• What Is an Overdose?
• How ODs Happen and Tips to Prevent Them
• How Can You Tell if a Person Has Overdosed?
• What to Do if Someone Overdoses
• Calling 911
• When Help Arrives
• What NOT to Do if Someone Overdoses

What Is an Overdose?

Overdose (OD) happens when you take too much of a drug (or a combination of drugs), and it overwhelms your body -- especially your brain and other important organs like your liver, heart, lungs and kidneys. When this happens your body looses the ability to cope with the drug: you may pass out, stop breathing, have heart failure or have seizures. All of these can kill you. But overdoses don't have to be fatal!

Anyone who uses drugs can overdose; from the first-time user to the veteran. There are many risk factors for overdose: some aren't even drug-related. Problems caused by poor health, depression/low self esteem, homelessness, drug prohibition/ scarcity and lack of syringes don't have immediate solutions. While it's good to be aware of them (thinking about how and why you use can lead to safer use), this brochure focuses on simple steps you can take to reduce your risk of overdosing. It also tells you how to keep someone alive if they OD.

How ODs Happen and Tips to Prevent Them

Mixing drugs (like heroin, pills and alcohol) is the most common cause of death by overdose. Drugs taken together can interact in ways that increase their overall effect. With depressants (drugs that slow you down), the risk of passing out or stopping breathing increases. With stimulants (drugs that speed you up), the risk of seizures or heart attacks increases.

• Avoid mixing drugs that have the same effects, such as heroin with other depressants (like alcohol, Xanax or Clonopin) or cocaine with other stimulants (like speed and ecstasy).

If you plan to drink and do heroin too, take smaller amounts, do the heroin first and pace your drinking. If you do the heroin and then drink over a period of hours, it may give your body a chance to clear some of the heroin from your system before the effects of the alcohol fully build up. Plus, your mind is clearer when you're measuring your heroin dose. (The same goes for downs.)

Remember, the more you plan out in advance, the less room there is for error and panic in the event of an actual OD.

Tolerance has a lot to do with overdosing. If you are using a drug for the first time your body will not be used to it. If you haven't used for a while -- like time in jail or detox -- your tolerance decreases and your body can't take as much as it could before.

Many people who overdose have just come out of jail or detox. Be especially careful if you use after you've been away for a while: not only has your tolerance gone down, the strength of the dope may have risen.

• Do a little less if you haven't used lately. Even if it's only been a few days, your body may react to the drug like it did when you first began to use. If your health has worsened or you've lost weight since your last use, consider that too when measuring your dose.

• Take the drug in a way that gets you high more slowly -- snorting heroin or cocaine rather than injecting it, for example.

• Try to use with someone who knows what to do in case you go out. If you must use alone, let a friend know so they can check in on you.

• Try to find out as much as you can about the stuff you plan to use: it may have gotten stronger since the last time you tried it.

• Be careful if you're using a new drug, as it will be hard to know how much to do. Try to use with someone who has some experience with the drug you're doing, and with new users.

Some people OD because they just do too much in a short time period, and the drugs build up in their system, leading to an overdose.

• Let your drugs work first before you do more. If you don't give your body enough time, you will overwhelm it.

• Purchase just the amount you plan to use. If you have to buy more than you need, see if you can stash it somewhere, like with a non-using friend.

• Keep track of how much you've used. Remember that each time you do more, you are increasing the amount of drugs in your system.

• Take control of your own preparation and intake. You are the only one who really knows how much you can handle.

There is no quality control with illegal drugs. Basically, you don't really know what you're getting. Street drugs vary in purity from day to day. They are often cut with cheaper drugs (or other materials) that can be dangerous, unpredictable and increase your chances of overdosing. Every time you buy from a different dealer or new batch, it's a gamble.

• Check out anything that's new: does it taste, smell and look OK?

• If you have doubts about what you just bought and you normally shoot-up, snort a bit first instead. Or ...

• Do a tester shot first to see how strong the drugs are. You can even push a little in, and once sure it's ok, do the rest.

• If you get something that's really strong, let your friends know. If you get your needles at an exchange, see if they can put up a bulletin board or make up a hot sheet warning users of especially strong (or bad) dope.

• Try to buy from a regular source that you trust. Establish a relationship with a dealer who will talk to you about their product. Talk to the other buyers; the more information you have about potency, the better.

Changes in your health or body can put you at risk for an OD. Getting sick or losing weight affects your tolerance and your body's ability to adjust to the drug.

• Use less when you are sick or while you are recovering from illness.

• If you have lost weight, do a tester shot or take less to see how much you need.

• Women usually weigh less than men. If you're a woman getting high with a man, make sure your needs are taken into account when your dose is measured.

• Maintain your health by eating and sleeping well, drinking lots of juice and water and getting an annual physical.

Although not necessarily a cause of overdose, using alone increases the chance of fatally overdosing because there is no one there to call for help or take care of you if you go out. When you can, use with people you trust and talk with them about an overdose plan (see below).

• Put together a support system of people who know you use. Let them know when you plan to use alone and ask them to check in on you.

• If you are alone and overdosing, or afraid you might, call 911 or one of your supportive friends while you still can.

