Drug and Alcohol Overdoses in The United States and Missouri

drug and alcohol overdoses in the United States and Missouri

While there have been declines in some states, Missouri hasn’t been one of them. Even with the national average going down by 4.2%, overdose deaths in Missouri went up by 17%. Opioid-related deaths have been the most common, as fentanyl and heroin have taken the most victims.

Most current data shows that drug-related overdose cases have increased continuously in the past two decades. The main culprit for lethal overdoses changed throughout the years, but the final numbers reported kept on growing. Since 1990, drug-related reported deaths tripled. 

Many factors have affected the national scenario of overdoses. In 1999, trace amounts of cocaine and prescription opioids were the most often found among victims. Surprisingly, prescription opioids were still among the top three killers by 2017, along with synthetic narcotics (other than methadone) in first and heroin in third. Cocaine-related deaths dropped to the fourth most common cases reported.

One of these changes in the United States were the multiple waves of the opioid crisis – specifically, three of them. The first, starting in 1990, was caused by prescription opioids. However, the second one was marked by the increase in heroin-related deaths in the 2010s. But the worst of them has been the rise of synthetic opioid overdoses. Starting in 2013, it quickly reached unprecedented numbers in just four years.

As of now, fentanyl is and has been the drug more commonly linked to overdose deaths. Initially, death reports were mostly concentrated on the East coast, as the drug first came in through New England. Now, it has started to spread over to the West coast, meaning this wave of the opioid crisis is still bound to rise even more.

What Is An Overdose And What Happens During One?

An overdose is a result of an excessive dose of one or more substances for the body to process. It is a biological response to that overstimulation, and it can result in many different symptoms. They can be caused by a number of illicit and legal substances, like pills, alcohol, opioids, prescription medication, and even over-the-counter medicine. 

Overdoses aren’t necessarily all lethal and can be reversed depending on the dose, the symptoms, the timing of the response, and many other factors. What makes an overdose deadly are the effects of the substance(s) on the body and how quickly they worsen. It is difficult to say what dose is “safe” for each person since it differs from person to person. While there is a stipulated average to be avoided, tolerance and general habits come into play in this.

That is why accidental overdoses are the most common, and hard to avoid. Whether it is only someone’s first time, or even if they’ve been addicted for long, anyone can overdose. Lowered tolerance, substances with lethal reactions when mixed together, increasing usual doses – many things can cause an overdose. This could actually put people suffering from a dual diagnosis even more at risk from overdosing accidentally.

The signs of an overdose will depend on what was being used. In an oversimplified way, the red flags to look out for are:

  • Marijuana: extreme drowsiness, unsteady gait, agitation, vomiting, fast heart rate, psychosis
  • Opioids: lowered level of consciousness, shortness of breath or no breathing, cold/clammy skin, bluish skin, constricted or dilated pupil (depends on brain activity)
  • Stimulants: fever or overheating, fast and/or erratic heart rate and other cardiovascular problems, high blood pressure, agitation, hallucinations and/or other psychotic behavior, seizures
  • Central nervous system (CNS) depressants (benzodiazepines, sleeping pills, barbiturates): shallow breathing, slow heart rate, sweating, and clammy skin, coma, respiratory arrest
  • Hallucinogens: psychotic behavior, agitation, delirium
  • Inhalants: marked CNS depression, loss of or going in and out of consciousness, coma, irregular heartbeat

Reportedly, one of the most common symptoms is respiratory problems. That is especially true when using depressant substances, such as alcohol or opiates. They slow down the nervous system to the point of affecting breathing, and eventually, could shut down the system. 

Long-term Effects of An Overdose

Overdosing can cause permanent damage to multiple organs, depending on the effects. The time it might take to address them can be too long to avoid long-term consequences. It is virtually impossible to be “prepared” for an overdose and the possible outcomes.

As respiratory problems are some of the most common effects, brain injury deriving from them are common, too. Slow breathing or lack thereof can cut the supply of oxygen to the brain. These injuries, called hypoxic or anoxic brain injury, damage and kill neural brain cells. 

These effects depend on how much time the brain goes without oxygen. But five minutes is enough for a victim to suffer permanent brain damage. They can range from mild to severe, such as:

  • Limited movement, loss of balance and/or coordination
  • Damage to the senses such as hearing and sight
  • Speech problems, from speech impediments to inability to communicate
  • Problems with written communication
  • Difficulty thinking and/or concentrating
  • Memory problems
  • Vegetative state 

Besides brain injuries, other organs can become overworked and scarred from the experience. Since the liver is responsible for processing toxins, it is at high risk of permanent damage. Additionally, the kidneys can also suffer from the overdose because they are responsible for filtering substances. These two organs are more likely to fail or suffer from permanent damage if there was a pre-existing or dormant disease before the overdose.

What To Do During An Overdose

The right procedure would obviously depend on the symptoms. If they are blacking out, or they look like they are sleeping but will not respond, that could be a red flag. If their system has slowed down too much, they would do exactly that.

The first and most important step is to call for an ambulance. There are a number of drugs and procedures that can only be used and performed by licensed professionals. The sooner you call them, the better the chances of recovery for the victim are. 

One of the recommended cautionary actions to take is to put the person in the recovery position. It is recommended that they should be put lying on their left side. What you need to do is:

  • Stretch the arm they are lying in a right angle from their body, to stop them from rolling over
  • Put the hand from their other arm under their chin, to keep the mouth open
  • Turn the person slightly to the side 
  • Bend the knee from the leg that is on top so it can support their position

The recovery position helps keep their airways clear. This way, the person won’t choke in case they throw up, and they won’t turn to a position that is harder to breathe.

