Drug Overdose

Overdose is now the largest cause of death amongst injecting heroin users.
Many drug users overdose because they don't realise the risks they are taking when they inject heroin and use combinations of heroin and other drugs (including alcohol).
Many deaths happen because people who see overdoses often don't know what to do to help.

This section aims to change that by giving you information on:
IF SOMEONE OVERDOSES DON'T ASSUME THEY'LL COME ROUND

1. Don't panic, put them in the recovery position
2. Dial 999 and ask for an ambulance
3. Stay with them until the ambulance arrives
4. If you don't THEY MAY DIE
5. Watch out for signs of an overdose:
   • Deep snoring
   • Unwakeable
   • Turning blue
   • Not breathing

Watch out for overdose risks:

• Mixing drugs Mixing drugs and alcohol
• Using heroin and methadone when tolerance is low - particularly after a detox or break in use Injecting heroin and other tranquillizing drugs

Stay with people who may have taken too many drugs but are not yet showing signs of overdose. If they are sleeping lay them on their side in the recovery position and keep checking them. Many people have died several hours after taking an overdose.

IF SOMEONE IS UNCONSCIOUS AND BREATHING PUT THEM IN THE RECOVERY POSITION

Open their airway by tilting the head back and lifting the chin Straighten the legs Place the arm nearest to you at right angles to their body Pull the arm furthest from you across their chest and place the back of their hand against the cheek nearest to you Get hold of the far leg, just above the knee, and pull it up, keeping the foot flat on the ground Keep their hand pressed against the cheek and pull on the upper leg to roll them towards you, and onto their side Tilt the head back to make sure they can breathe easily Make sure that both the hip and the knee of the upper leg are bent at right angles Dial 999 and ask for an ambulance Stay with them until the ambulance arrives

Overdose risks

The main things that cause overdose are:

1. Injecting drugs - Heroin injectors are about 14 times more likely to die than non-injectors. People who inject heroin are much more likely to overdose than people who smoke it.
2. Mixing drugs and alcohol - Most overdoses happen when people have alcohol or downers - like valium and temazepam - in their system at the same time as injected heroin.
3. Using opiates when tolerance is low - It only takes a few days for tolerance of opiates to drop. After a week or so without opiates, a dose that at one time wouldn't have touched you, can kill you.

• People who die have often overdosed before and survived.
• It isn't normally 'new users' who overdose; it's usually people who've been injecting for years.
• Sometimes overdoses aren't accidental. Feeling depressed, hopeless or not caring whether you live or die can all make overdose more likely. Talking about feelings is important and can help reduce the risk of non-accidental overdose.

• Think about your own overdose risks.

• Think about the risks taken by people you know.

• Look after yourself. Look out for your mates.

• Many people who overdose actually die 2 or 3 hours after injecting heroin. Especially when they've taken a combination of alcohol or downers, with methadone or heroin.
• This is because it takes time for drugs that have been swallowed to be absorbed into the bloodstream.
• So, just because someone survives the initial hit, it doesn't mean they're going to be OK.

Methadone and overdose

• If you inject heroin, being in methadone treatment reduces the risk of overdose.
• Heroin injectors not in methadone treatment are around four times more likely to die than those who are in treatment. This is mainly because of increased risk of an overdose.
• But, methadone is really dangerous if it is taken by people who aren't used to it. As little as 40mg can kill an adult.
• Most methadone overdoses happen among those who have bought methadone from someone in treatment.
• The overdose risks are even higher if people take methadone and drink alcohol together, or within a few hours of each other.

Myths and things that are dangerous to do

There are lots of myths about what you can do to bring someone round when they have overdosed.
But, if someone has taken a lethal dose of drugs there is nothing you can do to wake them up, except call an ambulance. They can then be given naloxone ­ the heroin antidote.

Myth 1 'Walking people around helps'

Trying to walk people around may make things worse because it wastes time, and there is a risk they might fall, or get dropped.
It is also possible that as the heartbeat increases with exercise, drugs will be absorbed into their bloodstream more quickly.

