Download Suspected Drug Overdose TIPS

Ottawa Inner City Health December 2008
Suspected Drug Overdose TIPS
Background the majority of clients/patients who are admitted to OICH are
living with concurrent disorder. The staff may expect that clients will suffer
periods when their mental health and/or substance use will be unstable as
indicated by behaviors which range from excessive sleeping to aggression.
1) When staff observes behavior which they find concerning they should
try to assess the patient and gather information about recent events
which might contribute to a better understanding of what is occurring.
2) When there is reason to suspect that recent drug or alcohol use may
be the cause of the behavior staff should try to find out as much as
possible about the substance and the quantity used.
Assessment Tips
Depressants (Opiates, benzodiazapams and alcohol)

If the person has taken too many opiates they tend to be sedated,
pupils are often pinpoint size. The greatest danger from opiate
overdose is respiratory arrest so it is important to count how many
times a minute they are breathing, if they are a normal skin colour and
if you can get them to wake up. Opiates can be very slow acting so
the person may seem ok at first and then slip deeper and deeper.
People who are at highest risk are those who are not used to taking
opiates and those who have been off them (ie in jail) for a while.
These people have poor capacity to tolerate high doses of opiates.
Valium and other benzodaizapines like Ativan also have a sedating
effect and it can be hard to know what people have taken when you
assess them however, the assessment and the danger signs are the
same. Alcohol is also a depressant however; there are special
concerns when people have been drinking that they may vomit and
then breath vomit into their lungs.
For any situation where the client appears to under the influence of
some depressant you should be concerned when you observe:
Stupor, coma or the person cannot be roused-call nurse on call
Slow Breathing (less than 8 times per minute) or irregular
breathing (more than 10 seconds between breaths)-call nurse
on call
Bluish skin colour, paleness-call nurse on call
Vomiting when unconscious-call 911
Seizures-refer to emergency plan and if unexpected for this
client, call 911
In any situation where you are concerned you can give the client
oxygen at 1.5 L per minute while waiting for other help.
Ottawa Inner City Health December 2008
It is never a good idea to recommend to a client who has a long term
problem with the use of any depressant that they stop “cold turkey”
without having a medical person assess their risk and planning for
their care. When the depressant effect is removed abruptly from the
body, the brain may become over stimulated leading to seizures and
even death.

Methadone is particularly dangerous because it is so long acting and
hard to reverse. A dose of 50 mg of Methadone could kill an adult who
has not taken opiates before. It is normal for people to be much
sleepier than usual when their Methadone dose is adjusted and you
may even see them sleeping when they are sitting up or eating. This
is not a concern as long as they are breathing well and you can rouse
them when you need to. This effect wears off in a day or so.
Stimulants (Crack, Cocaine etc)

The signs and symptoms of cocaine or crack overdose are quite
different from depressant overdose. These drugs are powerful
stimulants so the signs of overdose include both the psychological and
stimulant effects of the drug on the brain. The classic signs are high
blood pressure with a fast heart rate and increased breathing. A high
temperature can occur. Normally you will also see agitation,
confusion, irritability, and sweating. Seizures can occur. Cocaine
overdose can also look like a heart attack with chest pain. They think
this is because the drug causes a spasm in the heart and the heart
cannot cope because it is so stimulated. Stroke is rarer but can occur.

If you are concerned you need to call the nurse on call.
Sometime sedation is given with valium or another medication to
reduce the agitation, irritability, and prevent seizures. Tylenol
can be given for elevated body temperature.
For any situation where the client appears to under the influence of
some stimulant you should be concerned when you observe:




Heart rate greater than 110 beats per minute-call nurse
on call
Fever greater than 38.0 C-Call nurse on call
Seizures-refer to emergency plan and if not expected for
this client call 911 prior to notifying the nurse on call
Complaints of chest pain-call 911