Administration of a drug in a quantity that exceeds that which the body can metabolize or excrete before toxicity develops constitutes an overdose. Whether it is accidental or deliberate, drug overdose is a significant problem that is encountered by providers of emergency medical care. Accidental overdose is common among users of illegal substances of abuse, since little reliability can be placed on the potency, presence of adulterants, and even identity of the street substance. For example, HEROIN potency has been demonstrated to range from 3 to 90 percent. Overdoses and deaths from heroin are therefore common. The prevalence of comorbid disorders in substance-abusing populations, particularly DEPRESSION, has been found to be high. Thus, deliberate drug overdoses taken in the attempt to commit SUICIDE are frequently encountered in this population. Also, people with a psychiatric illness but no drug-abuse problem most often attempt suicide with a drug overdose. Substances frequently implicated in drug overdose involve non-narcotic ANALGESICS (painkillers), BENZODIAZEPINES (tranquilizers), OPIATES, or ANTIDEPRESSANTS—often in combination with alcohol.

The treatment of a drug overdose begins by providing basic supportive care (i.e., ensuring that there is adequate ventilation and monitoring the heart), calling 911, an emergency medical service (EMS), or the Poison Control Center (see Appendix I in Volume 4). If little time has elapsed since ingestion, efforts may be made to prevent further absorption of the drug by such means as gastric lavage or by administration of activated charcoal. Other treatments include increasing the rate of excretion through forced diuresis or giving specific antidotes (e.g., NALOXONE for opiate overdose) when the substance is known or can be identified from the presenting clinical syndrome. Obtaining a careful drug history from the patient or accompanying individuals is of paramount importance in effectively treating and minimizing risks from a drug overdose, which often results in death.

See Also

Drug Abuse Warning Network; Drug Interactions and Alcohol)

Bibliography

JAFFE, J. H., KNAPP, C. M., CIRAULO, D. A. (1997). Opiates: Clinical aspects. In J. H. Lowinson et al. (Eds.), Substance Abuse: A Comprehensive Textbook, 3rd ed. (pp. 158-166). Baltimore, MD: Lippincott, Williams, & Wilkins.

KOSTEN, T. R., & ROUNSAVILLE, B. J. (1988). Suicidality among opioid addicts: 2.5-year follow-up. American Journal of Drug and Alcohol Abuse, 14, 257-369.