When we are at equilibrium with our own being, nature, and other people, we tend to be happy, fully present and exude joy. Now, the unconscious mind is always trying to maintain this equilibrium even in the daily chaos that we humans put our bodies and minds through. However, when we fail to deliberately consume more of the things that facilitate the mind-body equilibrium, we go off-balance and compromise our well-being. Often times we have unknowingly or knowingly consumed substances that poison our organ systems. When an overdose of the poisonous substances occurs, our organ systems start to fail.

The focus of the current blog article is, however, the most recognized context of the use of the term “overdose”; mind-body disequilibrium. The literal and generally recognized meaning of overdose is the consumption of a substance in amounts that exceeds the body’s capacity to process the substance. Overconsumption may be accidental or intentional. Substances subject to overdose include drugs, chemicals, herbal remedies, and alcohol.  

Substance overdose can be life-threatening and is often harmful. Drug related overdose can result from addiction-driven substance abuse. In this article, we discuss drug, chemical, natural substance, and alcohol types of overdoses. The article highlights signs/symptoms of an overdose and steps to take to reverse overdose and prevent overdose-related deaths. The author also offers discussions on long-term strategies to prevent drug addiction and overdose.

Drug Overdose

As you may agree with me, drug overdose is what first registers in our minds when the word overdose makes rounds. As it turns out the most common type of reported overdose is drug overdose. Drug overdoses occur when a person takes an excessive amount of prescription medication, over-the-counter drugs, or illicit drugs.

Common drugs associated with overdose include opioids, sedatives, hypnotics, and stimulants. According to the National Institute on Drug Abuse (NIDA), opioids are the leading cause of drug overdose related deaths. The death rate from opioid overdose has been trending upwards since 2015 as depicted by NIDA in the below graph.

Opioids overdose

Morphine and codeine are examples of naturally occurring opioids derived from the opium poppy plant.  Heroin, fentanyl, oxycodone, methadone, and hydrocodone are examples of opioids that are synthetic or semi-synthetic derivatives of morphine and codeine.

Opioids have strong pain-relieving properties and can either be prescription or illicit. Medical professionals prescribe opioids to manage moderate to severe pain mostly following surgery, injury, or medical procedures. Additionally, health care providers legally use opioids to manage chronic pain in conditions such as cancer, severe back pain, or pain associated with certain medical conditions.

The risk for overdose and addiction is inherently high for opioids.  Opioids work by binding to specific receptors in the brain, spinal cord, and other parts of the body. The binding reduces the perception of pain and produces a sense of euphoria and relaxation.

While opioids can provide effective pain relief, their euphoric outcome contributes to their misuse and addiction. When people use opioids on a regular basis, they develop olerance, where they then need higher doses to achieve the same pain relief and euphoric effects. This can escalate to dependence and addiction with an increased risk for overdose.

In addition to prescription opioids, illegal opioids such as heroin are in circulation within the drugs market. In fact, many opioid overdoses involve illicit opioids. The increasing availability of highly potent synthetic opioids like fentanyl has led to a significant increase in overdose deaths.

The United States and several other countries have been facing an opioid crisis characterized by a dramatic increase in opioid-related overdoses, addiction, and deaths. Factors contributing to the crisis include over-prescription of opioids for pain management, lack of awareness about the risks of addiction, unmanaged mental health issues, and the availability of illegal opioids.

What happens when one overdoses on opioids?

Opioids depress the central nervous system (CNS). An overdose can lead to suppressed breathing, decreased heart rate, and unconsciousness. Besides respiratory distress and week pulse, other signs of an overdose include:

• Pinpoint pupils
• Bluish lips and fingertips
• Cold and clammy skin
• Confusion
• Unresponsiveness/unconsciousness
• Low blood pressure and a weak pulse.

What do you do when you suspect an opioid overdose?

To help someone you suspect has overdosed, call 911 immediately. While waiting for paramedics to arrive, the use of naloxone (Narcan) is crucial for reversing opioid overdoses.

