Drug Addiction: Overcoming Dependencies and Avoiding Overdoses

What is addiction?

Addiction is a chronic neuropsychiatric disorder defined by a dependence on a psychoactive substance or activity that has harmful consequences for a person’s life and for the normal functioning of the brain.

Drug Addiction

Drug Addiction

The most common addictions are to tobacco (nicotine) and alcohol. Next comes cannabis, followed by opiates (heroin, morphine), cocaine, amphetamines, and synthetic derivatives (‘new synthetic products’). There are also addictions related to activities (not substances) such as gambling, video games, sex, or compulsive shopping.

The installation of addiction involves at least three causes in addition to a genetic vulnerability.

The causes consist of an increased motivation to use drugs (addiction to pleasure), a negative emotional state (search for relief), and a reduced ability to control oneself (loss of control over consumption). Genetic vulnerability depends on changes in various genes, which explain individual differences in the response to drugs.

Therefore, addiction primarily begins because of the pleasure generated by the substance of addiction. But this feeling is related to electrical and chemical changes caused by the substance within different neural circuits in the brain. The drug may interfere with the molecules responsible for transmitting information between nerve cells (the “neurotransmitters”) or with their receptors.

What effects does addiction have on the brain?

The addictive drug or activity can interfere with the molecules that transmit information between neurons (the “neurotransmitters”) or with their receptors.

Addiction, therefore, depends on the pleasure created by the addictive substance (or activity), a pleasure that is triggered by changes in the electrical and chemical functioning of the brain. The brain is, in fact, a very complicated and evolutionary computer whose “circuits” are made up of nerve cells (“neurons”) connected by “synapses”: these are called “neural networks”. Each network is specialized in one function.

At the level of the connection between the individual neurons, the “synapse”, information is transmitted by chemical substances (the “neurotransmitters”). In each neuron, the information is electrically conducted through the entire nerve cell.

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Not all phenomena within the “neural circuits” of the brain are perfectly known, but a release of dopamine, the “neurotransmitter of pleasure and reward”, is mainly observed. This is especially true for the “core of pleasure and reward”, which is part of the reward circuit. Recent research suggests that the regulation of this dopamine release is regulated by a system that combines other neurotransmitters, acetylcholine, and glutamate.

But beyond this release of dopamine, other mechanisms are also involved, including the release of serotonin or the activation of “endorphin” receptors, molecules naturally present in the brain (“endogenous”) and involved in the fight against pain and well-being (“endorphins”). Several genetic studies have demonstrated the central role of the endogenous opioid system in certain components of the induced addiction processes, and this role is believed to be common to all drugs.

Thus, the ‘mu-opioid receptors are directly involved in the ‘positive reinforcement’ properties of opioids, alcohol, nicotine, cannabinoids, and perhaps psychostimulants. These “mu” receptors are also responsible for the physical component of opioid-induced dependence and play an important role in cannabinoid- and nicotine-induced physical dependence. Delta opioid receptors could play a complementary role to mu receptors and be involved in modulating the “tonic” effects of alcohol opioids, nicotine, and also psychostimulants.

With regular drug use, the repeated stimulation of these different receptors leads to a decrease in natural endorphin production. From then on, pleasure is achieved only by taking the external substance, which leads to an increase in tolerance to the drug and to a phenomenon of “withdrawal” as soon as the drug is discontinued.

Finally, stimuli that are repeatedly associated with drug use (“conditioning”), such as always being at the same place or time of day, may eventually activate the release of dopamine even before the drug is taken. This can lead to “psychological dependence”, such as the need for a cigarette at coffee time. This may explain how the signs of the environment (advertising, bar, the smell of alcohol) can trigger relapse even after long abstinence.

Functional MRI tests of the brain of dependent people show a “hypoactivation of the frontal cortical regions” and a “hyperactivation of the regions involved in motivation, memory, conditioning, and emotions”. But it is not clear whether this functional deregulation is a predisposition that precedes the development of addiction or whether it is simply the result of chronic drug use.

What are the signs of addiction?

Addictions can occur at any time in life, but the period between 15 and 25 years is the most favorable for their occurrence. In general, men are more often affected by addictions than women. The risk-taking behavior of teenagers and young adults makes the first experiences easier. In particular, early drug use in a brain that is not mature yet exposes a person to a greater risk of altering neural circuits and promoting the onset of addiction and dependency.

Common signs of all these addictions include “loss of self-control”, “interference with school and professional activities” and “continued use despite awareness of the disorder”. Other mechanisms reinforce the addiction: The body gradually becomes less sensitive to the substance and its effects, and the user must increase the dose to achieve the same level of pleasure. Repeated use of drugs alters the neural networks in the brain and disturbs the feelings of pleasure. The dopamine network gets out of control and causes a constant need for pleasure.

What are the causes of addiction?

