Opioids How do people overdose on Oxycodone?

[Lucky25]

Please excuse the lengthy question, but I am confused by the concept of prescription opiate overdoses. Their are thousands upon thousands every year. I fully understand how someone can overdose on a street drug like heroin. Given the extreme variability in potency and purity, a typical dose could end up being fatal if you end up getting a batch laced with fentanyl etc. However, I simply don't understand how someone can overdose on a drug like oxycodone or hydrocodone with a known dose and known purity other than through extreme irresponsibility? The only instances that logically makes sense to me is naive users who have no tolerance and bang an oxy 80 their first time, not knowing a proper first time dose should be around 10-20mg. It also makes sense how someone mixing opiates with other suppressants can overdose. However I need the following clarified:

So as one takes opiates they gain a tolerance which requires more of the drug to achieve the same effects. However, does this mean that their is less suppression of breathing etc than a non- tolerant person too? So, if someone slowly increased their dose by 5mg every month for a number of years could they end up taking doses of several hundred milligrams and be perfectly safe due to their tolerance?

In short, for experienced opiate users, are overdoses because they take a radically higher dose than they typically do? Or is their some threshold you can hit where an overdose is all but guaranteed, regardless of tolerance?

Personally, I never took more than 25 mg. When this stopped creating recreational effects for me, I stopped using for a period of time until this dose produced effects again. I can't envision a way in which I could ever OD unless I literally tried to...

 

[Jabberwocky]

Most of these “opioid ODs” are actually poly substance overdoses. Namely benzos and opioids, and alcohol and opioids.

It’s actually a lot harder than most people realize to fatally OD on just opioids alone. It’s not that hard to OD, just not fatal ones.

 

[GetMeOutOfThisCRAP]

I've wondered this too.. after a certain point I just struggle breathing and that's even a good 40 mgs before actually OD'ing or so. It loses it's euphoria when I'm panicking about dying and I imagine people taking huge amounts are not naive to the drug either.

I know when I've done too much when I've got numbness and tingling all over my body (happened during an unfortunate time and location too). But even at that point I think I would need alot more oxy to die.

 

[tacodude]

It could be alcohol, legally prescribed benzo by a clueless doctor, benzo given by a friend as a headache pill, pain levels reducing leading to more respiratory depression and ability to fall into it due to pain not causing one to be pulled out and distracted from the effect, and many other ways.

Easy way to put it... Shit happens.

IMO those numbers are greatly exaggerated

 

[Jekyl Anhydride]

Oxycodone hits the Kappa Opioid Receptor fairly hard and makes for an unpleasant experience when taken in non fatal excess, but just as H addicts can grow their habit to over a gram a day Oxy users can build heroic tolerances as well. I don't agree with a "Universal Amount" that causes OD's but instead a highly variable amount depending on many factors and the individual. Tolerance and other sedative drugs being at the top of the list.

 

[PerpetualAnhedonic]

While tolerance develops to many (especially the psychological) effects of opioids, it doesn't really develop for the depressant effects on the respiratory system....so while people are taking more and more as they gain tolerance, they're further depressing their respiratory system, unbeknownst to them, that they're not immune to suffocation- despite their partial immunity to the other effects- put simply.

And as others have already stated, a great many of "opioid" OD's are actually due to polysubstance abuse. Substances such as benzos, barbs, alcohol in combination greatly increase not only the respiratory depressant effects that I already spoke of, but the whole nervous system as well..plus the vomiting.

Fairly simple concept to understand, really.

-PA

 

[tacodude]

Jekyl it coverts into oxymorphone though, which is a quite potent mu agonist

 

[GetMeOutOfThisCRAP]

I assume when one OD's they nod out without realizing it and then stop breathing? What if someone realized they made a mistake and took a bunch of adderall/coffee/caffeine pills or something to counteract the passing out part... would that even help save anyone? sorry if dumb q

 

[Jabberwocky]

If you take enough stimulants it can kinda prevent OD, but if someone has taken enough gabaergic and opioid substances to depress the breathing significantly nothing will help other than an antagonist. Plus when the stims wear off they’re fucked regardless. If anything stims are dangerous because tend to increase ones capacity for opioids... at least until they wear off.

That’s how I ODd on clonazepam, cocaine and heroin...

 

[Lucky25]

While tolerance develops to many (especially the psychological) effects of opioids, it doesn't really develop for the depressant effects on the respiratory system....so while people are taking more and more as they gain tolerance, they're further depressing their respiratory system, unbeknownst to them, that they're not immune to suffocation- despite their partial immunity to the other effects- put simply.
-PA

This is the clarification I was looking for. This is what I was getting at with the concept of a "threshold where overdose is all but guaranteed regardless of tolerance". However, with anecdotes of people taking hundreds and hundreds of milligrams I'm curious at what dose this starts to take place. Again, if there's a threshold like this where you know od is likely regardless of tolerance, you'd think it would be fairly simple just to avoid taking a dose that large.

 

[PerpetualAnhedonic]

This is the clarification I was looking for. This is what I was getting at with the concept of a "threshold where overdose is all but guaranteed regardless of tolerance". However, with anecdotes of people taking hundreds and hundreds of milligrams I'm curious at what dose this starts to take place. Again, if there's a threshold like this where you know od is likely regardless of tolerance, you'd think it would be fairly simple just to avoid taking a dose that large.

There is no universal "threshold" for this. It depends on a great many factors regarding each specific individual, their body, their health, everything they've consumed....impossible to say how much will be too much.

Perhaps it'd be even simpler to stick around lower dosages than to get up to higher ones where you WOULD have to be concerned with this dilemma. And yes, there are people with tolerances such as you state.

-PA

 

[PerpetualAnhedonic]

If you take enough stimulants it can kinda prevent OD, but if someone has taken enough gabaergic and opioid substances to depress the breathing significantly nothing will help other than an antagonist. Plus when the stims wear off they’re fucked regardless. If anything stims are dangerous because tend to increase ones capacity for opioids... at least until they wear off.

That’s how I ODd on clonazepam, cocaine and heroin...

Jabberwocky hit the nail on the head here for getmeout's question....psychostimulants WILL wake you up, AS WELL AS open up your airways....but only until they wear off....danger in this being that you may wind up OD'ing on opioids/downers without realizing it until the stim wears off and then your totally fucked.

-PA

 

[tacodude]

OD don't have to be fatal. For someone managing pain any effect beyond pain relief is a side effect indicating an overdose such as nodding, itching, or even "euphoria" type effects

What you're thinking of are fatal overdoses if not for intervention such as narcan, which can hit immediately or gradually come on slowly. Usually immediate falling out (going unconscious during the overdose process) is associated with injecting, but could easily happen nasally or even orally if it turned out to be fentanyl and some powder ends up under the tongue absorbing sublingually, which increases the bioavailability of fentanyl a large amount vs swallowing it being the reason they make sprays, lollipops, and dissolving sublingual tablets yet no oral sustained released tablet likely due to the amount needed being excessively much if diverted for abnormal use or abuse of use. That being said gradual overdoses are not just from oral dosing, but could result from injecting where maybe an hour or two after injecting things just start getting overwhelming and one is unable to stay above the effect as they were.

Overdoses are really unpredictable. That's why opioids really should only be used for pain or at least if one is using it for other reasons they should stick with oral and nasal use as there's really no reason to do anything more.... Unless it's opium where smoking it is definitely the way to do it only if done proper.

 

[GetMeOutOfThisCRAP]

One thing to watch out for (which I was not cautious of) can be disabling the extended release mechanism of some of those guys. I definitely have disabled OP formulas thinking they were weaker and have been hit HARD and nodding out powerfully. I suppose the mg's would be the same but in some ways I have found some specific type of pills to be stronger than others, even if the dosages are equal. Idk if anyone can vouch for that too. Additionally, I've always found that if I go past the dosage that my body desires selfishly there is no euphoria for me anymore. I just feel really spaced out and pretty paranoid tbh.

And would you always be vomiting between nods in the event of an OD or can it just hit you all at once and you vomit in your sleep??? Might be helpful if someone can give a timeframe in which an OD normally occurs. There have been times in the past where I've stayed up late due to fear that I would stop breathing in my sleep, but that may have been paranoia.

Oh... and watch out for fake fent pills... it can always happen to those who buy illegally

 

[NeoLid]

This is the clarification I was looking for. This is what I was getting at with the concept of a "threshold where overdose is all but guaranteed regardless of tolerance". However, with anecdotes of people taking hundreds and hundreds of milligrams I'm curious at what dose this starts to take place. Again, if there's a threshold like this where you know od is likely regardless of tolerance, you'd think it would be fairly simple just to avoid taking a dose that large.

Tolerance to respiratory depression will still develop but at a slower rate then the euforic effects, I think thats why people say they stop getting high off opioids after using it for a long time. But even still it wont come to the point where you cant get any euforia. Large part of opioids deaths is people nodding out and choking on their own vomit. I think more people die this way then from respiratory depression. In fact I think most death from prescription pills are from this. Aswell another way is people releasing after staying clean for a week or 2 and just overestimating their tolerance. With prescription opioids respiratory depression is probably the least common way to of other then maybe for people doing the first time or like I said relapsing.

 

[Wilson Wilson]

Most of these “opioid ODs” are actually poly substance overdoses. Namely benzos and opioids, and alcohol and opioids.

It’s actually a lot harder than most people realize to fatally OD on just opioids alone. It’s not that hard to OD, just not fatal ones.

This is indeed the case.

The stats are always like "so many thousand OD's where opioids were involved..." gotta watch that careful wording.

Don't get me wrong not trying to say that you cannot die from oxy alone, because of course you can. Only that it is far more common for combinations to kill people.

Once you get a tolerance to opioids you want to make your stash go further. Mixing any opi with benzos will achieve that so it's common practice. Unfortunately it'll also increase the risk of an OD significantly.

If you take enough stimulants it can kinda prevent OD, but if someone has taken enough gabaergic and opioid substances to depress the breathing significantly nothing will help other than an antagonist.

I have almost died from an oxy + load of benzos combo in the past. I could literally feel myself stop breathing. I guess I was lucky in my case that I could feel this happening before I passed out.

Anyway I just took a load of amphetamine and stayed awake until the oxy wore off. Was fucking terrifying at the time but I survived and finally quit the fucking oxy.

 

[S.J.B.]

The stats are always like "so many thousand OD's where opioids were involved..." gotta watch that careful wording.

Don't get me wrong not trying to say that you cannot die from oxy alone, because of course you can. Only that it is far more common for combinations to kill people.

Yeah, polydrug intoxication is overwhelmingly the cause of drug poisoning deaths, more so than people realize because of the way coroner's reports are done.

The CDC’s statistics, and all other American statistics I have come across, always talk about what drugs are “involved” in a death. There are many cases where people have died after having consumed both an opioid and one or more other depressants, but where only the opioid will be listed as having contributed to the death.

To find evidence for this, you have to find data that includes the cause of death as determined by the coroner, but that also lists all of the drugs found in the body at the time of death. The only government that I have found so far that reports drug-poisoning deaths in this fashion is that of Scotland.

You can find Scotland’s drug poisoning statistics here: https://www.nrscotland.gov.uk/stati...eaths/drug-related-deaths-in-scotland/archive. All of the important data can be found in Tables 5 to 7.

If you look at the deaths “involving” more than one drug (including alcohol as a drug) as a proportion of the total number of drug poisoning deaths, you can see that most of them are polydrug deaths:

2009: 76.1%
2010: 73.0%
2011: 76.7%
2012: 80.7%
2013: 91.8%
2014: 69.5%
2015: 72.0%
2016: 82.5%
2017: 85.9%
2018: 87.7%

However, if you look at the deaths where more than one drug was found in the blood (including alcohol as a drug) as a proportion of the total number of drug poisoning deaths, you can really see just how rare it is to die from a single-drug overdose:

2009: 96.9%
2010: 95.7%
2011: 98.8%
2012: 97.9%
2013: 95.1%
2014: 92.7%
2015: 93.3%
2016: 94.2%
2017: 97.0%
2018: 96.4%

In the 2017 and 2018 statistics, it can be seen that only a single opioid drug, alone or in combination with alcohol, was present in only 2.2% (2017) and 1.9% (2018 ) of cases where any opioid drug was present at the time of death. If it were possible to remove the cases where alcohol is present from these sets, it would surely be even lower. When you consider the cases where only one opioid (or an opioid and alcohol) are “involved” in a death where any opioid drug is involved, however, the numbers jump up to 12.3% (2017) and 7.1% (2018 ).

It has been shown that even a small amount of alcohol will increase the lethality of a given dose of morphine, and there is no reason to suspect that this would not be the case with any combination of opioids with other depressants (http://www.ncbi.nlm.nih.gov/pubmed/7595326).

One of the real untold stories hidden in these numbers is the ubiquity of benzodiazepines, which are present in the following proportion of drug poisoning deaths:

2014: 69.5%
2015: 71.0%
2016: 72.9%
2017: 76.1%
2018: 77.5%

Compare this to the proportion of the deaths where any opioid is present:

2014: 91.2%
2015: 89.1%
2016: 88.2%
2017: 90.6%
2018: 89.3%

In another case, a study done in the province of New South Wales in Australia showed that every single poisoning death involving oxycodone over a decade occurred while at least one other drug was present - in 68.6% of these cases, a benzodiazepine (http://onlinelibrary.wiley.com/doi/10.1111/j.1556-4029.2011.01703.x/full).

It looks like benzodiazepines are playing nearly as large a role as opioids in Scotland’s and New South Wales’s drug poisoning deaths, yet the public has absolutely no idea. Is it any different in the United States? A few years ago, I would have seen no reason why it would be, although in the past couple years, street fentanyl may have increased the proportion of single-drug overdoses a little bit, to the extent that it is sold alone and not as a heroin adulterant. I would love to see some data that would tell me one way or the other.

 

[Wilson Wilson]

Yeah, polydrug intoxication is overwhelmingly the cause of drug poisoning deaths, more so than people realize because of the way coroner's reports are done.

The CDC’s statistics, and all other American statistics I have come across, always talk about what drugs are “involved” in a death. There are many cases where people have died after having consumed both an opioid and one or more other depressants, but where only the opioid will be listed as having contributed to the death.

To find evidence for this, you have to find data that includes the cause of death as determined by the coroner, but that also lists all of the drugs found in the body at the time of death. The only government that I have found so far that reports drug-poisoning deaths in this fashion is that of Scotland.

You can find Scotland’s drug poisoning statistics here: https://www.nrscotland.gov.uk/stati...eaths/drug-related-deaths-in-scotland/archive. All of the important data can be found in Tables 5 to 7.

If you look at the deaths “involving” more than one drug (including alcohol as a drug) as a proportion of the total number of drug poisoning deaths, you can see that most of them are polydrug deaths:

2009: 76.1%
2010: 73.0%
2011: 76.7%
2012: 80.7%
2013: 91.8%
2014: 69.5%
2015: 72.0%
2016: 82.5%
2017: 85.9%
2018: 87.7%

However, if you look at the deaths where more than one drug was found in the blood (including alcohol as a drug) as a proportion of the total number of drug poisoning deaths, you can really see just how rare it is to die from a single-drug overdose:

2009: 96.9%
2010: 95.7%
2011: 98.8%
2012: 97.9%
2013: 95.1%
2014: 92.7%
2015: 93.3%
2016: 94.2%
2017: 97.0%
2018: 96.4%

In the 2017 and 2018 statistics, it can be seen that only a single opioid drug, alone or in combination with alcohol, was present in only 2.2% (2017) and 1.9% (2018 ) of cases where any opioid drug was present at the time of death. If it were possible to remove the cases where alcohol is present from these sets, it would surely be even lower. When you consider the cases where only one opioid (or an opioid and alcohol) are “involved” in a death where any opioid drug is involved, however, the numbers jump up to 12.3% (2017) and 7.1% (2018 ).

It has been shown that even a small amount of alcohol will increase the lethality of a given dose of morphine, and there is no reason to suspect that this would not be the case with any combination of opioids with other depressants (http://www.ncbi.nlm.nih.gov/pubmed/7595326).

One of the real untold stories hidden in these numbers is the ubiquity of benzodiazepines, which are present in the following proportion of drug poisoning deaths:

2014: 69.5%
2015: 71.0%
2016: 72.9%
2017: 76.1%
2018: 77.5%

Compare this to the proportion of the deaths where any opioid is present:

2014: 91.2%
2015: 89.1%
2016: 88.2%
2017: 90.6%
2018: 89.3%

In another case, a study done in the province of New South Wales in Australia showed that every single poisoning death involving oxycodone over a decade occurred while at least one other drug was present - in 68.6% of these cases, a benzodiazepine (http://onlinelibrary.wiley.com/doi/10.1111/j.1556-4029.2011.01703.x/full).

It looks like benzodiazepines are playing nearly as large a role as opioids in Scotland’s and New South Wales’s drug poisoning deaths, yet the public has absolutely no idea. Is it any different in the United States? A few years ago, I would have seen no reason why it would be, although in the past couple years, street fentanyl may have increased the proportion of single-drug overdoses a little bit, to the extent that it is sold alone and not as a heroin adulterant. I would love to see some data that would tell me one way or the other.

Wish I could give you 10 likes for digging up these stats! Amazing work.

The media in the UK does talk about a "Valium crisis" and similarly worded benzo scares in Scotland so that part is being reported. Mainly the problem in Scotland comes from what the media calls "street Valium" which is just pressed blues that could contain anything, similarly to the market for pressed bars, but as you know from those stats the deaths occur when they're combined with opioids. The reason they're a particular danger though is because people expect a much less potent benzo, diazepam, but actually get a potent RC like clonazolam, flubromazolam, or flualprazolam. Sometimes it is just straight up alprazolam or etizolam. Since all of these are anywhere from 10x to 100x more potent than diazepam, and the users are most commonly heroin addicts... well you can see where that leads. And that's why there's a lot of benzo related deaths in Scotland. It comes down to unregulated black markets, not prescription pills. I can tell you getting a benzo script in the UK is a bitch and a half even if you have severe anxiety.

A similar problem exists with pregabalin more recently too. There's a BBC doc that focuses on its popularity in Ireland but it was commonly and freely prescribed as an uncontrolled drug throughout the whole UK just a few years ago. I had the stuff practically thrown at me. It was only made a controlled drug when Pfizer's patent expired fully in 2019, even though there were warnings of abuse going back to 2014. Many addicts, many fakes now doing the rounds, same story again. I've even seen the Guardian refer to it as "new Valium."

Regarding fentanyl I believe there are stats that exist from the ONS in the UK about that, I'd try to dig them up but I'm just popping on before work right now, can look later if you want. I've seen news reports based on the stats so digging up the stats themselves should be easy. ONS data is always released in public reports.

 

[Jopeth]

Because people often to try to get as high as possible, and due to the nature of intoxication, make mistakes. Id also say that deaths due to asphyxiation like vomiting while nodding on the back, or fading out in a bath or jacuzzi and drowning due to opiate intoxication are included as well.

 

[Swim15]

Many of my friends are nurses/docs and healthcare workers. I am as well but and quite a few have better stories than me.

I can’t tell you how common it is for families to have to control medication for other family members as they are admittedly blatantly irresponsible and will just grab a handful of any medication they’re prescribed without reading what it is or the directions.

I’m not making this up and have seen dozens of ER admittances for it. Most of you guys aren’t taking into account that the general population gets way more credit on intelligence than they even remotely deserve and a large percentage of people might as well be clinically regarded with how they act.

If you don’t believe me, find an ER nurse and ask her about her stories.