Drug overdose

An overdose is when you take a toxic (poisonous) amount of a drug or medicine.

Symptoms of an overdose can occur rapidly, but sometimes people can experience a delay in symptoms.

Not all overdoses are fatal or life threatening, however medical advice should always be sought if overdose is suspected or has occurred.

An overdose is a medical emergency that requires immediate medical attention. Always call triple zero (000) if you know or think that someone has had an overdose.

Substances that people can overdose on include:

• alcohol
• prescription medications
• over-the-counter (non-prescription) medications
• illicit drugs
• some herbal remedies.

Symptoms of overdose

A wide range of signs and symptoms can occur when a person overdoses, and everyone responds differently. Signs and symptoms depend on a variety of factors including:

• which substance (or substances) they took
• how much they took
• the strength of the drug
• how they took it
• their state of health
• their age.

Symptoms of a drug overdose (including alcohol poisoning) may include:

• nausea and vomiting
• severe stomach pain and abdominal cramps
• diarrhoea
• chest pain
• dizziness
• loss of balance
• loss of co-ordination
• being unresponsive, but awake
• limp body
• seizures (fitting)
• drowsiness and confusion
• agitation
• paranoia
• slow or erratic pulse
• difficulty breathing, shallow or erratic breathing or not breathing at all
• hallucination
• visual disturbances
• choking or gurgling sounds
• snoring deeply
• blue fingernails or lips
• pale or clammy face
• loss of consciousness.

The Alcohol and Drug Foundation has more information about different types of drugs, their effects and risk factors.

First aid for overdose

If you think someone has taken an overdose:

• Try your best to stay calm.
• Call triple zero (000) for an ambulance.
• If the person is unconscious but breathing, place them gently on their side in the recovery position. Ensure their airway remains open by tilting the head back and lifting the chin. (This can help them to breathe and stop them from choking if they vomit.)
• Check breathing and monitor their condition until help arrives.
• Do not try to make the person vomit.
• Do not give them anything to eat or drink.
• Keep any pill containers to take to the hospital.

Overdose – what to do in an emergency has detailed information about dialling triple zero (000) for a drug overdose, and what will happen in the emergency department.

If you think someone may have taken an overdose but they are not showing any symptoms and seem okay, call the Poisons Information Centre on 13 11 26 (24 hours, 7 days) for advice on what to do.

An overdose can still be an emergency, even if the person seems okay at first.

Consider first aid and naloxone training for an overdose response

Some knowledge of basic first aid could mean the difference between life and death in an emergency. Consider:

• Overdose first-aid and naloxone training – Victoria has various health services that can teach you how to prevent, recognise and respond to a drug overdose. They will also organise free naloxone (a medication that can reverse opioid overdose) for you to carry if you’re at risk of experiencing or witnessing an opioid overdose. Many people carry naloxone and have used it to reverse thousands of overdoses. See the ’where to get help’ section of this fact sheet for service details.
• A first-aid course – so that you will be able to manage if someone is injured or becomes ill.

Paracetamol overdose

Paracetamol is a common form of pain management and is also used to reduce fever. It is usually bought over the counter without a prescription.

It is one of the most common medicines taken by young children in an accidental overdose.

Paracetamol is also commonly taken by people who intend to harm themselves (suicide attempts).

Signs of paracetamol overdose include:

• drowsiness
• coma
• seizures
• abdominal pain
• nausea
• vomiting.

Another name for paracetamol is acetaminophen (often known by its brand name, Panadol®).

There is only a small difference between the maximum daily dose of paracetamol and an overdose, which can cause liver damage.

Large amounts of paracetamol are very dangerous, but the effects often don’t show until about 2 to 3 days after taking the tablets. Treatment must start early to be effective, before the effects begin.

Always seek treatment for paracetamol overdose immediately, even if the person seems well.

Treatment for drug overdose

Medical care for overdose depends on:

• The drug (or drugs) taken.
• The dose.
• When and how the drug was taken.
• What else it was taken with.
• The effect on the person – including any medical complications resulting from the overdose.

If you go to hospital for a suspected drug overdose, the healthcare team will typically:

• Perform a full assessment in the emergency department – which may include blood tests, observation and psychological review.
• Remove the drug from your body – for example, by giving activated charcoal, which binds the drug so the body can’t absorb it.
• Administer an antidote, when possible – for example, naloxone hydrochloride (brand names Prenoxad®, Nyxoid®, Narcan®) is a drug that can reverse opioid overdose.
• Admit you to hospital for further treatment.