The occurrence of addiction is based on three components: the individual, the product, and the environment.

Every individual is more or less susceptible to addiction, and part of this susceptibility is genetic. It is said to be based on different associations of modifications in relation to many genes, whereby each modification is not triggering on its own. Some of these genes are involved in the dopamine or opiate system.

For a given drug, these genetic variations also partly explain the variability of the effects experienced by each individual. For some people, pleasant sensations and positive effects on mental functioning (disinhibition, forgetting problems, improved cognitive performance, etc.) may be an incentive to use drugs again. People who suffer from anxiety states have an introverted character or a depressive tendency, for which psychotropic drugs, especially alcohol, improve mental functioning, and have an increased risk of dependence. This also applies to people who are afraid of emotions.

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Finally, the age at which consumption begins also plays a role. Early initiation is responsible for increased vulnerability, probably due to changes in the neural circuits in the brain. The onset of alcohol consumption in early adolescence increases the risk of alcohol dependence in adulthood by a factor of ten, compared with a later onset around the age of 20.

Some substances appear to be more addictive than others, given the proportion of dependent people among their users. The most addictive product is tobacco (32% of users are addicted), followed by heroin (23%), cocaine (17%), and alcohol (15%).

The speed at which the addiction develops also varies according to the substance: addiction to tobacco, heroin, and cocaine can develop within a few weeks, while addiction to alcohol is much slower. Among video games, network games are known to be the most addictive, especially multiplayer role-playing games.

Finally, environmental factors also play a role, in particular, the availability of products and the “role model” function in the environment: the main risk factor for tobacco dependence is the fact of having grown up in a smoking apartment, which makes it easier to access tobacco. Similarly, cannabis dependence is strongly associated with having friends who smoked.

What are the complications and risks of smoking?

Untreated, addictions can have serious and even tragic consequences.

The serious consequences can be directly and immediately related to excessive use of the substance: overdoses, alcohol coma, accidents, and violence.

An overdose is the accidental or unintentional ingestion of a product that exceeds the limited dose tolerated by the body. This changes the inner balance and causes various signs that can go as far as the death of the person.

It has been shown that driving after drug use increases the risk of being responsible for a fatal accident by a factor of 8.5. If the driver has also consumed cannabis, this risk increases by a factor of 15.

Complications can be caused in the long term by side effects: many cancers associated with alcohol and tobacco use, cardiovascular and respiratory diseases, HIV and hepatitis infection, neurological and psychiatric disorders in regular drug users, etc.  In addition, repeated drug use promotes cognitive disorders (e.g. concentration, expression, and memory difficulties) that can affect school and professional outcomes or even lead to gradual dropout from school or to marginalization and dismissal. A serious addiction that is not treated more often leads in the long run to isolation, de-socialization, and impoverishment.

Other long-term consequences are still little known, in particular, the effects of alcohol and cannabis use during adolescence on the development and function of the brain in adults. During this period (up to the age of 20-25 years) the brain still matures and appears to be more susceptible to toxic effects. In addition, it has been found that the earlier drug use occurs, the greater the risk of long-term dependence.

What are the different types of drugs?

Whether legal or illegal, psychoactive drugs have an effect on the body and especially on the activity of neurons in the central nervous system.

Hallucinogens are psychotropic chemicals that cause hallucinations, i.e. changes in perception and consistency of thought: hallucinogenic mushrooms (Psilocybin), LSD (lysergic acid), mescaline, ketamine.

Cannabis (marijuana, hashish, tetrahydrocannabinol concentrate, or THC) is more of a disturbing substance, like solvents, but in high doses, THC is a hallucinogen.

Stimulants are substances that increase the activity of the nervous system and the functioning of the body. They also increase heart and respiratory rates and raise blood pressure. They can cause a feeling of euphoria and in high doses, they can also cause hallucinations: Cocaine, Crack, amphetamine, ecstasy (a derivative of amphetamines), but also MAOI antidepressants, tobacco, caffeine, khat, betel, and kola nut.

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Narcotics or central nervous system depressants are opiate-derived or chemically related painkillers that can cause drowsiness. These highly addictive substances can quickly lead to addiction: opiates (opium, morphine, heroin, oxycodone, fentanyl, etc.). Barbiturates, neuroleptics, sedatives (benzodiazepines) are similar.

Alcohol has a calming and anxiolytic effect on nerve structures, similar to sedatives. It acts on the reward circulation in the GABA (gamma-aminobutyric acid) receptors of dopamine cells and increases dopamine release. It thus provokes an almost immediate disinhibition effect proportional to the doses ingested (reflex dysfunction, drunkenness).

Diagnosis of Addiction

When should one consider addiction?

There are no specific signs, but a series of behaviors that, when put together, become evocative.

