Heroin Overdose: Signs, Symptoms & Treatment

A heroin overdose occurs when an individual consumes more heroin than their body can process, overwhelming their system and leading to potentially fatal consequences. Overdosing on heroin slows down the body’s vital functions, particularly breathing, which can quickly lead to unconsciousness, coma, or death if not addressed immediately. The risk of overdose is heightened by the unpredictable strength of heroin and the frequent presence of other potent substances like fentanyl.

Recognizing the signs and symptoms of a heroin overdose is critical for timely intervention. Immediate action can save a life, but it requires knowing what to look for.

Signs & symptoms of opioid overdose include1,2:

• Slow or shallow breathing: Breathing may become extremely slow or stop altogether.
• Blue lips or fingertips: A bluish tint, known as cyanosis, can appear due to lack of oxygen.
• Weak pulse: The heartbeat may be slow, irregular, or hard to detect.
• Unconsciousness: The person may be unresponsive and unable to be awakened.
• Limp body: Muscles may feel relaxed or weak.
• Choking or gurgling sounds: These sounds may indicate airway obstruction or difficulty breathing.
• Cold or clammy skin: Skin may feel cold to the touch and appear pale.

Identifying these symptoms early and responding quickly is crucial in managing a heroin overdose.

A heroin overdose is a critical medical emergency that requires immediate action. If you suspect someone is overdosing on heroin, the first and most important step is to call 911 for emergency assistance. Time is crucial in these situations, and prompt medical intervention can be the difference between life and death. While waiting for help to arrive, administering Narcan (naloxone) can temporarily reverse the effects of the overdose. Staying with the person, trying to keep them awake, and monitoring their breathing are essential actions to take during this critical period.

If you suspect someone is overdosing on heroin, take the following steps to help them3:

1. Call 911 immediately: Inform the dispatcher that you suspect a heroin overdose. Provide them with as much information as possible, including the person’s condition and location.
2. Administer Narcan/naloxone: If you have Narcan (naloxone) available, administer it immediately. Narcan can temporarily reverse the effects of an opioid overdose and buy time until professional help arrives.
3. Keep the person awake and breathing: Encourage the person to stay awake and try to engage them in conversation. If they are unconscious but breathing, place them in the recovery position (lying on their side) to prevent choking.
4. Monitor their breathing and vital signs: Keep a close watch on their breathing, pulse, and overall condition. If they stop breathing, begin CPR if you are trained to do so.
5. Stay with them until help arrives: Do not leave the person alone. Continuously monitor their condition and be ready to provide information to emergency responders when they arrive.

These steps are vital in responding effectively to a heroin overdose, helping to stabilize the individual until professional medical care is available.

Narcan (Naloxone) for Opioid Overdoses

Narcan, also known as naloxone, is a medication specifically designed to reverse the effects of opioid overdoses, including those caused by heroin. It works by quickly binding to opioid receptors in the brain, displacing the heroin and temporarily reversing the life-threatening effects such as respiratory depression. Narcan is safe, easy to administer, and available in both injectable and nasal spray forms, making it a critical tool in preventing overdose deaths.

Take the following steps to use Narcan to reverse an opioid overdose4:

1. Check for responsiveness: Before administering Narcan, try to rouse the person by shouting their name and shaking them gently. If they are unresponsive, proceed with the following steps.
2. Administer the spray: Hold the Narcan nasal spray with your thumb on the bottom of the plunger and your first and middle fingers on either side of the nozzle. Gently insert the tip of the nozzle into one nostril until your fingers are against the person’s nose. Press the plunger firmly to release the dose into the person’s nostril. This should be done in one quick motion.
3. Call 911 immediately: After giving the first dose, call 911 to get emergency medical help. Inform the dispatcher that you have administered Narcan for a suspected opioid overdose.
4. Wait and monitor: After administering the first dose, wait 2-3 minutes while observing the person’s breathing and responsiveness. If there is no improvement or if the person relapses into an unresponsive state, administer a second dose if available.
5. Stay with the person: Continue to monitor their condition and provide support until emergency medical services arrive.

Knowing how to use Narcan can save a life. These steps ensure the best possible outcome during a heroin overdose emergency until professional help arrives.

While taking an excessive amount of heroin is a primary cause of overdose, several other factors significantly heighten the risk. These include mixing heroin with other substances, using heroin after a period of abstinence, and existing health conditions.

Common causes and risk factors of heroin overdose6,7:

• Mixing heroin with other substances: Combining heroin with other depressants, such as alcohol or benzodiazepines, can dramatically increase the risk of respiratory failure. When heroin is mixed with stimulants like cocaine or meth, a practice known as “speedballing,” the risk of overdose is further elevated due to the conflicting effects these substances have on the body. The unpredictable interactions between these drugs make an overdose more likely.
• Using heroin after a break: After a period of abstinence, such as during recovery or after incarceration, a person’s tolerance to heroin decreases significantly. If they resume using heroin at the same dosage they used before the break, their body may not be able to cope, leading to an overdose. This is a common scenario among those who relapse.
• Health conditions and age: Chronic health conditions, especially those affecting the liver and kidneys, can impair the body’s ability to metabolize heroin, increasing the risk of overdose. Additionally, older adults face a higher risk due to slower metabolism and the likelihood of other medical issues.
• High potency or purity of heroin: The potency of heroin can vary widely, and users may not be aware of how strong their supply is. A batch with higher-than-expected purity can lead to an overdose, particularly if the user is unaware of its strength.
• Using heroin alone: Individuals who use heroin alone are at greater risk of fatal overdose because there is no one to assist or call for emergency help if they experience an overdose.

