WHEN TO CALL AN AMBULANCE
People are often reluctant to call an ambulance for fear of police involvement or concern about the cost of a call-out. The police will only attend if there is a fatality or if their presence is requested, for example if the ambulance crew feel threatened. This is an issue worldwide.
In addition to unconsciousness, call for emergency help when someone is:
-having a seizure
-experiencing severe headache
-experiencing chest pain
-experiencing breathing difficulties
-extremely paranoid, agitated and/or confused.
-It is not necessary for someone to have all of these signs or symptoms for them to be overdosing. Exhibiting only a few could still mean nthey are in trouble and need emergency help.
DON’T IGNORE GURGLING AND SNORING
Snoring and gurgling can mean a person is having trouble breathing.
With substance use, especially substances that slow down the systems of the body (eg: benzodiazepines, opioids, GHB), snoring may indicate a serious and potentially life threatening obstruction of the airway.
The noise generated results from reduction in the size of the airway, and the result is a reduction in the volume of air that is able to move in and out of the lungs with each breath, and vibration of tissues around the airway as the comatose person struggles to move air in and out of the lungs. The larger the obstruction, the smaller the amount of air that gets in, and the greater the effort that is required to try and get air into the lungs. The obstruction occurs when the person is unable (due to their substance use) to move their head/neck/body to allow better air flow, and because collapse of the airway due to decreased muscle activity around the airway that normally keeps it open – this is because they are unconscious, not because they are sleeping.
In the setting of substance use, snoring is not something that should be seen as ‘normal’. Don’t let people ‘sleep it off’ if they are snoring – this may be a sign of significant and life threatening emergency – attempt to wake them immediately.
If they do wake then the snoring (airway obstruction) will resolve. If they do not wake, call emergency services and ask for an ambulance. Follow the instructions from the operator (you will probably be asked to roll the snoring person onto their side and open their mouth to maximise the flow of air).
NALOXONE HALF-LIFE
Naloxone or Narcan is the used by paramedics to revive people who have had an opiate or opioid drug overdose. Anyone who has been revived using naloxone needs to understand the danger of taking more drugs afterwards because they can overdose a second time. Naloxone can precipitate withdrawal symptoms which bring a powerful urge to take more drugs. Because naloxone has a half-life of 1-1.5 hours, considerably less than heroin and morphine, taking more opiates can bring on a second overdose. Drugs like methadone, and sustained-release opioids like OxyContin and MS Contin, provide the drug over 12 hours or more, so the effect of naloxone will wear off long before those drugs have exited your system.
PERMANENT BRAIN DAMAGE AND OVERDOSE
Hypoxic brain injury, which is caused by a lack of oxygen to the brain, is an under-reported consequence of heroin overdose. These brain injuries can cause coma, seizures and, in worst case scenarios, brain death. The long-term consequences of hypoxia depend on how long the brain is without adequate oxygen supply. Basically, the longer a person is not breathing, the more potential damage is being done to the brain. In many overdose cases such information is unknown. Health outcomes depend on the success of damage control measures, the area and extent of brain tissue deprived of oxygen and the speed with which oxygen was restored to the brain.
A brain injury can result in mild to severe impairment of:
-movement, balance and co-ordination
-senses such as hearing or vision
-spoken and written communication
-thinking, concentration and memory.
-In severe cases, brain injuries from overdoses can leave people in a vegetative state.