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Responding to Opioid Overdose

Responding to opioid overdose situations can potentially save a life. Even so, it might be difficult for anyone to tell whether someone is just highly intoxicated on opioids or if they are undergoing an overdose.

In the following guide, you will learn how to recognize and respond to an opioid overdose situation. In case you are unsure about the situation, you should treat it as an overdose because this could save a life. Read on to learn more:

Signs of Opioid Abuse

If someone has abused opioids and they are really intoxicated on these drugs, they will likely display some of the following signs and symptoms of opioid abuse:

  • Contracted pupils that appear smaller than normal
  • Droopy and slack muscles
  • Excessive scratching
  • Itchy skin
  • Nodding out
  • Slow response to external stimuli
  • Slurred speech

In case you are worried that they are getting too intoxicated on opioid, you should not leave them on their own. If they are still conscious, you should consider walking them around, keeping them awake, and monitoring their breathing.

Signs of Opioid Overdose

On the other hand, if someone has taken opioid in excess to such a point that they overdose, they are going to display some, most, or all of the following signs and symptoms of an opioid overdose:

  • A gurgling noise that is like a snore, sometimes known as the death rattle
  • Awake, but being unable to talk
  • Bluish purple skin tone for light skinned people and grayish or ashen tone for dark skinned people
  • Choking sounds
  • Clammy or pale face
  • Erratic, slow, or stopped pulse (or heartbeat)
  • Erratic, slow, shallow, or stopped breathing
  • Limp body
  • Loss of consciousness
  • Purplish black or blue tint to the fingernails and the lips
  • Unresponsiveness to outside stimulus
  • Vomiting

In case the person who took opioids is sleeping and they start making unfamiliar sounds, you should try to wake them up. This is because you might assume that they are snoring when in fact they are struggling with an opioid overdose.

Responding to Opioid Overdose

Although most people are not going to die immediately due to an opioid overdose, it is still important that you react as fast as possible and get them the help that they might need to recover.

This type of overdose is somewhat slow. It could, for instance, take anywhere between a couple of minutes to a few hours. If the victim survives, it is probably because they got help from someone.

That said, there are certain steps that you need to follow while responding to opioid overdose. They include but are not always limited to:

  • Assessment and stimulation
  • Administer naloxone or call for help (whichever is faster)
  • Administer naloxone
  • Perform chest compressions or rescue breathing
  • Aftercare

1. Assessment and Stimulation

The first thing that you should do while responding to opioid overdose situations is to perform an assessment and stimulation. You can assess the signs and symptoms of the overdose victim by checking if:

  • They answer when you shake them and shout their name
  • They are breathing
  • They are responsive
  • They can speak

You can also stimulate them through the sternal rub. In case the individual is in a heavy nod or unconscious, you should try and wake them up. You can do this by calling out their name or saying something that they might not necessary be excited to learn - such as that you are going to contact local law enforcement authorities or 911.

In case these efforts do not work, you should try and stimulate them. You can do this by rubbing your knuckles into their sternum. This refers to the region in the middle of the chest where the ribs meet. You can also rub your knuckles around the area on their upper lip.

Doctors mostly recommend stimulating the sternum instead of the lip because the opioid abuser might have prosthetic teeth or dental problems. If you rub the upper lip in these situations, you might cause unnecessary discomfort or pain especially if the rubbing is vigorous.

However, in case the opioid abuser is lying in a position that makes it difficult for you to reach their sternum - or if they blacked out in multiple layers of heavy clothing - you should consider rubbing the upper lip.

In case these efforts get the individual to wake up, you should try and get them to focus. You should also check if they are finally able to speak, if they are breathing normally, and other signs and symptoms of an overdose.

In case, they inform you that they are struggling with their breathing or are experiencing shortness of breath, you should call 911 immediately. You should also do this if they complain of chest tightness.

In the meantime, you should continue mentoring their vital signs - especially with regards to their pulse and breathing. You should also try and keep them alert and awake during this period.

If the stimulations, you attempted are not successful and the individual does not respond - or if they remain unconscious despite your attempts - you should not try to continue stimulating them. These would probably be emergency situations that will require you to call for help through 911 or by contacting a local poisons control center.

Calling for Help

If you suspect an opioid overdose, you should call 911. This is because medical professionals might be needed to assess the condition of the individual and get them the help that they need.

Even though you can administer naloxone to reverse the overdose situation, the individual might also be struggling with other health issues at the same time. Additionally, even those who survive drug overdoses still have a high risk of suffering other health issues due to the overdose - such as heart problems and pneumonia.

