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Recognizing Opioid Overdose Signs and How to Help: A Guide to Saving Lives

Clinically Reviewed by: Charee Marquez, LMFT

The opioid epidemic continues to pose a significant public health crisis, claiming thousands of lives each year. Recognizing the signs of opioid overdose and knowing how to respond promptly can be crucial in saving lives. In partnership with California Prime Recovery, an addiction treatment center in Orange County, CA, this blog aims to shed light on the signs of opioid overdose, provide guidance on administering naloxone—an opioid overdose reversal medication—and outline steps to assist someone experiencing an overdose.

What are Opioids?

Opioids are a class of drugs that include both prescription medications and illegal substances. They are primarily used for their pain-relieving properties but can also produce feelings of euphoria and relaxation, making them susceptible to misuse and addiction. Opioids work by binding to specific receptors in the brain, spinal cord, and other areas of the body known as opioid receptors. When these receptors are activated, they block pain signals and release dopamine, a neurotransmitter associated with pleasure and reward.

Types of Opioids

There are several types of opioids, including:

  1. Prescription Painkillers: These opioids are commonly prescribed by healthcare providers to manage moderate to severe pain. Examples include oxycodone (OxyContin), hydrocodone (Vicodin), morphine, and codeine.

  2. Heroin: Heroin is an illegal opioid drug synthesized from morphine. It is typically sold as a white or brown powder or as a black, sticky substance known as black tar heroin. Heroin is highly addictive and produces intense feelings of euphoria and relaxation.

  3. Synthetic Opioids: Synthetic opioids are manufactured drugs that are chemically similar to natural opioids but are made in a laboratory. Examples include fentanyl, tramadol, and methadone. Fentanyl, in particular, is much stronger than other opioids and is associated with a high risk of overdose.

How do Opioids Work in the Brain and Body?

Opioids work in the brain and body by binding to specific receptors called opioid receptors. These receptors are found in various regions of the brain, spinal cord, and other parts of the body. When opioids bind to these receptors, they modulate the transmission of pain signals and produce feelings of pleasure and euphoria.

In the brain, opioids primarily act on mu-opioid receptors, although they can also interact with delta and kappa opioid receptors to a lesser extent. Activation of mu-opioid receptors inhibits the release of neurotransmitters involved in the perception of pain, such as substance P and glutamate. This inhibition results in a reduction in the transmission of pain signals, leading to pain relief.

Additionally, opioids activate the brain’s reward system by increasing the release of dopamine, a neurotransmitter associated with pleasure and reinforcement. This surge in dopamine activity contributes to the feelings of euphoria and well-being commonly experienced with opioid use.

Side Effects of Opioids

Short-term side effects of opioids can include:

  1. Drowsiness: Opioids can cause feelings of drowsiness or sedation, making it difficult to stay awake or concentrate.
  2. Constipation: Opioids slow down bowel movements, leading to constipation, bloating, and discomfort.
  3. Nausea and Vomiting: Opioids can stimulate the part of the brain responsible for nausea, leading to feelings of queasiness and vomiting.
  4. Confusion: Opioids may cause confusion, disorientation, or cognitive impairment, particularly in higher doses.
  5. Itching: Opioids can cause itching or hives, known as pruritus, as a result of histamine release.
  6. Respiratory Depression: Opioids depress the respiratory system, leading to slowed or shallow breathing, which can be dangerous, especially in high doses or when combined with other depressants like alcohol or benzodiazepines.

Long-term side effects of opioids can include:

  1. Dependency and Addiction: Prolonged use of opioids can lead to physical dependence and addiction, characterized by cravings, compulsive drug-seeking behavior, and inability to control use despite negative consequences.
  2. Tolerance: With continued use, individuals may develop tolerance to opioids, requiring higher doses to achieve the desired effects. This can increase the risk of overdose and other adverse effects.
  3. Withdrawal Symptoms: Abruptly stopping or reducing opioid use can lead to withdrawal symptoms, including anxiety, restlessness, nausea, vomiting, diarrhea, muscle aches, and insomnia.
  4. Hormonal Imbalances: Chronic opioid use can disrupt hormonal balance, leading to changes in libido, menstrual irregularities, and decreased testosterone levels in men.
  5. Cognitive Impairment: Long-term opioid use has been associated with cognitive impairment, including difficulties with memory, attention, and executive function.
  6. Increased Pain Sensitivity: Prolonged use of opioids can lead to a phenomenon known as opioid-induced hyperalgesia, where individuals experience increased sensitivity to pain.
  7. Social and Occupational Impairment: Opioid addiction can have significant impacts on social relationships, employment, and overall quality of life, leading to financial strain, legal problems, and social isolation.