Naloxone is an opioid receptor antagonist that can quickly restore normal breathing. Rescue breaths can also be provided in case the affected person is not breathing, or the breathing is too slow/shallow. Respiratory failure can quickly add   to the opioids overdose death statistics, which is why acting fast is very important.

Long-term overdose interventions can help prevent deaths from overdose. Careful case assessment and adequate supervision by healthcare professionals while prescribing opioid medications is one way of minimizing overdose cases.

Behavioral therapies and counselling of addicted individuals either within addiction treatment centers or during overdose treatment in an emergency setting help prevent addiction and overdose recurrence. Furthermore, medical strategies exist that can help willing individuals overcome opioid addiction.

Medication-assisted treatment for Opioid addiction

Besides naloxone, there are several other medications and treatments options available to help counter opioid addiction. The medications are typically used as part of a comprehensive treatment approach called Medication-Assisted Treatment (MAT).

MAT combines medication with behavioral therapies and counseling to address opioid addiction effectively. some of the drugs used in MAT are discussed in the next paragraph. The medications are used for short-term detoxification and long-term maintenance.

Methadone is a long-acting opioid agonist. It acts by helping reduce cravings and withdrawal symptoms without producing the euphoric effects associated with other opioids. Clinicians administer Methadone under strict medical supervision in specialty clinics.

Buprenorphine is a partial opioid agonist hence activates opioid receptors in a way that is less intense than full opioid agonists. It acts like methadone in opioid addiction treatment. Qualified healthcare professionals prescribe buprenorphine in various settings.

Fina in our MAT list is naltrexone (vivitrol). Vivitrol is an opioid receptor antagonist like naloxone. It blocks the effects of opioids and reduces cravings. Naltrexone is available in both oral and extended-release injectable forms and usage requires supervision by a qualified healthcare professional.

Benzodiazepines Overdose

Diazepam (valium), Lorazepam (Ativan), Midazolam(versed), Alprazolam (Xanax), and Temazepam (Restoril) are commonly prescribed types of benzodiazepines (benzos). Prescription of Benzos is due to their anti-seizure, anti-anxiety, calming, and sedating properties. Like opioids, benzos depress the CNS. They act by enhancing the activity of the inhibitory transmitter gamma-aminobutyric acid (GABA).

Overdose resulting from benzos alone is rare. Most fatal overdose cases reported have involved interactions with other drugs especially those that are CNS depressants. Opioids and alcohol when used together with benzos have been the main culprits in benzos overdose cases that are fatal. The toxic potential for benzos varies based on type. Multiple sources have pointed to Xanax as having a toxic potential that is higher than the rest of the benzos.

Signs and symptoms to look for in case of benzos overdose include loss of consciousness, shallow breathing, drowsiness, confusion, slurry speech, and clumsy movements. When you suspect benzos overdose, follow steps highlighted for opioid overdose case.

Administering naloxone could save the person’s life if the concomitant use of the benzos and opioids exist. However, it is important to note that naloxone works only to reverse the effects of opioids and not that of benzos. Either way, considering the safety profile of naloxone, it is best to use medication in all suspected drug overdose cases.

Cocaine and Amphetamines Overdose

Cocaine and Amphetamines are CNS stimulants. Increased alertness, a sense of euphoria, and high energy are the effects of consuming the stimulant types. Cocaine is an alkaloid derived from the leaves of Erythroxylon coca (coca plant) and is highly addictive. The indigenous people of South America, the native home of coca plant, have used the leaves of the coca plant for thousands of years. Chewing the leaves is a leisure activity that provides stimulant effects. The natives also use coca leaves to manage altitude sickness.

Cocaine Overdose

The medicinal use of cocaine involves its addition to various medical preparations including elixirs, tonics, and multi-active ingredient medicines. People use the medicinal preparations for local anesthetic effects, depression, and a range of other illnesses. However, over the years, the use of cocaine for its medicinal properties has declined due to its highly addictive nature and many side effects.

