Overdose: symptoms, with which drugs, what to do?

Overdose means taking a very large amount of mind-altering substance and its consequences. The number of overdose deaths continues to increase worldwide, and also in France in recent years. According to the French Observation of Drugs and Addictive Tendencies (OFDT), approximately 1200 people die each year in France. The main causes are opioids, which account for 80% of deaths. Cocaine is involved in 13%, amphetamines in 8%, and new synthetic products in 4%. What are the signs of an overdose? From what quantity is there a risk of overdose? With what drugs? What is the risk of death?

Definition: what is an overdose?

Overdose, or acute intoxication, is a taking, accidentally or otherwise, a psychotropic substance likely to cause unconsciousness and be potentially fatal. Rather, we are talking about overdose in French, or acute intoxication. In general, it occurs in a context of drug consumption, such as heroin, opium, morphine, but also cocaine, ecstasy or MDMA. It can also be linked to a suicide attempt, in particular with certain medications morphine or benzodiazepine-type anxiolytics For example. It appears when the consumer takes a dose that exceeds his tolerance threshold, depending on his addiction to the drug, but also on his overall state of health. In most cases, the overdose results in a progressive loss of consciousness, and in cardiac arrest.

What are the symptoms of an overdose?

Overdose manifests itself in many different ways depending on the molecule involved in the acute poisoning.

• She always begins with disturbances of consciousness which may go as far as loss of consciousness and a state of coma which can be calm, with absence of tone, or on the contrary agitated.
• The person who overdoses may vomit, sweat intenselyto breathe more slowly until a total cessation of breathing.
• Depending on the drug used, the pupils may be very constricted in miosis, or on the contrary dilated in mydriasis.
• THE heart slows down gradually or accelerates very sharply until cardiac arrest.
• If nothing is done quickly, the dead occurs without resuscitation procedures being effective.

What drugs can cause an overdose?

According to the OFDT, the number of deaths by overdose of narcotic products has increased in recent years, especially with opioids like heroin, morphine, methadone, buprenorphine and codeine. Opiates are also the leading cause of overdose due to the pain mechanism of action that leads to a slowing of breathing and heart rate, as well as their potentially fatal dose without medical supervision in people consuming for the first time or changing supplier. Other drugs, due to their sedative effect, are likely to induce an overdose such asecstasy, cocaine and MDMA, which can cause life-threatening heart rhythm disturbances. Finally, some prescription drugs like benzodiazepines can induce drowsiness and coma if taken unchecked medical and in large quantities.

From what quantities is there a risk of overdose?

In a person who has never taken morphine, the usual dose that can trigger an overdose is above 1mg per kg of body weightor for example beyond 60 mg for a 60 kg person who never takes morphine. However, because of the habituation phenomenon, a regular user can quite consume much larger doses without risk of overdose. The same is true for drugs based on benzodiazepines which induce a habituation phenomenon. On the other hand, for cocaine, ecstasy and MDMA, the overdose can occur at any dose because it is rather related to arrhythmias which occur during dehydration or concomitant consumption of alcohol, for example.

Usually, the symptoms are evocative during the inspection of all these signs and even in the absence of witnesses, certain substances can be incriminated according to the symptoms. The best is to have a contact who knows the victim so that we can know which substances are usually consumed by it. The direct environment often provides a lot of information. In the absence of suspected substance, a blood test will allow to dose the different possible molecules and to initiate the treatment. While waiting for the results, vital functions must be maintained.

What to do in case of overdose?

In the presence of a person showing signs of an overdose, it is advisable tocall the emergency services urgently and to place, meanwhile, the subject in lateral safety position. Emergency hospitalization is systematic in the event of overdose after medical transport. The subject remains under observation until the action of narcotics has completely disappeared. The treatment is adapted according to the drug consumed. Some molecules are known, such as specific drug antidotes, and can be used to antagonize the effects of drugs. A detoxification protocol is then considered so that the addict becomes completely abstinent. THE flumazenil is used as an antagonist and competitive with benzodiazepines in case of overdose, just like the naloxone for morphine. However, there are no specific antidotes for cocaine, MDMA and ecstasy for example.

Can you die from an overdose?

The risk of death can occur even in a small dose, especially when it comes to cocaine, MDMA, and ecstasy. It is most often associated with a dehydration and concurrent use of alcohol or other drugs. This risk is also very high with the consumption of morphine because the user does not always know the purity of the product he is buying. We do not know the exact risk for each product because the risk depends on the user and the product at a given time.

To prevent the risk of overdose among consumers who cannot be prevented from consuming, it is important to ensure good hydration during consumption, and to take regular breaks. We advise avoid consuming other products at the same time, and always start with the smallest dose. In certain festive environments, it is possible to make test his drug to better know its composition. By making sure to always start with the smallest dosage, in particular when changing supplier or for the first time, you limit the risk of overdose. Do not hesitate either to consume accompanied by someone who can give the alert in case of loss of consciousness.

► If you are a regular user of opiates, do not hesitate to obtain them in the CSAPA (Centres for Care, Support and Prevention in Addictology) and the CAARUD (Centre d’Accueil et d’Accompagnement à la Reduction risks for Drug Users) a overdose kit made of naloxone in the form of a nasal spray or intramuscular injection kit. It will allow you to act quickly if one of your loved ones loses consciousness, and to ask those around you to act in the same way with yourself in the event of symptoms of overdose.

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