What is an Opioid Overdose?

An opioid overdose occurs when someone has taken an excessive amount of opioids, leading to a dangerous level of opioid intoxication that can result in severe and potentially life-threatening symptoms. Opioids depress the central nervous system, including the respiratory system, and high doses can cause respiratory depression, which can lead to breathing difficulties, unconsciousness, and, in severe cases, death.

During an opioid overdose, the body’s natural drive to breathe is suppressed, resulting in slowed or shallow breathing, or even a complete cessation of breathing. Without adequate oxygen supply to the brain and other vital organs, serious complications can occur rapidly.

What Causes an Opioid Overdose?

An opioid overdose occurs when the amount of opioids in the body surpasses what the body can tolerate, leading to respiratory depression, loss of consciousness, and potentially fatal consequences. Opioids, whether prescription painkillers like oxycodone and morphine or illicit drugs like heroin, can cause respiratory depression, which is a slowing or stopping of breathing. Here are common ways in which someone can overdose on opioids:

  1. High Dose:

    • Taking a higher dose of opioids than the body can tolerate increases the risk of overdose. This can happen when individuals take more than the prescribed dose of a medication or when using illicit opioids.
  2. Tolerance:

    • Over time, individuals may develop tolerance to the effects of opioids, meaning that they need higher doses to achieve the same pain relief or euphoria. If someone takes a dose that their body is not accustomed to, it can lead to overdose.
  3. Combination with Other Substances:

    • Combining opioids with other substances that depress the central nervous system, such as alcohol, benzodiazepines, or other sedatives, can significantly increase the risk of overdose. The combined effect on respiratory function can be particularly dangerous.
  4. Illicitly Manufactured Fentanyl:

    • Illicitly manufactured fentanyl, a synthetic opioid that is much more potent than other opioids, has been a major contributor to opioid overdoses. Its high potency increases the risk of overdose, especially when people unknowingly consume fentanyl-laced substances.
  5. Unintentional Overdose:

    • Accidental overdose can occur when individuals miscalculate the dosage, take multiple doses too closely together, or mistakenly use a more potent opioid than intended. This can happen in situations of drug misuse or when opioids are obtained from illicit sources.
  6. Reduced Opioid Tolerance:

    • Individuals who have undergone periods of abstinence, such as during addiction treatment or incarceration, may experience a reduced tolerance to opioids. If they resume use at previous levels, the risk of overdose is significantly increased.
  7. Lack of Access to Naloxone:

    • Naloxone, an opioid antagonist, can reverse the effects of an opioid overdose if administered promptly. Lack of access to naloxone or delayed administration can contribute to fatal outcomes.

It’s important to note that opioid overdoses can happen to individuals who are using opioids for legitimate medical purposes, those who misuse prescription opioids, and individuals who use illicit opioids. Understanding the risks, promoting responsible prescribing practices, and providing education on overdose prevention and intervention are crucial components of addressing the opioid epidemic.

Signs and Symptoms of an Opioid Overdose

Signs and symptoms of an opioid overdose can vary depending on factors such as the type and amount of opioid consumed, as well as individual tolerance and metabolism. However, common signs and symptoms of an opioid overdose may include:

  1. Unresponsiveness: The person may be unconscious and unable to be awakened, or they may be extremely difficult to rouse.

  2. Shallow or Slow Breathing: Breathing may become slow, irregular, or shallow. In severe cases, the person may stop breathing altogether.

  3. Pinpoint Pupils: The person’s pupils may appear very small (pinpoint), even in dim lighting. This is a classic sign of opioid intoxication.

  4. Blue Lips or Fingernails: A bluish or grayish tint to the lips, fingertips, or nails (cyanosis) may indicate oxygen deprivation.

