Drug Overdoses and the Deadliest Drugs in America

Drug overdoses resulting in death have dramatically increased in the US in recent decades. Primarily the opioid addiction epidemic has steadily claimed more lives every year since the late 1990s and shows no signs of slowing. Among the most dangerous drugs in that epidemic have been prescription painkillers, heroin, and illegal fentanyl. However, lethal overdoses involving benzodiazepines have also shown a dramatic upward trend. Benzodiazepines are prescription drugs like Valium, Xanax, and Klonopin. Also, the number of cocaine involved fatal overdoses have risen and fallen in the last two decades but has been steadily increasing again in the last several years.

Dangerous Drug Combinations

It is increasingly rare in drug treatment to find someone with an addiction that uses just one substance. Similarly, those who die from drug overdoses often have more than one substance in their systems. The CDC (Centers for Disease Control and Prevention) has, for example, tracked opioid involved cocaine overdoses because this combination is common. Also, Stanford University researchers have found that almost 30% of fatal opioid overdoses also involve benzodiazepines. Other drug combinations have caused significant public health crises in recent years such as heroin mixed with fentanyl, which is a particularly lethal combination. Additionally, alcohol is a common substance involved in polydrug fatal overdoses that include substances of all types.

Tragically, celebrity deaths from drug overdoses have illustrated the lethality of polydrug use. Actress Carrie Fisher died this year with evidence of heroin, cocaine, methadone, Ecstasy, and alcohol in her system. Reaching further back into celebrity history, Elvis’s death involved multiple painkillers and tranquilizers; Jimi Hendrix died after taking barbiturates (sleeping pills) and drinking alcohol, and Michael Jackson died, having taken three sedatives. Celebrity deaths can touch millions, but as sad as news is of such deaths, for every celebrity that dies from an overdose, there are thousands upon thousands of ordinary people that die from the same causes.

Drug Potentiation and Overdose Risk

Drug overdoses are technically poisonings. They occur intentionally when someone has the wish to die, but in many cases of addiction, they occur accidentally. There are several risk factors involved in an addictive process that can lead to fatal overdose. These are:

  • Tolerance—the physical need for greater amounts of an addictive substance to produce the desired effects. Tolerance builds over time. Consequently, people with a high tolerance for a substance may not feel as intoxicated as they would like, and take high dosages that can be lethal.
  • Unknown ingredients and doses in illegal substances—naturally, illegal drugs are not subject to any quality control regulations. Therefore, people who consume them cannot be certain what adulterants may have been used or the toxic effects of the ingredients. Adulterants are added to illegal drugs for profit-making purposes. Also, purity of the addictive substance cannot be predicted, causing other problems. Perhaps, for example, the user does not have a tolerance for the amount of addictive substance within a particular ‘batch’.
  • Depression—people with addictions are universally prone to clinical depression. Many unfortunately become suicidal at some point in their illness.
  • Cognitive disorganization—confusion, impaired judgment and impaired memory are just some of the cognitive declines associated with repeated intoxication. Users can miscalculate their use and overdose because of mental disorganization.
  • Drug combinations that cause potentiation. Potentiation is the interaction between two or more drugs that results in drug effects becoming stronger because they are used together. Some common and lethal drug interactions are:
    • Alcohol and opioids
    • Alcohol and benzodiazepines
    • Painkillers and alcohol
    • Heroin and cocaine

There are many more potentially lethal combinations of substances, and these are just examples of how two substances can potentiate to life-threatening and even fatal effects. A life-endangering combination of drugs is known as MDI–multiple drug intoxication–or CDI, combined drug intoxication.

People may take more than one drug in a specific pharmacological class such as two or more sedatives, for example. They may also take combined drugs from different categories. Although drugs may be unrelated and belong to different pharmacological classes, they may have a similar effect that can be deadly when combined. For instance, benzodiazepines, barbiturates, and alcohol all depress the central nervous system. When combined, their effects can cause respiratory arrest, cardiac arrest, or coma because they severely depress brain and nervous system activity.

Non-Fatal Drug Overdoses in Addiction

There are probably far more non-fatal drug overdoses in addiction than most would imagine, although the general public tends to think of any overdose as a fatality. This is far from true, and in fact, it has been estimated that prior to a fatal overdose, many people have at least one non-fatal one. It is thought, for example, that at least 50% of opioid users have had at least one overdose. Some estimate the numbers are higher than 50% of that population has, and that for every fatal opioid overdose, there are 20-25 non-fatal ones. Many who eventually die from opioid drug overdoses, for instance, had experienced multiple non-fatal ones.

Research shows that a significant predictor of eventually suffering a fatal drug overdose is having survived one in the past. So it would seem that people who have been using opioids, and who are further along in their ‘careers’ of addiction, are at significantly higher risk for overdose than people who are new initiates into addictive drug use.