Recognizing these risk factors is crucial in understanding how heroin overdoses occur and how they can be prevented. Being aware of these causes can also help guide those at risk toward seeking help and adopting harm-reduction strategies.

Risk of Fentanyl-Laced Heroin

One of the most significant dangers associated with heroin use today is the contamination of heroin with fentanyl, a synthetic opioid that is 50 to 100 times more potent than morphine8. Fentanyl-laced heroin is particularly hazardous because users are often unaware of its presence, leading to a substantially higher risk of overdose.

The dangers of fentanyl-laced heroin:

• Unpredictable potency: The presence of fentanyl in heroin makes its potency highly unpredictable. Even a tiny amount of fentanyl can cause an overdose, especially since users may not realize it is mixed in their supply. This unpredictability greatly increases the risk of accidental overdose.
• Rising overdose deaths: The increase in fentanyl-related overdoses has been alarming. According to the CDC, synthetic opioids like fentanyl are now responsible for the majority of opioid overdose deaths in the United States. This trend highlights the danger posed by fentanyl-laced heroin.
• Challenges in prevention: Because the illicit drug market is unregulated, it is difficult for users to know whether their heroin is contaminated with fentanyl. Harm reduction strategies, such as using fentanyl test strips, avoiding using heroin alone, and always carrying naloxone, are essential for those who continue to use heroin.

Understanding the risks associated with fentanyl-laced heroin is vital for anyone using or considering using heroin. It also emphasizes the importance of seeking professional help to avoid these dangers and ensure safety.

Harm reduction is a set of strategies designed to minimize the negative health, social, and legal impacts associated with drug use, without necessarily requiring abstinence. For individuals who use heroin, harm reduction practices are crucial in preventing overdoses and ensuring safer use. These strategies acknowledge the reality of drug use and focus on practical ways to reduce the risks, ultimately saving lives.

Tips to prevent a heroin overdose6,7,8,9:

• Always carry naloxone (Narcan): Naloxone is a medication that can rapidly reverse the effects of an opioid overdose, including heroin. Carrying naloxone and knowing how to use it can be life-saving, not just for yourself, but for others who might be at risk.
• Use with someone else present: Avoid using heroin alone. Having someone nearby can be critical, as they can administer naloxone or call for emergency help if an overdose occurs.
• Test your drugs before use: Due to the high risk of heroin being laced with fentanyl, it’s important to test your drugs before using them. Fentanyl test strips can help detect the presence of this potent substance, reducing the risk of an unexpected overdose.
• Start with a small dose: Especially if your tolerance has decreased or you are unsure of the purity of the heroin, start with a smaller dose to gauge its effects.
• Avoid mixing substances: Mixing heroin with other drugs or alcohol significantly increases the risk of overdose. Avoid combining substances to reduce the likelihood of dangerous interactions.
• Educate yourself and others: Understanding the signs of overdose and how to respond can make all the difference in an emergency. Share this knowledge with others in your community to help create a safer environment for everyone.

By following these harm reduction strategies, individuals who use heroin can significantly reduce their risk of overdose and its devastating consequences.

References

1. Harm Reduction Coalition. (n.d.). Recognizing Opioid Overdose. Retrieved from https://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/recognizing-opioid-overdose/
2. Substance Abuse and Mental Health Services Administration (SAMHSA). (n.d.). Opioid Overdose. Retrieved from https://www.samhsa.gov/medications-substance-use-disorders/medications-counseling-related-conditions/opioid-overdose
3. Harm Reduction Coalition. (n.d.). Responding to Opioid Overdose. Retrieved from https://harmreduction.org/issues/overdose-prevention/overview/overdose-basics/responding-to-opioid-overdose/
4. Narcan. (n.d.). Frequently Asked Questions. Retrieved from https://narcan.com/frequently-asked-questions
5. Massachusetts Department of Public Health. (n.d.). Opioid Overdose Risk Factors. Retrieved from https://www.mass.gov/info-details/opioid-overdose-risk-factors
6. Centers for Disease Control and Prevention (CDC). (n.d.). Overdose Prevention Strategies. Retrieved from https://www.cdc.gov/overdose-prevention/prevention/index.html
7. Centers for Disease Control and Prevention (CDC). (n.d.). Safety and Prevention of Overdose. Retrieved from https://www.cdc.gov/stop-overdose/safety/index.html
8. New York State Office of Addiction Services and Supports (OASAS). (n.d.). Prevent Overdose: What You Need to Know. Retrieved from https://oasas.ny.gov/prevent-overdose
9. New York State Department of Health. (n.d.). Opioid Overdose Prevention: Know the Signs. Save a Life. (Publication No. 9895). Retrieved from https://www.health.ny.gov/publications/9895.pdf