The legality of cocaine use varies widely across the globe. In the US, cocaine is a schedule II-controlled substance. The non-medical use is illegal. In many countries, cocaine sale and use are illegal in all settings. Some countries allow cultivation of the coca plant for traditional purposes but have banned extraction of cocaine for commercial and/or personal purposes.

Despite the heavy regulation on cocaine, drug dealers still produce and distribut it to the public under street names such coke, crack, freebase, rock, blow, powder, snow, white, flake, C, line, and Charlie among others. Notably, Colombia is the major contributor to the illegal cocaine business according to the US Bureau of International Narcotics and Law Enforcement Affairs.

Amphetamine Overdose

Amphetamines are synthetic compounds whose CNS stimulatory effects last longer than cocaine . Amphetamines are available only on prescription. Like cocaine most amphetamines are schedule II-controlled substances.

Racemic amphetamine is the basic amphetamine compound from which other amphetamine types are derived. The racemic type comprises of both dextroamphetamine and levoamphetamine isomers. Other derivatives include methamphetamine (MA, meth or crystal meth), methylenedioxymethamphetamine (MDMA, ecstasy, or Molly), phentermine, desoxyn, and lisdexamfetamine. Both MA and MDMA are highly potent with a high potential for addiction.

Illicitly manufactured and distributed MA goes by the street names meth or crystal meth. Illicit MDMA goes by ecstasy or Molly and due to the adverse health effects of unregulated use of MDMA, the drug category has a schedule I-controlled substance label. Pharmaceutical methamphetamines including desoxyn and phentermine. Professionals prescribe the drugs for some cases of attention deficit hyperactive disorder (ADHD) and obesity.

Cocaine and Amphetamines Overdose Symptoms

• Extreme agitation that may be accompanied by anxiety, restlessness, paranoia, and irritability.
• Delirium showing up as extreme confusion, disorientation, and sometimes hallucinations.
• Muscle twitching, tremors and sometimes seizures
• Hyperthermia where the body temperature is extremely high.
• Chest discomfort and/or severe chest pain
• Tachycardia, palpitations, high blood pressure, and heart arrythmias.
• Vomiting
• Respiratory distress and loss of consciousness

The best way to assist someone suspected of cocaine or amphetamine overdose is to call for medical help (911) and stay with the person until help arrives. Emergency professionals manage the symptoms from stimulants’ overdose.

Once the individual is stable, behavioral therapies and counselling can be provided to prevent overdose recurrence and help the individual overcome addiction. Increased access to treatment for addiction and recovery services is likely to have a significant impact on overdose prevention.

Chemical Overdose

In the previous sections of this article, we discussed drug overdose. Understandably, both pharmaceutical and illicit drugs are chemicals. However, in this section chemical overdose refers to non-drug chemicals including household chemicals and toxic substances present in our environment. Household chemicals can include cleaning products, pesticides, solvents, and other substances commonly found in homes.

Carbon Monoxide Poisoning

Environmental sources of toxic chemicals include polluted air. Carbon monoxide (CO) is a form of polluted air that can quickly cause the death of the person inhaling the gas. According to the centers for disease control and prevention (CDC), at least 420 people die and another 100,000+ visit the emergency department each year in the US due to accidental CO poisoning. The US Bureau of Labor Statistics reports that inhalation of CO fumes was the leading cause of workplace chemical overdose and poisoning deaths in 2017.

Poisoning by Hydrogen Sulfide Fumes and Other Chemicals

Arsenic, ‘forever’ chemicals, and lead are examples of toxic water contaminants that can be life-threatening at high doses and are still largely present in the public water systems. Other occupational chemical hazards, besides CO fumes, that have led to fatal poisoning include hydrogen sulfide (H₂S) fumes, natural gas, ammonia, methane gas, methanol, toluene, chlorine, solvents, and dichloromethane.