Myth 2 'Putting people in cold baths wakes them up'

- If you have heard of people who woke up when they were put in the bath, it was because they were lucky and hadn't taken a lethal dose. It was not because they were put in the bath.
Putting people in the bath is dangerous because it takes time to run the bath - and they could die while it is filling. Even if they are alive when they are put in, they could easily drown or die of cold.

Myth 3 'Hurting, hitting or burning can bring them round'

- You do need to know if someone is sleeping or unconscious. You can tell this by rubbing your knuckles on the middle of their chest. If this doesn't wake them, they are unconscious and you need to call an ambulance and start first aid.
Anything more drastic won't make any difference to whether or not they come round, and could cause them serious injury!

Myth 4 'Injecting people with salt water is an antidote to overdose'

- Some people think that giving an injection of salt water to someone who has overdosed will bring them round.
Injecting salt water is dangerous because:

1. It wastes time that should be spent putting the person in the recovery position and calling for an ambulance
2. If, in the panic, the salt water is given in a used syringe, it could give them HIV or hepatitis!

The idea of injecting people with salt water might have come from people seeing friends in hospital being given a saline (salt) ‘drip' and thinking this was part of the cure.In fact the drip is put up to keep a vein 'open' so they can inject medication. The salt doesn't affect the overdose at all.

Calling an ambulance

Sometimes people don't call ambulances because they are worried about the police coming as well.

When suicide was illegal the police were always called to overdoses. Suicide is not illegal anymore, so they no longer have to come.

Many areas have developed policies so that the police don't get called to all overdoses.
Ask your drug service what the local policy is.
If an ambulance is not called and someone dies, the police will come so that they can inform relatives and investigate the death.

Calling an ambulance saves lives.

Signs of overdose

If someone has overdosed, put them in the Recovery Position and keep watching them. (Refer to diagram below) You need to know if they are unconscious.

1. You find out by rubbing your knuckles on their sternum - the centre of their rib cage.
2. If you can't wake them or they are showing other signs of unconsciousness such as:
   • Snoring deeply
   • Turning blue
   • Not breathing

Giving mouth-to-mouth recitation

1. The person should be lying flat on their back.
2. Remove chewing gum or anything else you can see in their mouth and then lift their chin.
3. Pinch their nostrils together, using your first finger and thumb.
4. Take a deep breath and make a good seal around their lips with your mouth.
5. Blow steadily until you see their chest rise.
6. Take your mouth away and let their chest sink right back down.
7. Repeat steps 3 to 6.

If you are giving mouth-to-mouth but find that they:

• Aren't moving at all (look to see if their eyes are moving)
• Are getting bluer or colder

1. Don't waste time looking for a pulse.
2. Start chest compression (sometimes known as heart massage) straight away.
3. Even if their heart is still beating, if they are not moving and are getting bluer or colder, their heart beat can't be that strong.
4. You won't do any harm by starting chest compressions, and you could save their life.

To start chest compression you need to:

1. Find the place where the ribs meet the breastbone, and lay two fingers there.
2. Put the heel of your other hand on their breastbone, just above where your two fingers are.
3. Place your first hand on top of this hand, locking your fingers together
4. Keeping your shoulders above the centre of the casualty's chest and your arms straight, press down on the chest to a third of its depth.
5. Release the pressure, but keep your hands where they are. This is chest compression.
6. Do 15 chest compressions at the rate of 100 compressions a minute - this will take just under 10 seconds.
7. Give two breaths of mouth-to-mouth.
8. Continue mouth-to-mouth and chest compressions at the rate of 15 compressions to two breaths, until help arrives.
9. If their heart starts beating again, and their colour changes from blue to pink, continue with mouth-to-mouth if necessary.

The source of the above information is the Exchange Supplies. This information has been summarized by and for FARS services. For the direct link to this source, click on: www.exchangesupplies.org/drug_information/campaigns/campaignmaterials/odbooklettext.html