View source for Drug overdoses

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{{Infobox Disease
 | Name = Drug overdose
 | Image = CharcoalPO.jpg
 | Caption = [[Activated carbon]] is a commonly used agent for [[decontamination]] of the [[gastrointestinal tract]] in overdoses.
 | DiseasesDB = 
 | ICD10 = T36-T50
 | ICD9 = {{ICD9|960}}-{{ICD9|979}} 
 | ICDO = 
 | OMIM = 
 | MedlinePlus = 
 | eMedicineSubj =  
 | eMedicineTopic =  
 | MeshID = D015537
}}

The term '''drug overdose''' (or simply '''overdose''' or '''OD''') describes the [[ingestion]] or application of a [[drug]] or other substance in quantities greater than are recommended<ref>[https://web.archive.org/web/20080129162235/http://www.treatment-now.com/resources/definitions/ http://www.treatment-now.com/resources/definitions/] [archived]</ref> or generally practiced.<ref name="uphs">http://www.uphs.upenn.edu/addiction/berman/glossary/</ref> An overdose may result in a [[toxicity|toxic state]] or [[death]].<ref name="uphs"/>

==Classification==
The word "overdose" implies that there is a common safe dosage and usage for the drug; therefore, the term is commonly only applied to drugs, not [[poisons]], though even certain poisons are harmless at a low enough dosage.  

Drug overdoses are sometimes caused intentionally to commit [[suicide]] or as [[self-harm]], but many drug overdoses are accidental, the result of intentional or unintentional misuse of medication. Unintentional misuse leading to overdose can include using prescribed or unprescribed drugs in excessive quantities in an attempt to produce [[euphoria]].

Usage of [[illicit drugs]] of unexpected purity, in large quantities, or after a period of drug [[abstinence]] can also induce overdose. [[Cocaine]] users who [[Injection (medicine)#Intravenous infusion|inject intravenously]] can easily overdose accidentally, as the margin between a pleasurable drug sensation and an overdose is small.<ref>Study on [http://www.biomedcentral.com/1471-2458/7/31 fatal overdose] in New-York City 1990-2000, visited May 11, 2008</ref>

Unintentional misuse can include errors in dosage caused by failure to read or understand product labels. Accidental overdoses may also be the result of over-prescription, failure to recognize a drug's active ingredient, or unwitting ingestion by children<ref>"What to do with leftover medicines". ''Medicines Talk'', Winter 2005. Available at [https://web.archive.org/web/20090919013649/http://www.nps.org.au/consumers/publications/medicines_talk/mt14/what_to_do_with_left-over_medicines2 http://www.nps.org.au/consumers/publications/medicines_talk/mt14/what_to_do_with_left-over_medicines2] [archived]</ref> A common unintentional overdose in young children involves multi-vitamins containing iron. [[Iron]] is a component of the [[hemoglobin]] [[molecule]] in [[blood]], used to transport [[oxygen]] to living cells. When taken in small amounts, iron allows the body to replenish hemoglobin, but in large amounts it causes severe [[pH]] imbalances in the body. If this overdose is not treated with [[chelation therapy]], it can lead to death or permanent [[coma]].

The term overdose is often misused as a descriptor for [[adverse drug reaction]]s or negative [[drug interaction]]s due to [[polypharmacy|mixing multiple drugs simultaneously]].

==Signs and symptoms==
{| class="wikitable" style = "float: right; margin-left:15px; text-align:center"
|+ Toxidrome<ref name = Goldfrank98>{{cite book |author=Goldfrank, Lewis R. |title=Goldfrank's toxicologic emergencies|publisher=Appleton & Lange |location=Norwalk, CT |year=1998 |pages= |isbn=0-8385-3148-2 |oclc= |doi= |accessdate=}}</ref>
|-
!Symptoms|| [[blood pressure|BP]] || [[heart rate|HR]]  || [[respiratory rate|RR]] || [[Temperature|Temp]] || [[Pupils]]|| [[bowel sounds]]||[[diaphoresis]]
 |- 
 | [[anticholinergic]] || ~ || up || ~ || up || up || down || down
 |- 
 | [[cholinergic]] || ~ || ~ || unchanged || unchanged || down || up || up
 |- 
 | [[opioid]] || down || down || down || down || down || down || down
 |- 
 | [[sympathomimetic]] || up || up || up || up || up || up || up
 |- 
 | [[sedative-hypnotic]] || down || down || down || down || ~ || down || down
|}
Signs and symptoms of an overdose varies depending on the drug or toxin exposure. The symptoms can often be divided into differing [[toxidrome]]s. This can help one determine what class of drug or toxin is causing the difficulties.

