Author: Anjali Talcherkar, PhD

Narcotics, also known as opioids, are drugs that include prescription pain relievers as well as illicit street drugs. Narcotic painkillers such as OxyContin and Vicodin are used to treat moderate to severe pain. However, they can lead to physical dependence and addiction with regular use over time or misuse.^1,2  Misuse and addiction can lead to narcotics overdose. In 2019, approximately 50,000 in the U.S. people died from overdoses related to opioid use.³

In This Article:

• Signs of Narcotics Overdose
• Treating a Narcotics Overdose
• Long-term Treatment for Opioid Addiction

Signs of Narcotics Overdose

Drug overdose is the most frequent cause of accidental death in the U.S. Opioids are responsible for the highest number of overdose deaths.⁴

Narcotics misuse can lead to death due to the effect of opioids on the part of the brain that regulates breathing. If you are worried someone you know may be experiencing an overdose, look out for certain narcotics overdose symptoms.

Signs of an opioid overdose include:⁴

• Dilated pupils
• Unconsciousness
• Difficulty breathing
• Stupor
• Sluggish movements
• Confusion
• Cold/clammy skin
• Slowed heart rate
• Low blood pressure
• Bluish tint to nails and skin

If you see someone exhibiting signs of a narcotics overdose, call 911 immediately. The most widely misused opioid drugs include:⁴

• Fentanyl
• Heroin
• Oxycodone
• Morphine
• Methadone
• Hydrocodone
• Codeine
• Carfentanil
• Tramadol
• Hydromorphone

Some of these opioids are highly potent and misusing them can create life-threatening side effects. For example, fentanyl is around 50-100 times more potent than morphine.⁵ And carfentanil is approximately 100 times more potent than fentanyl.⁶

Misuse of narcotics includes taking prescription opioids more frequently or in larger amounts than prescribed by your doctor. Misuse also occurs if you modify the form of the narcotic to achieve increased effects (e.g., crushing pills or opening capsules),  combine multiple opioids, or mix opioids with illicit substances.⁷

Risks of Narcotics Overdose

Certain risk factors increase the chance of experiencing a narcotics overdose. These include:⁸

• Having an opioid use disorder as defined by the American Psychiatric Association’s Diagnostic and Statistical Manual (DSM-5) clinical criteria
• Taking opioids in injection form
• Retaking opioids after an extended period of abstinence
• Using prescription opioids without a prescription
• Using a high prescribed dosage of opioids (i.e., the equivalent of 100mg of morphine or more daily), regardless of whether that dosage was prescribed by a doctor
• Combining opioids with alcohol or other substances or medicines that suppress respiratory function (e.g., barbiturates, benzodiazepines, anesthetics, or certain pain medications), including medications prescribed by your doctor
• Having concurrent medical conditions that affect the immune system, major bodily functions, or ability to take medications consistently as prescribed (e.g., certain mental health conditions, liver disease, respiratory conditions, or autoimmune diseases)

Treating a Narcotics Overdose

Death is preventable in most severe overdoses if the narcotics overdose is handled immediately. Naloxone is a medication that can reverse the effects of an overdose by restoring breathing in a person who has overdosed on opioids. Naloxone is not effective on non-opioid drugs such as cocaine or methamphetamine.

Naloxone can be given in the following ways:⁹

• Healthcare providers and first responders can inject a dose of naloxone into a person’s muscle, vein, or under the skin.
• A nasal spray form of naloxone can be used by family members, loved ones, or bystanders by spraying into one nostril of the person who has overdosed while they lay on their back. In April 2021, the FDA approved a new, more potent 8 mg naloxone nasal spray under the brand name Kloxxado.¹⁰ A 4-mg naloxone nasal spray is also available under the brand name Narcan.

Naloxone is available in many states without a prescription from your local pharmacy. In other areas, a doctor’s prescription may be required. Health insurance may cover the cost of the medication; check with your insurer. If you don’t have insurance, some drug manufacturers offer coupons to help cover the cost of naloxone. Or you may be able to get naloxone free of charge from community health organizations or your local health department.⁹

Naloxone is effective in blocking the symptoms of opioid overdose for only 30 to 90 minutes and should not be considered an “overdose cure.” A person who is treated with naloxone should also receive immediate care and monitoring by an emergency healthcare provider.⁹

Initial treatment of opioid overdose begins with supportive care and may include assisted respiration and CPR in addition to naloxone administration, if needed.⁴

Long-term Treatment for Opioid Addiction

Formal treatment can help address the underlying issues leading to addiction and opioid overdose. Finding the right treatment program can help you detox safely and establish long-term recovery.

Detox, the first stage of addiction treatment, usually lasts three to seven days but can be longer depending on the length of substance use. Detox helps to stabilize the individual and manage the uncomfortable and potentially medically significant effects of coming off of opioids. This initial phase often includes the use of medications to ease the detox process. Doctors usually start by gradually lowering the dosage until you are completely free from the drug.

Once detox is over, your care team may recommend that you enter a long-term inpatient facility or outpatient program, especially if you have experienced a narcotics overdose. Statistically, if you do not receive any treatment beyond detox, you are at higher risk of relapse into narcotic drug use.¹¹

A variety of treatment options are available:¹²

• Inpatient treatment provides intensive management of chemical dependence and co-occurring disorders. Residential program options include therapeutic communities where a person remains for 6 to 12 months to achieve long-term change. Shorter-term programs (i.e., 30 to 60 days) prepare individuals for treatment in a community-based setting.
• Outpatient treatment includes behavioral therapy that can help you identify unhelpful through patterns and manage substance use behaviors, and stay motivated to achieve long-term sobriety.
• Recovery support groups include 12-step and other peer support programs that provide motivation and accountability to stay sober.

If you or a loved one is struggling with opioid dependence, reduce the chances of a narcotics overdose by pursuing treatment proactively. Call 800-934-1582(Who Answers?) for help with locating treatment services.