Surviving an overdose is not the same as recovering from one. As International Overdose Awareness Day on August 31 turns attention to the realities of overdose, experts stress that the emergency does not end when a patient regains consciousness. The first few minutes can be critical, with doctors racing to stabilise the patient and identify the substance involved, but what follows can be just as important.
“In the first 30 to 60 minutes, we assess airway, breathing, circulation, consciousness, vital signs and blood glucose. Rapid stabilisation is crucial because some toxins can cause sudden respiratory failure, seizures, cardiac rhythm disturbances or coma. Early supportive treatment and timely antidotes can significantly improve outcomes,” says Dr Sree Sowjanya P, head of the department of emergency at Apollo Hospitals, Jubilee Hills.
The immediate emergency approach is similar for both accidental and intentional poisoning. “Patients’ breathing patterns, blood pressure, heart rate, level of consciousness, glucose levels and ECG are assessed first and look for immediate life-threatening after effects of the poisoning,” shares Dr Asiya Butool, senior consultant and HOD – department of emergency medicine at Renova Century Hospitals, Banjara Hills.
However, after initial stabilisation, the approach can differ significantly depending on the circumstances. An accidental overdose may result from a dosing error, medication mix-up, drug interaction or accidental ingestion. An intentional overdose, meanwhile, may signal self-harm, severe psychological distress or a psychiatric crisis. Where substance misuse is involved, addiction may need to be addressed alongside the immediate toxicity. “When the substance is unknown, doctors have to piece together the clues. Symptoms, examination findings, medicines available at home, empty strips or bottles, information from relatives and the circumstances in which the patient was found can all help identify the likely toxin. Blood glucose, ECG, routine investigations and selected toxicology tests may further narrow the possibilities available,” explains Dr Asiya.
For doctors, knowing what was consumed, approximately how much was taken and when it happened can significantly guide treatment. “Families should bring medicine strips, bottles, prescriptions or packaging, if safely available, and tell doctors about other medicines, alcohol or substances consumed, the likely quantity and when symptoms began,” says Dr Sree Sowjanya.
Doctors distinguish between accidental poisoning, medication toxicity, intentional overdose and substance-related toxicity by looking at the circumstances, history and evidence surrounding the event. “Doctors consider the circumstances, history and evidence surrounding the event. Accidental poisoning may follow dosing errors or mistaken ingestion; medication toxicity can result from interactions or organ dysfunction. Intentional overdose raises concerns about self-harm, while recreational substance toxicity is assessed through history, examination and toxicology findings,” says Dr Sree Sowjanya.
Serious medication toxicity can also occur without any intention to overdose. “Serious toxicity can occur without deliberate overdose through accidental double-dosing, drug interactions, kidney or liver impairment, dehydration, incorrect dosing, swallowing another person’s medication, or combining medicines with alcohol. Older adults and people taking multiple medicines may be particularly vulnerable to unexpected toxicity,” she adds.
For families and bystanders, recognising the warning signs can be critical. “Warning signs include unusual drowsiness, unconsciousness, confusion, vomiting, abnormal pupils, seizures, slow or difficult breathing, blue lips, sweating or sudden behavioural changes. An unexplained collapse, especially with medicine strips, bottles or drug paraphernalia nearby, should raise suspicion of overdose,” says Dr Sree Sowjanya.
If someone is unconscious, extremely drowsy or showing signs of breathing difficulty after suspected drug or medication use, immediate medical help is essential. “Check breathing, place an unconscious but breathing person on their side, and monitor them closely. If they are not breathing normally, begin CPR if trained. Do not leave them alone, and avoid giving food, water or medicines by mouth,” she advises.
Even when consciousness returns, the danger may not necessarily be over. “Even after consciousness returns, the patient may not be out of danger. Depending on the toxin involved, doctors may continue to watch for breathing difficulties, aspiration-related lung injury, seizures, abnormal heart rhythms, kidney or liver injury, electrolyte disturbances and altered neurological status,” notes Dr Asiya.
Understanding the circumstances behind an overdose or poisoning is important because treating the toxicity alone may leave the underlying problem unaddressed. “Describing every poisoning simply as a ‘drug overdose’ can miss the bigger picture. The substance involved determines the immediate medical risks, but the circumstances surrounding the ingestion can shape the patient’s long-term needs. Treating the toxicity without addressing the reason behind it may save the patient from the immediate crisis while leaving the underlying cause and the risk of another episode untouched,” says Dr Asiya.
Once medically stable and able to participate in an assessment, patients may require psychiatric or addiction evaluation depending on the circumstances. “Psychiatric and addiction assessment are an important part of recovery when a patient is medically stable and able to participate in assessment. A patient following suspected self-harm may require psychiatric evaluation, while someone with problematic substance use may need counselling, de-addiction treatment, medication-assisted treatment or a combination of approaches, depending on the underlying problem.
Medication is usually combined with counselling and relapse prevention support. Integrated approach works best by treating addiction and mental health problems together through coordinated services,” Dr Asiya concludes.