What are the signs and symptoms of an overdose?

As opioid overdoses that do not lead to death are several times more common than fatal overdoses, it becomes clear just how common opioid overdoses are and potentially how easily or quickly they can occur. Thus it is crucial that all staff are aware of how to deal with such a situation.

So many people die because it was not recognised that they were experiencing an overdose. Interventions to reverse an overdose are redundant if the overdose has not been identified. It is very common that people will assume that the person who has overdose is asleep because they appear to be snoring and therefore it is crucial that people are very familiar with the signs:

• Person is unresponsive.
• Person has slow/shallow/rasping breathing (often mistaken for snoring).
• Person has pale skin and may have blue lips (cyanosis).
• Person has pinpoint (constricted) pupils (indicates that opiates have been consumed) however opiate overdose should not be ruled out if pinned pupils are not present.

In the majority of cases, death will not occur instantaneously. Many deaths happen two or three hours after drug use. Only one-quarter of deaths happen immediately after drug administration. This timeframe provides an opportunity for intervention.

The majority of witnesses actively intervene to address the emergency, but many of their actions tend to be incorrect and ineffective (slapping their collapsed companion, walking them around, etc.). In research interviews with people who had experienced or witnessed an overdose, only half had called for an ambulance; their principal reasons for not doing so were fear of police involvement and belief that they could handle the situation themselves [^1].

Additional material
Signs of an opioid overdose