Symptoms of opioid overdoses include slow breathing, heart rate and pulse.<ref>{{cite web|last=Chandler|first=Stephanie|title=Symptoms of an opiate overdose|url=http://www.livestrong.com/article/68582-symptoms-opiate-overdose/|publisher=Live Strong|accessdate=17 May 2012}}</ref> Opioid overdoses can also cause pinpoint pupils, and blue lips and nails due to low levels of [[oxygen]] in the blood. A person experiencing an [[opioid overdose]] might also have muscle spasms, [[seizures]] and decreased consciousness. A person experiencing an opiate overdose usually will not wake up even if their name is called or if they are shaken vigorously.

==Causes==
The [[Psychoactive drug|drugs]] or [[toxin]]s which are most frequently involved in overdose and death (grouped by [[ICD-10]]):
<div class="references-medium" style="-moz-column-count:2; column-count:2;">
* [[Acute alcohol intoxication]] (F10)
** [[Ethanol|Ethyl Alcohol]]
** [[Methanol poisoning]]
** [[Ethylene glycol poisoning]]
*[[Opioid overdose]] (F11)
* Among [[sedative]]-[[hypnotics]] (F13)
**[[Barbiturate overdose]] (T42.3)
** [[Benzodiazepine overdose]] (T42.4)
** Uncategorized sedative-hypnotics (T42.6)
*** [[Ethchlorvynol]] (Placidyl)
*** [[gamma-Hydroxybutyric acid|GHB]]
*** [[Glutethimide]] (Doriden)
*** [[Methaqualone]]
*** [[Ketamine]] (T41.2)
* Among [[Stimulant]]s (F14-F15)
** [[Cocaine overdose]] (T40.5)
** [[Amphetamine#Overdose|Amphetamine overdose]] (T43.6)
** [[Methamphetamine]] (T43.6)
* Among [[Tobacco]] (F17)
** [[Nicotine]] (T65.2)
* Among [[Poly drug use]] (F19)
** Drug "cocktails" ([[Speedball (drug)|Speedballs]])
* Medications
** [[Aspirin poisoning]] (T39.0)
** [[Paracetamol toxicity]] (T39.1)
** [[Tricyclic antidepressant overdose]] (T43.0)
** [[Vitamin poisoning]]
* [[Pesticide poisoning]] (T60)
** [[Organophosphate poisoning]]
** [[DDT#Effects_on_human_health|DDT]]
</div>

==Diagnosis==
Determination of the substance which has been taken may often be determined by asking the person. However, if they will not, or cannot, due to an [[altered level of consciousness]], provide this information, a search of the home or questioning of friends and family may be helpful.  

Examination for [[toxidrome]]s, drug testing, or laboratory test may be helpful. Other laboratory test such as [[glucose]], [[urea]] and [[electrolyte]]s, [[paracetamol]] levels and [[salicylate]] levels are typically done. Negative drug-drug interactions have sometimes been misdiagnosed as an acute drug overdose, occasionally leading to the assumption of [[suicide]].<ref>[http://www.preskorn.com/columns/0207.html Column - Fatal Drug-Drug Interaction As a Differential Consideration in Apparent Suicides<!-- Bot generated title -->]</ref>