Drug Overdoses and Treatment Seeking

Studies have investigated the correlation between a non-fatal overdose and seeking out addiction treatment. A dramatic finding is that overdose survivors who discuss their addiction with supports are more likely to enter treatment. Particularly, those whose families members are educated about the addiction, and treatment resources, are more amenable to entering treatment after an overdose. However, a great many survivors of drug overdoses are not ready for treatment and so are not willing to go. Second to that group, is another large number of survivors who still do not think their drug use is problematic even though they are just recovering from an overdose.

Dangerous Misconceptions about Drug Overdoses

There are many myths about drug overdoses that lead to serious and life-long health consequences, as well as to death. Among such myths are:

  • Most overdoses are intentional because addicts are so miserable. This is a myth. Indeed, addicted people do suffer a great deal, and some become so depressed that they intentionally take their own lives. However, the great majority of fatal drug overdoses are accidental.
  • Overdoses happen quickly. Some do happen quickly, but most do not. There are progressing stages of a fatal overdose, and obtaining emergency medical care can prevent deaths. In fact, many fatal overdoses occur because others let them ‘sleep it off’. Passing out is not always ‘just what happens’ when people misuse substances. It is a sign of overdose.
  • A dose of Narcan will stop an overdose. Narcan, or naltrexone, can temporarily reverse an overdose. However, ‘temporarily’ is the key word here. When the anti-overdose drug wears off, the overdose can resume because drugs are still in the system. Narcan can buy time until emergency medical attention is obtained, but should not be considered a cure for overdose.
  • It’s inexperience that causes most overdoses. This is notably not true. It is thought that at least 80% of fatal overdoses occur among people who are long term and regular users of the substances that kill them. Studies show that the first non-fatal overdose among opioid users typically occurs two years after beginning use.

The Prevalence of Fatal Drug Overdoses

Here are some other important facts about fatal drug overdoses:

  • Drug overdoses now far outstrip any other cause of accidental death in America, including car accidents. And, overall, the CDC has reported that drugs now kill more people than cars, guns or falls do.
  • Prescription drugs lead in fatal overdoses, but illegal drug involved deaths have been dramatically increasing in recent years. In 2015, for example, the CDC reported over 52,000 overdose fatalities with just over 33,000 of those deaths involving an opioid. They also report death rates from illegal substances such as heroin and non-pharmaceutical fentanyl rising steadily and dramatically in recent years.
  • Overdose fatalities are likely higher than statistics show. It is difficult to know the exact number of overdose deaths, or the specific drugs involved in a great many drug overdoses. This is caused by several factors. One significant problem in gathering such statistics is that not all communities test for a comprehensive range of substances during autopsies. Consequently, not all drugs contributing to a fatal overdose are known. Also, while it is widely accepted that many fatalities include a combination of substances, death records frequently mention only one drug.
  • Alcohol overdoses, or ‘alcohol poisoning’ claimed, on average, 6 people every day, or about 2200 per year, in the U.S. from 2010-2012.

What to Do When Someone Has Overdosed

Among regular users of addictive drugs, there are ‘home remedies’ for drug overdoses that may increase the chances of death. Also, some that have ‘proven’ to work are said by experts to have been effective only by chance. Therefore, many of the ‘remedies’ amount to folklore among addicts. Such methods include walking the overdose victim around, injecting them with water, putting them in showers or baths, and putting ice in or on their bodies. All such methods carry inherent risks. For example, ice lowers body temperature, further compromising the overdose victim, and people have drowned in baths. Overall, home methods waste valuable time. They allow the overdose to progress when summoning emergency medical attention could have saved a life.

Here is a list of what to do if you are with someone and suspect an overdose is occurring:

  • Err on the side of caution. If you believe an overdose is in progress, act.
  • Call 911 to summon emergency medical attention ASAP, stay on the line and follow the operator’s instructions.
  • Stay with the person till help arrives.

You may have to provide rescue services yourself if you are familiar with them while you wait for emergency medical responders. You should never, however, only provide services yourself without obtaining medical aid, too. Even if your loved one appears to respond to your efforts, they still need care ASAP.

Additionally, 911 personnel rely upon you to provide information. Answer all questions and follow directions. If you have a loved one that has overdosed in the past, or you believe they may, you should learn more about rescue methods such as:

  • Administering rescue breathing if breathing stops.
  • Administering CPR if heartbeat stops.
  • Administering naltrexone (Narcan) to temporarily interrupt an opioid overdose.
  • Positioning the head and body to keep airways open.
  • Putting someone in the recovery position.

Such methods are an effort to keep drug overdoses from becoming fatal while awaiting emergency medical assistance. Always call 911 first.