skin, blackouts (periods of amnesia without other neurological impairment),seizures, stupor (state of lethargy and immobility with decreased responsiveness to stimulation) and ultimately to unconsciousness.

 

What to do in case of alcohol overdose?

Alcohol poisoning or overdose treatment usually involves hospitalization and medical supportive care in order to provide careful monitoring, prevention of breathing or choking problems and oxygen therapy. It is important to prevent dehydration by administering fluids intravenously. In addition, the use of vitamins and glucose may be needed to prevent serious complications.

 BENZODIAZEPINES OVERDOSE

Benzodiazepines (alprazolam, lorazepam, clonazepam, valium etc.) are commonly used to reduce anxiety, to help people sleep, to relax the body as well as a treatment for seizures and alcohol withdrawal.

What is benzodiazepines abuse and what are the consequences?

The ingestion of high doses of benzodiazepines alone or combined with other drugs which are responsible for overdose. Similarly to other substances abuse, signs and symptoms accompanying depressant sedative state include altered level of consciousness, respiratory depression, hypothermia (low body temperature), miosis (excessive constriction of the eye pupil), hypotension and bradycardia. Diagnosis of benzodiazepine ingestion is primarily based on the clinical history and clinical manifestations.

 

What to do in case of benzodiazepines overdose?

The treatment for benzodiazepines overdose usually involves hospitalization and medical supportive care in order to provide careful monitoring, prevention of breathing or choking problems and oxygen therapy. Treatment of an overdose of benzodiazepines includes gastric lavage, intubation and volume infusion (hypotension) as well as a prolonged hospital stay.

Flumazenil, a specific benzodiazepine antagonist, reverses the life-threatening effects of a benzodiazepine overdose. It is important to note that after the administration of flumazenil the patient may wake up and then re-sedate because the half-life of benzodiazepines is longer than the Flumazenil. Flumazenil use has been associated with seizures in patients with chronic benzodiazepine use and when antidepressants are used by the patient. Therefore, Flumazenil should be avoided in patients with a seizure disorder or when a drug capable of causing seizures has been ingested. Continuous monitoring must be instituted if flumazenil is used to arouse the patient.

 

 STIMULANTS OVERDOSE

Stimulants are substances that increase alertness, attention, and energy. Currently, legal stimulants are prescribed to treat obesity as appetite-suppressants, ADHD, narcolepsy, and infrequently depression—in specific cases. The most commonly used stimulants are amphetamines, methamphetamines, illegal drugs as Cocaine and crack also are included in this category. The Canadian Alcohol and Drug use Monitoring Survey (CADUMS)  showed that 1.1% (277.678 Canadian residents) above the age of 15 years use crack and cocaine in 2012 (11).

Moreover, according to the National Survey on Drug Use and Health (12) around 913.000 American met the criteria for cocaine use disorder in 2014. In addition, the Drug Abuse Warning Network (13) reported that 40% of the visits to emergency departments for drug abuse were related to cocaine and almost seven thousand cocaine overdose related deaths occurred in 2015 (14).

What the consequences of stimulants overdose?

An overdose of stimulants causes significant behavioral or psychological changes, and the types and symptoms severity depend on the dose, level of tolerance and length of use. The most serious negative effects involve confusion, seizures, stroke, chest pain, or cardiac arrhythmias, breathing failure, coma and death.

What to do in case of stimulants overdose?

The following should be warning signs to call 911 immediately if individual:

  • Is unconscious or confused
  • Has severe headaches or seizure
  • Has chest pain and/or breathing difficulties.

 

Similar to other drugs, the treatment of a stimulant overdose includes administration of IV fluids, close monitoring, possible intubation and restoring blood circulation.

For more information contact:

  • The Habitude Addiction Program
  • 905-523-8369 
  • 905-523-9006
  • habitude.ca

 

References:

  1. https://www.overdoseday.com/resources/overdose-basics/
  2. https://www.canada.ca/en/health-canada/services/substance-abuse/prescription-drug-abuse/opioids/national-report-apparent-opioid-related-deaths.html
  3. drugabuse.gov
  4. https://store.samhsa.gov/shin/content//SMA16-4742/SMA16-4742.pdf
  5. https://www.hsph.harvard.edu/nutritionsource/alcohol-full-story/#possible_health_benefits
  6. Canadian Institute for Health Information. Alcohol Harm in Canada: Examining Hospitalizations Entirely Caused by Alcohol and Strategies to Reduce Alcohol Harm. Ottawa, ON: CIHI; 2017
  7. http://www.statcan.gc.ca/pub/82-624-x/2013001/article/tbl/tbl1-eng.htm
  8. http://madd.ca/pages/impaired-driving/overview/statistics/
  9. https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2015/NSDUH-FFR1-2015/NSDUH-FFR1-2015.
  10. https://www.niaaa.nih.gov/alcohol-facts-and-statistics
  11. https://www.canada.ca/en/health-canada/services/health-concerns/drug-prevention-treatment/drug-alcohol-use-statistics/canadian-alcohol-drug-use-monitoring-survey-summary-results-2012.html#s4
  12. https://www.drugabuse.gov/publications/research-reports/cocaine/what-scope-cocaine-use-in-united-states

13. Center for Behavioral Health Statistics and Quality (CBHSQ). Drug Abuse Warning Network: 2011: Selected                 Tables of National Estimates of Drug-Related Emergency Department Visits. Substance Abuse and Mental                   Health Services Administration; 2013

14. https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

 

 

 

 

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