==Prevention==
The distribution of [[naloxone]] to [[injection drug users]] and other [[opioid]] drug users decreases the risk of death from overdose.<ref>{{cite journal |author=Piper TM |title=Evaluation of a naloxone distribution and administration program in New York City |journal=Subst Use Misuse |volume=43 |issue=7 |pages=858–870 |year=2008 |pmid=18570021 |doi=10.1080/10826080701801261 |url= |author-separator=, |author2=Stancliff S |author3=Rudenstine S |display-authors=3 |last4=Sherman |first4=Susan |last5=Nandi |first5=Vijay |last6=Clear |first6=Allan |last7=Galea |first7=Sandro}}</ref> CDC estimates that US programs for drug users and their caregivers prescribing take-home doses of naloxone and training on its utilization are estimated to have reversed 10,000 opioid overdose deaths.<ref>{{cite web|title=OD Prevention Program Locator.|url=https://web.archive.org/web/20120513134450/http://www.overdosepreventionalliance.org/p/od-prevention-program-locator.html|publisher=Overdose Prevention Alliance|accessdate=15 May 2012}}</ref><ref>{{cite journal|title=Community-Based Opioid Overdose Prevention Programs Providing Naloxone — United States, 2010|journal=Centers for Disease Control and Prevention||date=2010 December|url=http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6106a1.htm}}</ref> Healthcare institution-based naloxone prescription programs have also helped reduce rates of opioid overdose in the US state of North Carolina, and have been replicated in the US military.<ref>{{cite journal|author=Albert S, Brason FW 2nd, Sanford CK, Dasgupta N, Graham J, Lovette B.|title=Project Lazarus: community-based overdose prevention in rural North Carolina|journal=Pain Medicine|date=2011 June|url=http://www.ncbi.nlm.nih.gov/pubmed/21668761}}</ref><ref>{{cite journal|author=Beletsky L, Burris S, and Kral AH.|title=Closing Death's Door: Action Steps to Facilitate Emergency Opioid Drug Overdose Reversal in the United States|journal=Center for Health Law, Policy and Practice, Temple University School of Law|date=2009 July|url=http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1437163|accessdate=2012-05-12}}</ref> Nevertheless, scale-up of healthcare-based opioid overdose interventions is limited by providers’ insufficient knowledge and negative attitudes towards prescribing take-home naloxone to prevent opioid overdose.<ref>{{cite journal|author=Beletsky L, Ruthazer R, Macalino GE, Rich JD, Tan L, Burris S.|title=Physicians' knowledge of and willingness to prescribe naloxone to reverse accidental opiate overdose: challenges and opportunities|journal=Journal of Urban Health|date=2007 January|url=http://www.ncbi.nlm.nih.gov/pubmed/17146712}}</ref> Programs training police and fire personnel in opioid overdose response using naloxone have also shown promise in the US.<ref>{{cite web|last=Beletsky L, Moroz E.|title=The Quincy Police Department: Pioneering Naloxone Among First Responders.|url=https://web.archive.org/web/20120514032020/http://www.overdosepreventionalliance.org/2012/05/quincy-police-department-pioneering.html|publisher=Overdose Prevention Alliance|accessdate=15 May 2012}}</ref><ref>{{cite journal|author=Lavoie D.|title=Naloxone: Drug-Overdose Antidote Is Put In Addicts' Hands|journal=Huffington Post|date=2012 April|url=https://web.archive.org/web/20120429073229/http://www.huffingtonpost.com/2012/04/26/naloxone-drug-overdose-antidote_n_1456531.html}}</ref>

==Management==
Stabilization of the [[ABC (medicine)|ABCs]] are the initial treatment of an overdose. Ventilation is considered when there is a low respiratory rate or when [[blood gases]] show the person to be [[hypoxia (medical)|hypoxic]]. Monitoring of the patient should continue before and throughout the treatment process, with particular attention to temperature, [[pulse]], [[respiratory rate]], [[blood pressure]], urine output, [[electrocardiography]] (ECG) and O<sub>2</sub> saturation.<ref name="OHCM">{{cite book |title=Oxford Handbook of Clinical Medicine |last=Longmore |first=Murray |coauthors=Ian Wilkinson, Tom Turmezei, Chee Kay Cheung |year=2007 |publisher=Oxford |location=United Kingdom |isbn=0-19-856837-1}}</ref> [[Poison control center]]s and [[Medical toxicology|Medical toxicologists]] are available in many areas to provide guidance in overdoses to both physicians and the general public.