Chemical overdose is often unintentional, but cases of chemical suicides are not uncommon. Individuals with suicidal ideation have mixed household chemicals to produce H₂S or hydrogen cyanide (HC) fumes that in an enclosed space are fatal. Some people have survived the poisoning while others have died.  

How to Know Someone is Experiencing Chemical Overdose

The signs and symptoms of chemical overdose include:

• Convulsions
• Nausea and vomiting
• Collapse, convulsions, and/or loss of consciousness
• Pain in the throat and stomach cramps
• Drooling and breath odor
• Difficulty breathing

If you suspect exposure to a potentially toxic chemical, you should act immediately. The Poison Control Center handles chemical poisoning and calling them through their helpline (1-800-222-1222) should be the first step in preventing death from chemical poisoning. In case the poison center number is not within memory reach, calling 911 will get you the needed help.

Stay with the overdose victim if it’s safe to do so. Help the victim out of an ongoing poisoning situation if possible. Initiate CPR if the person is unconscious and stops breathing or does not have a pulse. The treatment option to reverse the poisoning will depend on the type of chemical.

Alcohol Overdose

Alcohol overdose is also referred to as alcohol poisoning. The poisoning occurs when an excessive amount of alcohol is consumed in a short period, leading to dangerous blood alcohol concentration. Binge and heavy drinking are documented risk factors for alcohol poisoning.

The duration required to reach toxic levels of alcohol will depend on the individual genetics (alcohol tolerance), pre-existing conditions, and co-consumption with other CNS depressants or drugs, among other determinants.

While alcohol poisoning is an acute consequence of consuming alcohol, there are other undesirable long-term outcomes of drinking alcohol. These long-term consequences are the ones that most of the public are aware or rather attentive to and include liver cirrhosis, heart disease, kidney disease, and brain damage.

If you live in a culture where drinking is normalized, you are likely to have witnessed alcohol poisoning. Did it make you re-think alcohol-derived fun? It did in my case, but only after I was the victim of alcohol poisoning myself and lost a very brilliant friend, aged 29, to alcohol induced liver cirrhosis.

Repeated episodes of alcohol overdose without medical intervention is bad for health. The pattern is a good predictor of early manifestation of alcohol induced chronic conditions such as liver cirrhosis.

Most times alcohol poisoning is a medical emergency that if not promptly handled can be life-threatening. Playing doctor with cold sponges and hot black tea may seem to work in some alcohol poisoning cases. However, health care experts do not recommend. Alcohol overdose survivors often need medical treatment. Some may even benefit from substance abuse treatment programs to address the underlying mental health or other health issues.

Signs and Symptoms of alcohol overdose include:

• Confusion
• Slurred speech
• Nausea and vomiting
• Seizures,
• Slow or irregular breathing
• Unconsciousness/passing out (blacking out).

Preventing alcohol overdose and poisoning

If you suspect that someone is experiencing alcohol poisoning, call for medical emergency services immediately and do not try to reverse the effects. Stay with the person until help arrives and provide any information related to the overdose and medical history of the individual that can aid the treatment.

While waiting for paramedics you can prevent choking in case of vomiting by leaning the person forward if they are sitting at an angle that is slightly upright. If lying down, rolling the person to lay on one side can prevent choking.

The best way to help someone is to prevent their downfall; this means if you observe that someone in your company is intoxicated, discourage them from consuming more alcohol and encourage non-alcoholic hydrating fluids. Another way you can help is to encourage those with alcohol use disorder close to you to seek treatment.

Natural Substance Overdose

It is easy and almost second nature for many people to assume that edible natural substances are inherently safe. While some herbal extractions and preparations are beneficial to the body when used in moderation, and in consultation with a qualified health professional, consuming too much can be deleterious and sometimes fatal.

Too much of some of the nutrients we get from our diet can also result in an overdose situation. Very interesting information on nutrients overdose is discussed in this article. The current section will focus on herbal extractions overdose/ poisoning.

