Stopping the Stigma of Mental Health - Part 2: Overdose

Posted on August 01 2018

In light of the tragic overdose of singer, actress, and mental health advocate, Demi Lovato, we have decided to continue writing this two part piece, this time regarding drug overdose, in hopes to bring forth awareness about mental health, and the stigma that sadly still encompasses mental illnesses today. We hope to be a part of the community that helps to heal and educate, and not discriminate those who have struggled, or currently struggle. If you or someone you know is struggling with substance abuse, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-HELP (4357).

Overdose

In the last blog, we discussed the stigma surrounding addiction and mental health. Today, we are covering the sensitive topic of drug overdose - which affects many people across the United States every day. Currently, opioid and heroin related deaths are at their highest peak in the United States, and more and more people are losing their lives each year.

Research has shown that in 2014, there were 47,055 drug overdose deaths in the United States - 28,000 of them being directly related to prescription opioids and heroin. In 2016, the rate jumped exponentially. More than 64,000 Americans died from drug overdoses, with half of the population overdosing on illicit drugs and prescription opioids.

Experts say that this year, the trend is continuing to rise with more Americans succumbing to their addictions, rather than accidental overdose. Is this part of the mental health crisis going on in today's society? Is it a lack of care, empathy, and compassion for those struggling? Is it accidental exposure to prescription drugs, legal, and illegal drugs?

There is no one answer. Researchers believe it is a combination of the above factors. At this point, the biggest concern remains, how can society take the necessary steps to lower this staggering death toll? With the proper care, education, and equipment to reverse the risk for overdosing, or reverse the potential lethal effects from overdosing, we as a society can begin to save lives from needless death. 

What is a Drug Overdose?

Drug overdoses occur when a person takes more than the medically recommended dose of a prescription or over-the-counter drug. Illicit drugs, may be taken in overdose amounts when a person's metabolism cannot detoxify the drug fast enough to avoid unintended side effects. 

Drug overdoses can involve people of any age, and they can be either accidental or intentional. Drug overdoses are most common in very young children - from crawling age to approximately 5 years old - and among teenagers to those in their mid-30s. Accidental overdoses are just that - accidental. They are caused without intent. Intentional overdoses are for a desired effect, either to produce a pleasurable feeling, or to harm oneself. First, let's explore accidental overdoses.

Accidental overdoses result from either a young child or an adult with impaired mental abilities, swallowing a medication left within their grasp. Young children may accidentally swallow drugs because of their curiosity about medications they may find. Children younger than 5 years - especially 6 months old to 3 years - tend to place anything they find into their mouths. Drug overdoses in this age group are generally caused when someone accidentally leaves a medication within the child's reach.

An adult - especially elderly people, or people who may be consuming too many medications - can mistakenly ingest the incorrect medication, or take the wrong dose of a medication. This is most likely seen in elderly patients who have the onset of Dementia and other impaired mental abilities. 

Intentional overdoses result from a desired effect. Adolescents and young adults are more likely to overdose on one or more drugs in order to harm themselves. Attempting to harm oneself may represent a suicide attempt. People who purposefully overdose on medications, and overdose on medications frequently, usually suffer from an underlying mental health condition(s). These conditions may or may not have been diagnosed before.

Risk Factors for Drug Overdose

Risk factors for drug overdose are things that would make someone more likely to abuse drugs, or more likely to accidentally take the incorrect medication, or take the wrong dose of a medication. 

Risk factors for accidental drug overdose include the following:

Age: Young children and the elderly are at risk.

Taking multiple medications

Mental Illness or Impairment

Risk factors for intentional drug overdoses include the following:

Gender: Men are more likely to abuse drugs than women.

Age: For example, people 45-54 years of age are more likely to abuse opioids, while people 25-34 years (or younger) are more likely to abuse heroin. 

Low income

Mental Illness

Highly daily dosage of medications

Injection drug use

Mixing alcohol with drugs

Using multiple drugs, street drugs, or drugs alone

History of overdose

What are the Signs & Symptoms of Drug Overdose?

Drugs have numerous effects on the entire body. Generally, in an overdose, the effects of the drug may be a heightened level of the therapeutic effects seen with regular use. In an overdose, side effects become more pronounced, severe, and can potentially be lethal.

Signs and Symptoms of an Overdose:

- Problems with vital signs (temperature, pulse, respiratory rate, blood pressure) are possible and can be life threatening. Vital sign values can be increased, decreased, or absent.

- Sleepiness, confusion, and coma are common and dangerous if the person aspirates.

- Cool and dry, or hot and sweaty skin.

- Seizures may occur.

- Chest pain, shortness of breath, rapid, slow or shallow breathing.

- Abdominal pain, nausea, vomiting, and diarrhea are all possible. Vomiting blood, or blood in stool can be life threatening.

- Organ damage

- Reduction of pupils

- Brain damage can also result from suppression of lung and heart function, and is generally permanent. 

Treatment of Overdose

If a person is suspected of an overdose, call 911 immediately!

Treatment will be based on the specific drug taken in the overdose. Any information provided about the amount ingested, time, and underlying medical problems will be very helpful to emergency responders.

Some of the treatments for a drug overdose include:

- Activated charcoal: which may be given to help bind the drugs and keep them in the stomach and intestines. This reduces the amount absorbed into the blood. The drug, bound to the charcoal, is then expelled in the stool. Often, a cathartic is given with the activated charcoal, so that the person more quickly evacuates stool from his or her bowels.