===Antidotes===
Specific [[antidote]]s are available for certain overdoses for example, [[Naloxone]] is the antidote for [[opiate]]s such as [[heroin]] or [[morphine]]. [[Charcoal]] is frequently recommended if available within one hour of the ingestion and the ingestion is significant.<ref name="AHAPart12">{{cite journal|last=Vanden Hoek|first=TL|coauthors=Morrison, LJ, Shuster, M, Donnino, M, Sinz, E, Lavonas, EJ, Jeejeebhoy, FM, Gabrielli, A|title=Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care|journal=Circulation|date=2010 November 2|volume=122|issue=18 Suppl 3|pages=S829–61|pmid=20956228|doi=10.1161/CIRCULATIONAHA.110.971069}}</ref> [[Gastric lavage]], [[syrup of ipecac]], and [[whole bowel irrigation]] are rarely used.<ref name=AHAPart12/>

==Epidemiology==
The [[National Center for Health Statistics]] report that 19,250 people died of accidental poisoning in the U.S. in the year 2004 (8 deaths per 100,000 population).<ref>[https://web.archive.org/web/20000302110323/http://www.cdc.gov/nchs/fastats/acc-inj.htm National Center for Health Statistics] [archived]</ref>

In 2008 testimony before a Senate subcommittee, Medical Epidemiologist Dr. Leonard J. Paulozzi<ref>[https://web.archive.org/web/20090110153719/http://www.cdc.gov/media/subtopic/sme/paulozzi.htm Centers for Disease Control and Prevention] [archived]</ref> of the [[Centers for Disease Control and Prevention]] stated that in 2005 (the most recent year for which data was available) more than 22,000 American lives were lost due to overdoses, and the number is growing rapidly. Dr. Paulozzi also testified that all available evidence suggests that unintentional overdose deaths are related to the increasing use of prescription drugs, especially opioid painkillers.<ref>[https://web.archive.org/web/20080405220639/http://www.cdc.gov/washington/testimony/2008/t20080312a.htm Centers for Disease Control and Prevention] [archived]</ref>

==See also==
* [[Adverse drug reaction]]
* [[Drug abuse]]
* [[Drug addiction]]
* [[Drug agonism]]
* [[Drug metabolism]]
* [[Drug therapy]]
* [[Drug usage]]
* [[Tricyclic antidepressant overdose]]
* [[Water intoxication]]
==References==
<div class>
<references/>
</div>

==Further reading==
<div class="references-small">
*{{cite book |author=Nelson, Lewis H.; Flomenbaum, Neal; Goldfrank, Lewis R.; Hoffman, Robert Louis; Howland, Mary Deems; Neal A. Lewin |title=Goldfrank's toxicologic emergencies |publisher=McGraw-Hill, Medical Pub. Division |location=New York |year=2006 |pages= |isbn=0-07-143763-0 |oclc= |doi= |accessdate=}}
*{{cite book | author = Olson, Kent C. | authorlink = | editor = | others = | title = Poisoning & drug overdose | edition = | language = | publisher = Lange Medical Mooks/McGraw-Hill | location = New York | year = 2004 | origyear = | pages = | quote = | isbn = 0-8385-8172-2 | oclc = | doi = | url = | accessdate = }}
</div>

==External links==
{{Wiktionary|overdose}}
*[http://www.quihn.org.au Fact sheets on illicit drugs, overdose prevention, detox and harm reduction strategies.]

{{drug use}}
{{Psychoactive substance use}}
{{Poisoning and toxicity}}

[[Category:Drug abuse]]
[[Category:Drug therapy]]
[[Category:Drug overdose| ]]
[[Category:Medical emergencies]]
[[Category:Poisoning by drugs, medicaments and biological substances| ]]
[[Category:Psychiatric diagnosis]]
[[Category:Side effects (drug)]]
[[Category:Suicide methods]]
[[Category:Substance abuse]]

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