• If you do use alone, unlock your door so the paramedics or your friends can get inside.

• Think through each step of your drug-taking. This will lessen the likelihood of making a mistake that can lead to overdose.

How Can You Tell if a Person Has Overdosed?

What happens when someone overdoses depends on the kind of drugs they have taken.

Depressant drugs like opiates (like heroin and Dilaudid) and sedatives (like Valium and alcohol) slow down your heart rate and breathing. A person who overdoses on a depressant may pass out, stop breathing or choke on their vomit -- any of which can lead to death. Sometimes you can hear a person's raspy breathing and know they're having problems. Often, you don't know they've stopped breathing. If their face turns blue they are very close to death and need immediate attention -- rescue breathing, or the Heimlich Maneuver (to clear a blockage in their windpipe) or CPR (if their heart has stopped). Call 911 immediately!

Stimulants (like speed and cocaine) speed up the body's functions. A person who has overdosed on any of these may collapse from exhaustion, have a seizure or become so disoriented that they accidentally hurt themselves. They can also have a heart attack or experience cardiac arrest.

Someone who is overdosing isn't always aware of what is happening. They may be helpless; if so, you need to act quickly. If a person stops breathing, it only takes a few minutes for them to die. Don't wait for them to "get over it": they could die, or suffer permanent brain damage from lack of oxygen.

What to Do if Someone Overdoses

If someone looks like they are overdosing, act quickly and follow these steps:

First, find out if the person is conscious. See if the person can open their eyes or speak to you: shake them and call their name. If that doesn't work try to bring them around by causing pain: rubbing their breastbone with your knuckles really hard, or twisting a pencil up against the space between their fingers. Don't worry about either of these methods hurting too much! It is more important that the person wakes up.

Calling 911

Many of us are afraid to call 911 when someone we know ODs. You may have had a bad experience with paramedics, or heard stories about people being arrested when the cops came too. But if you don't know how to do rescue breathing and/or CPR (or don't want to), and you don't have narcan, calling 911 may be the only way to save the person's life. Here are a few tips for your call:

When you make the call ...

• Be as calm as possible: the more things appear to be under control the less likely the cops will be sent.

• Be clear and concise. Telling the dispatcher someone's stopped breathing should get the paramedics zipping over. If you're asked if it's an overdose, don't lie. Say you think the person took something, but you're not sure what it was.

• Make sure you've given them the address, phone number (if there is one) and instructions on how to get into the building. (If you're squatting, send someone out to the street to wait, if you can.)

If you're afraid of the cops, absolutely cannot stay and no one else is around ...

• You can still call 911. If you're on the street or in a park, calling from a pay phone is pretty anonymous.

• If you can do it without hurting your friend, take her into the street, or the building doorway. The easier it is for the paramedics to get to her, the better. Remember to put her in the recovery position!

• If your friend is outside, try to get a passerby to help before you leave.

• If you can't move your friend, you can stay until you hear the sirens get really close, then split. Just make sure help can get to your friend: leave the door open, put a note up, etc. Again, remember to put her in the recovery position before you leave. A final suggestion: if it's not your place and there's a fire escape or back door, you can always wait until the last minute and duck out the back way.

If your friend wakes up: A person can OD again, so it's important to stay with your friend, or take her to the emergency room.

When Help Arrives

If it's just paramedics: The paramedics are there to help. Give them as much info as possible: what the person took, any medical conditions you know about, etc. (You don't have to tell them you used, or that you saw your friend use.) Be respectful of the paramedics and let them do their job; they will usually only call the police if they are physically threatened.

If the cops come too: Most times paramedics can figure out what's wrong with someone. Sometimes, though, when a person is really overdosed, or has taken drug combinations, it's not as obvious. Even if you have to pull the paramedic to the side to tell them what was taken, this can make a difference -- especially if more than one drug is involved! Just remain calm, don't have an attitude and be as honest as you can without getting yourself into trouble.

For many of you, hiding cookers, cottons, empty bags, etc. before anyone comes is standard practice. Remember to put the person in the recovery position while you do this!

What NOT to Do if Someone Overdoses

Do NOT inject the person with salt water, or milk. Neither will help revive the person, and the time you spend looking for a vein could be better spent doing rescue breathing or trying to wake them up.

Do NOT inject the person who has overdosed on heroin with cocaine or speed, or vice versa. It wastes valuable time and can make them worse: it's one more drug that their body has to deal with.

Do NOT put the person in a cold water bath -- they may drown. If they are still breathing, you can put them under a cool shower to wake them up, but stay there with them and keep the water away from their nose and mouth.

Do NOT leave someone who has overdosed alone, even after you've called an ambulance. If you must go, leave them in the recovery position.

The Straight Dope Education Series was created to provide accurate information about drugs so that people can make rational, safer and informed decisions about their drug use.

Special thanks to Dan Bigg of the Chicago Recovery Alliance, Raquel Algarin, L.P.N. of the Lower East Side Harm Reduction Center and the focus group participants from Citiwide Harm Reduction in Bronx, NY.

This publication is designed to provide accurate and authoritative information about the subject matter covered. It is distributed with the understanding that Harm Reduction Coalition is not engaged in rendering medical, legal or other professional services.