For opioid overdose cases, it is possible to safely administer naloxone. Naloxone is an opiate reversal drug, like an antidote. It aids with cutting the effects of the drug and restoring breathing. It has been used since the 60s and recommended as an emergency procedure to be done as you wait for help to arrive. 

Legal Issues: Will I Get Into Trouble If I Call 911?

In Missouri, there are laws protecting people who call for help for an overdose. Called “Good Samaritan Law”, it protects those who call 911 from arrest for drug possession or paraphernalia. Whoever actively calls for help and those experiencing the overdose will not be charged with minor drug or alcohol violations. 

The immunity from the Good Samaritan Law applies to the following charges: possession of a controlled substance, possession of drug paraphernalia, possession of an imitation controlled substance, keeping or maintaining a public nuisance, sale of alcohol to a minor, possession of an altered ID, purchase or possession of alcohol by a minor, violation of a restraining order, and/or violation of probation or parole. 

However, it does not apply to other possible charges related to the manufacturing or distribution of drugs. Also, it doesn’t null or protects from active warrants, especially if prior to the incident.

Other states and areas have also adopted similar laws. This is meant to reduce the number of deaths by encouraging people to call professionals. Unfortunately, they change from state to state.

Misconceptions About Overdosing And What Not To Do

There are dangerous beliefs about what to do when someone is overdosing that can actually make matters worse. Before doing anything, it is important that the priority is to contact a medical professional. Calling for an ambulance or taking them to the hospital is the best way to help. 

Still, due to portrayals in the media and misinformation, people tend to do the wrong thing in the hopes of helping. Even with the best of intentions, some of the biggest misconceptions of what to do are:

  1. Giving them a bath or a shower might help – These can both make their core body temperature go up or down too quickly, making their body shut down and go into shock. Additionally, they could also drown in a bath.
  2. Letting them sleep it off – By doing so, they might actually slip into a coma or die without your knowledge. Some of the symptoms of an overdose might actually make them sleepy. If they throw up, they could also choke. Some people also think that, if the person is snoring, they are safe because they are breathing – another misconception. This is indicative of breathing problems, also common to overdoses.
  3. Inducing vomiting – The idea behind this is usually to get the substance out of their system. First, this is not a substitute for a stomach pump, if it is needed. Second, this could make them choke as well as worsen other symptoms, like an irregular heartbeat.
  4. Giving them a stimulant (caffeine, cocaine, etc) – While you shouldn’t let them sleep it off, giving stimulants isn’t a good idea, either. This can overstimulate their system, or trigger more symptoms. Plus, mixing substances is what can lead to an overdose in the first place.
  5. Thinking they are safe and can even use again after Naloxone – Naloxone will wear off soon enough, usually lasting for only a couple of hours. In fact, a person can drop again even if they don’t abuse more. Naloxone should only be used to contain symptoms before emergency services arrive.
  6. Presuming they are okay because they are breathing – Overdosing is not linear, and it has ups and downs. The person might slip in and out of consciousness, for instance. It is also not always sudden, and it might take hours before the person actually is in serious trouble. Breathing just means their respiratory system hasn’t been affected – yet.

The best thing to do is to make sure they are in a safe environment as you get help. And not leave them alone. Only a professional can say what the best course of action can be for these situations. As each substance has its own symptoms, they all also have their own antidotes and treatment.

Don’t Wait For An Overdose To Get Help

When facing substance use disorder, an overdose is only proof that a drug or alcohol habit has gone too far. There are many moments and red flags that can come before it. There is no planning for it and no guarantee that you can get help in time. Even if you have overdosed in the past, there is still hope. Everyone deserves the help they need to never, ever have to face a traumatic experience like an overdose. 

Every time you use, you are risking an overdose. So the right time to ask for help is now. We at Sana Lake Recovery Center can help anyone turn away from substance use disorder and lead a clean, sober life. Our programs are designed according to your final goals, based on outcome studies and research. We believe in recovery that does more than getting you sober – it improves your quality of life.

If you or a loved one wants to learn more about our recovery treatment programs, visit our website and contact us today. We can answer all of your questions and provide you with any information you might need. Deciding to quit is a big step, and we hope to be the team that will help you in that journey to an independent, healthier you.

References:

https://www.emedicinehealth.com/drug_overdose/article_em.htm#what_are_the_symptoms_and_signs_of_a_drug_overdose

https://www.drugabuse.gov/related-topics/opioid-overdose-reversal-naloxone-narcan-evzio

https://www.cdc.gov/drugoverdose/data/statedeaths.html

https://www.cdc.gov/drugoverdose/epidemic/index.html

https://health.mo.gov/safety/ems/more/pdf/good-samaritan-brochure.pdf

Article Reviewed by David Sherman, MD

David Sherman, MDDavid Sherman, MD is a Fellow of the American Society of Addiction Medicine (FASAM) and board certified in Addiction Medicine with the American Board of Preventive Medicine. He is a native Missourian and graduated medical school at the University of Missouri-Columbia School of Medicine. Dr. Sherman completed a two-year fellowship in Addiction Medicine at the University of Florida in Gainesville. He leads a highly trained staff of master level certified addiction professionals. Men and women from all over Missouri and the United States come to Sana Lake Recovery Center to get the care they need and deserve.