- Naloxone HCL: Naloxone hydrochloride injection is indicated for the complete or partial reversal of opioid depression, including respiratory depression, induced by natural and synthetic opioids. This sterile solution is intended for intravenous, intramuscular, and subcutaneous administration.

- Narcan Nasal Spray: Narcan is an opioid antagonist used for the complete or partial reversal of opioid overdose - including respiratory depression. Narcan is also used for diagnosis of suspected or known acute opioid overdose, as well as blood pressure support in septic shock. It counteracts the life-threatening effects of opioid overdose, and it is the first and only FDA approved nasal form of Naloxone

- Naloxone Kit: These kits are used by Police Departments, Harm Reduction Coalition Agencies, Drug Treatment Centers, and family members at home. The Naloxone kit contains everything someone would need to reverse an overdose of opioids or heroin. It contains the Narcan Nasal Spray, Atomizer, Prefilled Syringe, CPR Mask, and Nitrile Gloves.

- Drug Overdose Prefilled Syringes: Drug Overdose Prefilled Syringes contain Naloxone Spray medication used to revive a person who is overdosing. The syringes are designed to work in conjunction with the MAD300 Nasal Atomization Device, and is safe, effective, fast-acting, and needleless.

- For certain overdoses, other medicine may need to be given either to serve as an antidote to reverse the effects of the drug taken, or to prevent even more harm from that drug taken. A medical professional will decide if treatment needs to include additional medicines. 

Bare in mind that agitated or violent people need physical restraint and sometimes sedating medications in the emergency department until the effects of the drugs wear off. This can be disturbing for a person to experience, and for family members to witness. Medical professionals go to great lengths to use only as much force and medication as necessary.

It is important to remember that whatever the medical team does, it is always to protect the person they are treating. For instance, sometimes the person has to be intubated, so that the doctor can protect the lungs or help the person breathe during the detoxification process. 

Everyone who suffers an overdose needs to be seen by their doctor for a follow-up. This is to ensure that there are no delayed injuries to any organ system, and to make sure that prevention against a recurrence is in place. 

After an intentional drug overdose has been managed and the person is out of danger, psychiatric care must be provided. The user of illicit drugs should also be considered for a psychiatric evaluation. In addition, finding a support group, or a rehabilitation facility for a psychiatric and substance abuse problem can be helpful.

For children, the experience of being treated for an overdose may have been frightening. They will need help in coping with the trauma, as well as learning from the mistake. Following up with their pediatrician can reduce anxiety. A key factor to remember is not to assign guilt, or make judgments. Discuss prevention and safety with the doctor.

Prevention & Prognosis

 

To prevent accidental overdoses, all medications must be kept in a safe, secure place. For children, keep all medications - including vitamins and over-the-counter medicines out of reach. For the elderly, make sure they understand how to take their medication, and can recognize one medicine from another. Supervision, pill containers, and labeling can help the person distinguish each medicine. Some pill containers even come with audible alarm clocks that can be used as a reminder to take medications at a certain time.

Intentional overdoses are a little more difficult to prevent, as the underlying issues need to be addressed, but it is possible. Unintentional, illicit drug overdose is a serious problem that is best solved by removing the person away from access to the illicit drug use. 

People who have certain mental health conditions need the help of family, friends, and medical professionals to assist with their own medication therapy, and to lend social support. Education, compassion, and care is needed in order for the person to remain clean and safe.

The prognosis for drug overdose can vary. In many cases, a person who overdoses generally recovers completely and without lasting physical disability. However; some drug overdoses are fatal, even with appropriate and timely treatment, as some drugs can cause damage to organ systems. The liver and the kidneys are two organ systems at high risk. 

If the mental health problems that led to an intentional overdose are not addressed, then the person remains at risk for repetitive drug overdoses. Multiple overdoses can have a cumulative effect on some organ systems, and can lead to injury and organ failure. 

Key Takeaways

Overdosing - whether accidental or intentional is dangerous, and needs to be treated as an immediate medical emergency. 911 should be contacted immediately, so help can get to the person as quickly as possible. 

With education and safety preparation, accidental overdoses are easier to prevent. Intentional overdoses take much more evaluation and time to establish the root of the issue. Education, however is necessary in these cases as well. 

Those who struggle with substance abuse should not be stigmatized. The biggest misconception, especially when discussing drug use, is that people make the choice to use, become addicted, and overdose. Unfortunately, that is not always the case, and it is not always that simple. Those with mental illnesses don't choose to lead that lifestyle, and they should be treated with the same kindness and compassion as any other patient who has a physical illness. 

It is only through openness, a willingness to talk, and educate, can society begin to make a difference. It is only through understanding can society lend a helping hand to those who are suffering, and healing can begin. As stated in the previous post: Addiction needs to be treated with tender care, gentleness, and compassion. It is not something to take lightly, and it is not something that anyone should shame. It is time to bring this taboo subject into the light. Support, encouragement, and help is what an individual struggling with addiction needs. Be there. Let's let everyone know that it is okay to have a mental illness and addiction problem. 

And, let's let everyone know that there is help and treatment available, and it is perfectly acceptable to receive it. Let's let them know that their lives matter, they are enough, and that their recovery is important, so we can start to see those heartbreaking numbers go down.  

Naloxone from Mountainside Medical Equipment on Vimeo.