Overdose from herbal extractions deemed to have health benefits and medicinal value is uncommon. Addiction is unlikely to be an issue in the overdose of unregulated herbal extractions. There are are few exceptions.

Some herbal extractions that cause overdose /poisoning

The US FDA has not approved Kratom for any use. It is freely accessible in some states but banned in others. Kratom has addictive potential and has been linked to some deaths resulting from overdose induced respiratory failure. While the US FDA has made toxicity advisory on Kava, it is easily available across stores and states in the US.

Toxic overdose on herbal extractions is often a result of one or a combination of the following:

• Interactions with pharmaceutical drugs/ components by intentional adulteration by manufacturers or co-consumption.
• When the involved herb already has inherent toxic elements (known or unknown) such as the belladonna, kava, and kratom.
• When higher than the recommended dose is intentionally consumed with the goal of alleviating a particular symptom or obtaining a particular outcome. An example is primrose oil used for mastalgia.
• When the extracted substance has significant levels of contaminants including heavy metals or biological agents. In this case, knowing the source is very important.

In the US, the commonly used herbal extractions and remedies include echinacea, ginseng, milk thistle, turmeric, garlic, gingko biloba, evening primrose, chamomile, saw palmetto, St. John’s wort, valerian, feverfew, and goldenseal. Among these, toxic overdose and undesirable long-term effects have been reported of gingko and goldenseal. St. John’s Wort poisoning is also a common topic in herbal extractions’ safety topics. When overdose occurs, the signs and symptoms will vary depending on the type of herb.

Gingko Poisoning

Higher than the recommended doses of gingko have caused effects ranging from gastro-intestinal distress to convulsive seizures and can be fatal. Symptoms of acute goldenseal overdose or poisoning include gastrointestinal distress (vomiting, diarrhea, stomach cramps), respiratory distress and cardiac arrest in severe cases. Long term use of both gingko and goldenseal has been linked to carcinogenesis even though proof of cancer causation in humans is non-existence.

St John’s Wort

St. John’s Wort is used for its anti-depressive effects and treats mild to moderate cases of depression. An overdose results from interaction with other drugs. Overdose can also be intentional on the premise that taking a higher dose will offer more benefits. Symptoms of overdose or poisoning by St. John’s wort include increased photosensitivity, dry mouth, gastrointestinal distress, confusion, and dizziness. In severe overdose cases, cardiac arrythmias, seizures and passing out can occur.

How to Help Someone Experiencing Natural Substance Poisoning

If you suspect that someone has overdosed on an herbal remedy or extractions, call the poison center for help (1-800-222-1222 if in the US). Stay with the person until help arrives and offer them some fluids to drink if they are conscious. Preventing overdose from herbal extraction requires that consumers stick to the recommended doses.

Creating awareness on the possibility of toxic overdose from herbal extracts is also a necessary prevention strategy. You are also encouraged to seek out information on the source of the herbal remedies you are consuming, which may help avoid toxic contaminants.

Sources

• Bureau of International Narcotics and Law Enforcement Affairs (2023). Retrieved from https://www.state.gov/bureau-of-international-narcotics-and-law-enforcement-affairs-work-by-country/colombia-summary/ .
• Bureau of Labor Statistics, U.S. Department of Labor, The Economics Daily, Fatal chemical inhalations in the workplace up in 2017 at https://www.bls.gov/opub/ted/2019/fatal-chemical-inhalations-in-the-workplace-up-in-2017.htm (visited September 28, 2023).
• Centers for Disease Control and Prevention (2023), Retrieved from https://www.cdc.gov/nceh/features/copoisoning/index.html#:~:text=When%20winter%20temperatures%20plummet%20and,due%20to%20accidental%20CO%20poisoning.
• Dunnick, J.K & Nyska, A (2013). The Toxicity and Pathology of Selected Dietary Herbal Medicines. Toxicologic Pathology. 41(2):374-386. doi:10.1177/0192623312466451
• National Institute on Drug Abuse, NIDA (2023). https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates