Opioids Question regarding the physiology o a fatal opiate overdose.

[Bomb319]

First of all, let me categorically state that this question is ONLY intended to satisfy my curiosity in the matter, being a student of pharmacy. I am NOT going to attempt to kill myself, I am NOT thinking of killing myself, and I certainly don't want to encourage OTHER people to kill themselves. It is a matter of interest alone.

Anyway, the reason I am asking this is because I have seen overdoses depicted in films, TV, literature etc. so many countless times, I naturally wonder which is the most realistic (although I recognize that some or all aspects of it cannot be said to be universal, so I have to be exceptionally broad). I suspect that some of these aforementioned depictions are way, waaaaaay off in thinking that the user would simply become higher and higher until he or she pass out cold, failing consciously experience cessation of breathing and other parts of the body shutting down; and then just simply never wake up. Personally, I have trouble buying into this "theory" particularly because a lethal dose of any opiate/opioid is going to stop your breathing entirely - ie, asphyxiation, oxygen starvation, and hypercapnia (high carbon dioxide in the blood) is essentially the same thing as drowning, or breathing in an inert gas such as helium, but without any oxygen. Not to mention the cardiac arrest and massive organ failure that follows.

This process is...painful to say the very least. Hypercapnia in particular is particularly one nasty culprit - research has shown rising blood-carbon dioxide levels to be the trigger that signals the brain to go into panic mode for survival. Build-up of CO2 in the blood is detected by the brain, which strongly activates the adrenal glands and other trigger sites. In addition, aspiration of vomit is also highly likely if not inevitable. Of course, this just blocks the airways further and collects in the lungs - not a pleasant experience.

So would these horrific symptoms not be dominating in opiate OD, with the victim suffering horribly as he or she desperately tries to gulp down air, but is entirely unable because the brain stem is saturated with the signal-blocking drug?

OR - does all this actually occur while you are fully unconscious as is most commonly depicted? I guess the root of this question comes down to whether or not your consciousness can "overpower" the massive chemical releases in the CNS and PNS, because the fight-or-flight response is one of the most primitive as well as most ingrained action the brain can perform, due to obvious evolutionary advantages in doing so.

So then does death occur while awake or while consciousness has already been lost, and absolutely NO pain is felt?

 

[SKR]

In a controlled environment, with terminal patients it's not uncommon for the family of the sick patient to be asked if the patient is in terrible pain that the family minds if they keep administering morphine even if that means the patient may succumb to the morphine before the cancer itself. If the family decide that's what they want (less pain and suffering), then that's the approach, to titrate the morphine till the patient is comfortable - it's actually a peaceful result....if you're sleepy as all fuck and succumb to the morphine I'm told they simply fall asleep from the morphine.

Not sure if a too larger shot of H is initially scary as one fades - is there enough "care" to panic as you're experiencing severe respiratory depression......my initial thought to your question was "it's an unpleasant way to go" but knowing what happens in hospital maybe the size of the shot negates the fight or flight panic of impending doom?

 

[morphine-dreams]

I can't speak from my own experience, but everyone I've talked to who's survived an opioid OD has described it as "falling asleep and suddenly waking up with a narcan shot". I can't answer your question in any detail, but as far as anecdotal evidence, there you go.

 

[Rob27shred]

I would have to say you lose consciousness & mostly don't feel any pain or panic. I have never had an OD where I had to be revived from (at least I think or maybe I'm just incredibly lucky) but have experienced what I would call "mini ODs" many times. What I mean by that is the times I shot up some type of heavy opiate at a high dose & went straight out as soon as enough of the drug got to my brain. A few times I was able to remove the needle from my arm, a few times I passed out with the needle still in my arm, one occasion I did not even complete the whole shot & woke up with a 3/4's empty syringe dangling from my arm. But back to the OP's question. Each time that happened to me there never was any pain or panic that I am aware of that I went through while I was unconscious. The last thing I remember in these situations was pushing the plunger down & getting a huge rush before I was expecting it. Then nothingness inbetween that & when I woke up.

However I do suspect that on at least 2 occasions I had some type of seizure when I was "out". Since the one time I awoke to a blood & sweat soaked couch, the needle I was using was bent up badly & feet away from me as if tossed, everything that was on the coffee table was swept off on to the floor, & my arm I was injecting into was pretty tore up & my lower legs had some pretty bad bruises. The other occasion was not as bad but I awoke on my side in a blood & sweat soaked spot on my bed. The sheets were all messed up yet the bed was made before I sat down for my shot, & the needle was still in my arm but bent pretty badly.

I still don't how I got lucky enough to not have caused permanent damage to my arm or just in general with those episodes. I know I thank god I didn't since I am a carpenter & make a living with my hands.

 

[tacodude]

It could also be a nightmare where in your head you are screaming "no I don't want this, someone save me" yet you can't open your mouth to scream for help as your vision fades.... It's not always pleasent and peaceful sadly.

This is a story from a member here

 

[George27]

a lethal dose of any opiate/opioid is going to stop your breathing entirely - ie, asphyxiation, oxygen starvation, and hypercapnia (high carbon dioxide in the blood) is essentially the same thing as drowning. This process is...painful to say the very least. Hypercapnia in particular is particularly one nasty culprit - research has shown rising blood-carbon dioxide levels to be the trigger that signals the brain to go into panic mode for survival.

You miss a point.
Opiates do not block respiration, they are not a muscle paralyzer or something like that.
They weaken ( usually do not block there still some breathing and death take like 1 hour) the automatic reflex for respiration, driven by the CO2 concentration in the blood. There is a depression of the ventral respiratory group: there is no more the trigger you are speaking about. So you suffocate without knowing that you are. You could breath faster, but you do not feel the need to do so.
In practice, this mean that you slip into sleep and than die.
Can go like this: someone with no tolerance buy the long-acting methadone form a junkie, drink it in the morning and after 12 hours he goes to sleep. Then he dies during the night; a story sometime told by newspaper. Because while sleeping it's all about the automatic reflex so it is more dangerous.
Another matter: with an OD on IV heroin you loose coscience suddenly, sometime the user has still the needle in the arm. I do not know why, but here there is some effect besides the hypercapnia.