A follow-up appointment with your doctor is important for everyone who has had an overdose. Your doctor can monitor your healing, advise on continued treatment (if required) or arrange for further help (referral).

Self-care after treatment with activated charcoal

If you were given charcoal in hospital, you will pass it with your next bowel motion in a day or two. Home care suggestions include:

• Follow all instructions given by the doctor.
• Drink plenty of water to avoid constipation.
• Be aware that charcoal could interfere with the effectiveness of other medications you may be taking. For example, if you are taking the oral contraceptive pill, you will need to use another method of contraception until your next period. If you are unsure about how charcoal may affect your other medications and what to do about it, ask your doctor.

Why an overdose might happen?

Sometimes it’s unclear if an overdose was accidental or intentional. There may be elements of both.

Regardless of why the overdose happened, it’s important to treat people who have experienced an overdose with care and dignity.

• Accidental – if a person takes the wrong substance or combination of substances in the wrong amount or at the wrong time without knowing that it could cause them harm. This may include people who take a drug to get a certain desired effect (for example to get ‘high’ or reduce unpleasant emotions), but don’t realise the strength or ingredients of what they’re taking.
• Intentional – a person who takes an intentionally harmful dose of a substance or combination of substances. This can be sign of physical, emotional, or internal distress, and highlight the need for some additional care and support.

Overdose risk factors

People of any age may overdose. Your risk factors for drug-related harm is increased when:

• More than one substance is taken at the same time.
• The body is not used to taking a certain substance.

Preventing overdose

Some ways to help prevent an overdose include:

• Practise medicine safety. Always read medication labels carefully. Take prescription medications only as directed. Keep all medications in their original packaging.
• Tell your doctor or other health professional if you have had an overdose before.
• Do not keep medications you no longer need. Return them to the pharmacist.
• Keep all medicines, alcohol, drugs and poisons locked away in a safe secure place and out of reach of children.
• Be careful when taking different substances (including alcohol) at the same time. They can interact negatively and increase your risk of overdose. Ask your doctor or pharmacist if there are any interactions you should be aware of.

Safer use

There is no safe level of drug use, use of any drug carries some risk. If you do choose to use a substance, here are some ways to keep you safer from overdose.

Start low and go slow:

• If you haven’t used a drug (such as heroin) for a while, your tolerance is likely to be a lot lower than it was before – take it slow and start with a smaller amount.
• If using drugs from an unknown source or of unknown purity, have a smaller test amount at first.
• If you have any unexpected or delayed reaction to a drug, do not take more.
• Make sure you’re in a safe environment with people you trust.
• Try to avoid using alone – let someone know where you are and what you are doing, or have a friend with you.
• Keep naloxone on hand – if you’re using opioid drugs like heroin, morphine or oxycodone – it helps temporarily reverse the effects of opioids. Victoria’s Take-Home Naloxone Program provides access to free naloxone to people who may experience or witness an opioid overdose from a range of community health providers across Victoria. Naloxone is also available from pharmacies registered with the Australian Government’s Take-Home Naloxone Program.
• Check any recent drug alerts if you live in Victoria. Remember, other false or contaminated drug products may be circulating, even if no warning has been issued about them.

Where to get help

• In an emergency, always call triple zero (000)
• Emergency department of your nearest hospital
• Victorian Poisons Information Centre Tel. 13 11 26 – for advice when poisoning or suspected poisoning occurs and for poisoning prevention information (24 hours, 7 days)
• Your GP (doctor)
• Suicide Call Back Service Tel. 1300 659 467
• Lifeline Tel. 13 11 14
• DirectLine Tel. 1800 888 236 – for 24-hour confidential drug and alcohol telephone counselling, information and referral. Free overdose training and naloxone from a health service is also available
• Harm Reduction Victoria Tel. (03) 9329 1500 or email: info@hrvic.org.au – for overdose training and naloxone from peers (the DOPE program)
• PAMS (Pharmacotherapy Advocacy Mediation Support) Tel. 1800 443 844 – free confidential telephone service run by Harm Reduction Victoria
• Self Help Addiction Resource Centre (SHARC) Tel. 1300 660 068 – for information and support for people concerned about a relative or friend using drugs
• St John Ambulance Australia (first aid courses) Tel. 1300 360 455