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Overdose
Introduction Many drug users overdose because they don’t realise the risks they are taking when they inject heroin and use combinations of heroin and other drugs (including alcohol). Many deaths happen because people who see overdoses often don’t know what to do to help. This booklet aims to change that by giving you information on:
As well as reading about what to do:
Your drug service may be organising first aid training. Going on one of these courses could help to save the life of anyone who overdoses while you’re around,or help someone else to save your life! Overdose risks Injecting drugs Mixing drugs and alcohol Using opiates when tolerance is low People who die have often overdosed before and survived. It isn’t normally ‘new users’ who overdose, it’s usually people who’ve been injecting for years. Sometimes overdoses aren’t accidental. Feeling depressed, hopeless or not caring whether you live or die can all make overdose more likely. Talking about feelings is important and can help reduce the risk of non-accidental overdose.
Think about your own overdose risks. Think about the risks taken by people you know. Look after yourself. Look out for your mates.
Many people who od actually die 2 or 3 hours after injecting heroin. Especially when they’ve taken a combination of alcohol or downers, with methadone or heroin. This is because it takes time for drugs that have been swallowed to be absorbed into the bloodstream. So, just because someone survives the initial hit, it doesn’t mean they’re going to be OK. Methadone and overdose Heroin injectors not in methadone treatment are around four times more likely to die than those who are in treatment. This is mainly because of increased risk of an overdose. But, methadone is really dangerous if it is taken by people who aren’t used to it. As little as 40mg can kill an adult. Most methadone overdoses happen among those who have bought methadone from someone in treatment. The overdose risks are even higher if people take methadone and drink alcohol together, or within a few hours of each other. Myths But, if someone has taken a lethal dose of drugs there is nothing you can do to wake them up, except call an ambulance. They can then be given naloxone the heroin antidote. Myth 1 ‘Walking people around helps’ It is also possible that as the heartbeat increases with exercise, drugs will be absorbed into their bloodstream more quickly. Myth 2 ‘Putting people in cold baths wakes them up’ Putting people in the bath is dangerous because it takes time to run the bath - and they could die while it is filling. Even if they are alive when they are put in, they could easily drown or die of cold. Myth 3 ‘Hurting, hitting or burning can bring them round’ Anything more drastic won’t make any difference to whether or not they come round, and could cause them serious injury! Myth 4 ‘Injecting people with salt water is an antidote to overdose’ Injecting salt water is dangerous because:
The idea of injecting people with salt water might have come from people seeing friends in hospital being given a saline (salt) ‘drip’ and thinking this was part of the cure. In fact the drip is put up to keep a vein ‘open’ so they can inject medication. Calling an ambulance When suicide was illegal the police were always called to overdoses. Suicide is not illegal anymore, so they no longer have to come. Many areas have developed policies so that the police don’t get called to all overdoses. Ask your drug service what the local policy is. Changing policies that get in the way of drug users calling an ambulance when someone overdoses might need the involvement of the local Drug Action Team (DAT). The DAT is responsible for getting everyone to work together to prevent drug problems. There may be a drug user representative on the Drug Action Team who could get help get this type of problem sorted. If there isn’t a drug user rep on the DAT, tell the drug service or needle exchange if you hear of the police coming to an overdose. They can then keep up pressure to change the policy. If the police come, there is a chance that the person who owns the property will be charged with ‘knowingly allowing drugs to be consumed on the premises.’ However, this is rare in cases of overdose. Injecting someone who then dies could lead to a charge of manslaughter - if there is enough evidence. Making sure there is no shouting or panic in the background when you dial 999 reduces the chances of the police coming. If you are really worried you could dial 999 and just tell the ambulance control room you have found someone unconscious. If an ambulance is not called and someone dies, the police will come so that they can inform relatives and investigate the death. Calling an ambulance saves lives. The rest of this booklet has information on how to tell when someone is unconscious, and how to keep them alive until the ambulance gets there. Signs of overdose You need to know if they are unconscious. You find out by rubbing your knuckles on their sternum - the centre of their rib cage. If you can’t wake them or they are showing other signs of unconsciousness such as:
What to do Dial 999 and ask for an ambulance. Stay with them until the ambulance arrives. Read and practise the following instructions - so that you know how to keep them alive until the ambulance gets there. If they stop breathing give 10 breaths of mouth-to-mouth resuscitation. Then, if you haven’t done it already, call an ambulance. Giving mouth-to-mouth To see illustration 1 The person should be lying flat on their back. 2 Remove chewing gum or anything else you can see in their mouth and then lift their chin. 3 Pinch their nostrils together, using your first finger and thumb. 4 Take a deep breath and make a good seal around their lips with your mouth. 5 Blow steadily until you see their chest rise. 6 Take your mouth away and let their chest sink right back down. 7 Repeat steps 3 to 6. If you are giving mouth-to-mouth but find that they:
Don’t waste time looking for a pulse. Start chest compression (sometimes known as heart massage) straight away. Even if their heart is still beating, if they are not moving and are getting bluer or colder, their heart beat can’t be that strong. You won’t do any harm by starting chest compressions,and you could save their life. To start chest compression you need to: To see illustration Find the place where the ribs meet the breastbone, and lay two fingers there. Put the heel of your other hand on their breastbone, just above where your two fingers are. Place your first hand on top of this hand, locking your fingers together Keeping your shoulders above the centre of the casualty’s chest and your arms straight, press down on the chest to a third of its depth. Release the pressure, but keep your hands where they are. This is a chest compression. Do 15 chest compressions at the rate of 100 compressions a minute - this will take just under 10 seconds. Give two breaths of mouth-to-mouth. Continue mouth-to-mouth and chest compressions at the rate of 15 compressions to two breaths, until help arrives. If their heart starts beating again, and their colour changes from blue to pink, continue with mouth-to-mouth if necessary. The recovery position To see illustration IF SOMEONE IS UNCONSCIOUS AND BREATHING PUT THEM IN THE RECOVERY POSITION Open their airway by tilting the head back and lifting the chin Straighten the legs Place the arm nearest to you at right angles to their body Pull the arm furthest from you across their chest and place the back of their hand against the cheek nearest to you Get hold of the far leg, just above the knee, and pull it up, keeping the foot flat on the ground Keep their hand pressed against the cheek and pull on the upper leg to roll them towards you, and onto their side Tilt the head back to make sure they can breathe easily Make sure that both the hip and the knee of the upper leg are bent at right angles Dial 999 and ask for an ambulance
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