It is, to this end, important that you get the individual medical assistance as soon as possible. By so doing, you can effectively reduce the harms and risks that are linked to an opioid overdose.

You should also remember that naloxone will only work if the individual only took opioids - that eventually led to the overdose. In case they also abused other drugs in addition to the opioids - such as cocaine, alcohol, benzodiazepines, speed, or any other drug that is not an opioid - then naloxone might not always be able to reverse the overdose fully.

In case you need to leave the individual struggling with an opioid overdose - even if it is just for one minute to call for medical assistance - you should keep them in the recovery position. This effectively means that you should lay them slightly on the side with the body supported by a bent knee and the face turned facing to the side.

In this position, the airway will be naturally clear. The recovery position could also reduce the risk that the individual will check on their vomit - which is highly likely because vomiting is one of the symptoms of opioid abuse and overdose.

What you will inform the people who respond to your 911 call will largely depend on the emergency response system that applies to drug overdoses in the local area. Irrespective of where you live, however, you should respond by informing the person who answers that the opioid abuser has stopped breathing or is experiencing slowed breathing and that they are unresponsive (if this is the case). You should also give your exact location or coordinates. If you tried administering naloxone but it did not work, you should inform the dispatcher.

In many states now, Good Samaritan Laws apply. This effectively means that if you live in one of these states, you do not have any risk of getting arrested for reporting a drug overdose involving opioid and any other illicit substances.

Irrespective of your fear of arrest, it is important that you do not let the individual who is overdosing continue suffering simply because you think that you might have to go through the criminal justice system or the local court system. The important thing is to get the loved one the help that they need as soon as possible.

While making the 911 call or a call to the local poisons control center following an opioid overdose, it is important that you:

  • Inform the dispatcher exactly where the overdose is happening and where you - and the individual struggling with an opioid - are
  • Give the dispatcher as much information as you possible can so that they can find you easily - such as by informing them where the building is located and on which floor you are
  • You should not use words like overdose or drugs, instead stick to the signs and symptoms that you are observing, such as the fact that they are not breathing, that they are unconscious or non-responsive, that they are turning blue - this will turn the call into a priority
  • Once the paramedics have arrived, you should inform them about everything that you know about the drugs that the individual might have been taking
  • In case the paramedics suspect that the individual might be overdosing on opioids, they are most likely going to give the victim an intranasal or injection dose of naloxone
  • You should reduce all background noises - or at least keep them to a bare minimum because if it is too noisy, the 911 first responders will dispatch the police and other law enforcement officials to secure the scene as well as protect the paramedics

Administer Naloxone

You can also administer naloxone if you suspect an opioid overdose situation. To do this, you need to:

  • Perform rescue breathing for a couple of quick breaths - in case the victim is not breathing properly or normally
  • Affix a nasal atomizer or applicator to the needless syringe before assembling the glass naloxone cartridge
  • Tilt the head back before spraying 50 percent of the naloxone up on one side of the nose before spraying the other 50 percent up the other side of their nose
  • In case breathing is still slow or stopped, you should continue performing rescue breathing as you wait until the naloxone starts taking effect
  • If you notice no changes in 3 to 5 minutes, you should administer more naloxone and continue breathing on the victim's behalf
  • In case you notice that a second dose does not lead to any changes, you should try and get them to a hospital or medical center as soon as possible

You can also apply injectable naloxone - but only do this if you absolutely know how to go about it or you have enough experience with intravenous drug application. This will require that you:

  • Perform rescue breathing for a couple of breaths in case the victim is not breathing
  • Use an intramuscular needle - also known as a long needle
  • Pop the orange top vial off
  • Draw up 1 cc (1 mm) of the naloxone liquid into the syringe
  • Inject the liquid right into a muscle - such as the shoulder, the upper and outer quadrant of the butt, or the thighs
  • Inject the liquid straight in to ensure that it goes into the muscle
  • In case you do not have a big needle, you can still use a smaller one - in this situation, however, you should inject right under the skin or into a muscle if it is possible
  • After you have injected the naloxone, you should continue the rescue breathing for 2 to 3 minutes
  • If you do not notice any changes within 2 and 3 minutes of applying the liquid, you should administer more naloxone before continuing to breath on behalf of the opioid overdose victim

In case there are no changes even after you have administered the second dose of naloxone, it is highly likely that something else might be off - either the overdose was too long or their heart has already stopped working; it could also mean that they have not abused opioids or that they have taken opioids that are unusually strong that will require higher doses of naloxone.

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