  5. Cold or Clammy Skin: Skin may feel cold or clammy to the touch, indicating poor circulation.

  6. Limp Body: The person’s body may feel limp or floppy, and their muscles may be relaxed.

  7. Vomiting: Some individuals may vomit during an opioid overdose, particularly if they have taken a high dose or have combined opioids with other substances.

Commonly Abused Opiates

Opioids are commonly prescribed for Acute use, typically a short term prescription, for example after a major surgery; and for Chronic use, which may be longer term prescriptions, for example to advanced cancer patients. However, the highly addictive nature of opioids make them easy for people to abuse. Many individuals start out with prescriptions for pain relief, but extended use of even prescription drugs affects the body’s dependence on drug induced dopamine and endorphin secretions.

Some commonly abused opioid drugs are:

  • Vicodin (Hydrocodone and Acetaminophen)
  • Morphine
  • Codeine
  • Fentanyl
  • Hydrocodone
  • Hydromorphone
  • Heroin (an illegal opioid)

Fentanyl and Heroin are responsible for the most number of overdose emergencies and deaths in the U.S.

How to Help in an Opioid Overdose Situation

If you suspect that someone around you is experiencing a drug overdosing, here are some initial steps to take.

Call 911

An opioid overdose incident requires immediate medical intervention. Call 911 or your local emergency medical number immediately. Gather any information you can provide, such as name of patient, location of the incident, name of the opioid that you find on the patient, and if you are aware of any other substances involved.

Check for Response

If you notice a person displaying any of the signs above, try to induce some kind of response from them by calling their name, tapping them on the shoulder, or administering a sternal rub. A sternal rub is performed by making a fist and rubbing the knuckles along their sternum (at the center of their chest, below the breastbone). If they respond to any of these, verify whether they can remain alert.

Administer Narcan (Naloxone)

Although Narcan is a prescription drug, it is usually available at pharmacies in cases of emergency situations. If you are a medical professional or have access to Narcan, immediately administer the drug while you wait for emergency medical professionals to arrive. Even if you are unsure whether the patient’s condition is due to opioid overdose, it is safe to give them Naloxone as a first step.

Perform CPR and/or Rescue Breathing

If you have had training in rescue breathing and CPR, you may administer rescue breathing if you notice the person is not breathing. If you are not trained in rescue breathing, you may administer CPR by giving them quick, uninterrupted chest compressions.

Stay Until Help Arrives

Try to keep the patient in a comfortable position while you wait for help to arrive. When medical help arrives, stay and provide any information necessary for you to hand them off.

Preventative Measures for Opioid Overdose

Not all overdose cases are due to abusing opioids. In many cases, it can be caused due to lack of knowledge, easy accessibility, and existing preconditions. Here are some suggestions of how to prevent opioid overdoses.

  • Only use opioids under prescription, exactly as prescribed
  • If you are using other medications be sure to ask your doctor about combining them
  • Do not combine prescription medications with other substances such as alcohol or unprescribed drugs
  • Have Naloxone handy and learn how to administer it 
  • Keep all medications out of reach of children and pets

How to Have a Successful Recovery from Opioid Overdose

After completing the emergency medical intervention, patients often go through the detoxification process which is usually a medically assisted treatment (MAT) in the case of opioids. However, it is not a secret that individuals walking out of a detox will most likely go back to using the drugs.

Is it possible to have a successful recovery? The answer is YES, and it lies in long term treatment. We offer several variations of long term recovery treatment plans to accommodate all kinds of patients with different kinds of lifestyles and obligations.

Some of our outpatient services include:

In short, we create an individualized treatment plan that include modalities that are custom tailored to suit your needs and requirements in order to create the maximum possible chances for successful long term recovery.

Opioid overdose is a serious and potentially life-threatening emergency, but with prompt intervention and access to naloxone, lives can be saved. By learning to recognize the signs of opioid overdose and taking steps to respond effectively, you can play a crucial role in preventing overdose deaths in your community. Remember, if you suspect an overdose, don’t hesitate to call 911 and take action—it could save a life.

Seeking Treatment? We Can Help!

At California Prime Recovery, as an in-network provider we work with most insurance plans, such as:

If you or a loved one are struggling with mental health challenges or substance abuse, reach out to California Prime Recovery today. Our team of compassionate professionals is here to support your journey towards lasting well-being. Give us a call at 866-208-2390

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