Addicts can spend a lot of time getting and using drugs and then recovering from them. As a result, people who abuse drugs may neglect what used to be important to them: family and friends, work, school, and recreational and social activities.

Drug users can become “secretive”, especially about how they spend their money. They will continue to buy drugs even if they know they cannot afford them.

People who abuse drugs can commit very risky or even illegal acts that they would not normally do, such as driving dangerously or stealing money. They may have difficulty remembering things and keeping commitments.

Even when parents try to maintain an open relationship with their children, they should still look out for behavior that may indicate addiction:

  • Problems at school “dropouts” (absenteeism or poor grades)
  • Greater secrecy around their possessions, friends, and activities
  • Use of incense, deodorant, or perfume to mask the smell of smoke or chemicals
  • New interest in clothing related to drug use
  • Increased need for money
  • The disappearance of prescription drugs, including narcotics and tranquilizers

Finally, the parents may find some drug-related items in the teenager’s bedroom, such as:

  • Bongs, syringes, or rolling paper
  • Inhalation products (such as hairspray, nail polish, or common household products)
  • Rags and paper bags as accessories for inhalation products
  • Drops for masking red eyes and dilated pupils

How is addiction diagnosed?

The diagnosis of addiction is based on clearly defined international criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

A person is considered an addict if he or she has met at least two of the following 11 criteria in the last 12 months:

  1. A strong, compelling craving for gambling
  2. Loss of control
  3. Significance of the time spent seeking their fix
  4. Increased tolerance to the addictive substance: the body gradually becomes insensitive to the substance and its effects, and the user must increase the doses to achieve the same level of enjoyment.
  5. Withdrawal symptoms when an abrupt cessation happens
  6. Inability to fulfill important family, social, and professional obligations
  7. Use of addictive drugs or gambling, even if there is a physical risk
  8. Personal, family, or social problems
  9. Persistent desire or effort to reduce doses or activity
  10. Reduction of normal activities in favor of drug use or gambling
  11. Continued use despite physical or psychological damage

The addiction is classified as mild if 2 or 3 criteria are met, moderate if 4 or 5 criteria are met, and severe if 6 or more criteria are met.

DSM’s experts list only drug and gambling addiction as an addiction. Intensive use of video games and sexual or professional hyperactivity is not yet considered addictions, as convincing scientific data is still lacking.

In addition, the adjustments of the brain lead to a long-term “negative effect” on the dependent subject (mood disorder, fear, irritability). This negative emotional state, together with the unpleasant feelings of withdrawal, would then become the main motivation for consumption (“desire for relief”), beyond the search for pleasant effects (“desire for reward”).

How is an overdose diagnosed?

The signs of overdose can take different forms depending on the drug consumed.

The following are signs to look for:

  • A reaction out of proportion to the normal effect (drowsiness, coma or hyperactivity, epileptic seizure, or hallucinogenic or psychotic episode).
  • Other effects are due to the chemical properties of the product.
  • Non-specific signs of deep brain and central nervous system dysfunction (confusion, dizziness, nausea, vomiting).

The diagnosis is usually easy if the product is known, but it is more difficult if there are several partners or if the person cannot or does not want to say what substance is involved.

Analyzing the person’s symptoms and looking for toxins in the blood with a test will make the diagnosis easier.

When should a doctor be called?

People with an addiction problem and their families are often reluctant to call a doctor even in the case of an overdose, for fear of police intervention.

It is, therefore, necessary to call for immediate help in case of confusion or unconsciousness, cramps, severe headaches, chest pain, breathing difficulties, and paranoid restlessness.

What is withdrawal?

Withdrawal is a group of disorders that occur when a psychoactive substance is totally or partially withdrawn after repeated and prolonged use. It is to be distinguished from the tapering of the patient, which is a medical process, designed to enable the patient to give up his or her medication without too many side effects.

Each withdrawal syndrome is specific to a particular addictive substance and may be accompanied by signs of a physiological disorder. Withdrawal is one of the indicators of addiction. The start and course of withdrawal are limited in time and depend on the type and dose of the substance used immediately before stopping or reducing consumption. In general, the characteristics of withdrawal are the opposite of those of acute intoxication or overdose.

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Opiate withdrawal syndrome is accompanied by a runny nose (rhinorrhea ), tearing (excessive tears), muscle pain, chills, goosebumps, and, within 24-48 hours, muscle and stomach cramps. The compulsive drug-seeking desire is still very pronounced and persists even after the physical signs have subsided.

The signs of cannabis withdrawal are related to the regulation of “endocannabinoids” in the central nervous system: irritability or even aggression, anxiety, sadness or even depression, restlessness, sleep disturbances, and reduced appetite. These signs of craving and their severity are very similar to those of smoking cessation, although sleep disturbances appear to be more pronounced in cannabis.

withdrawals caused by stimulants are less well-defined than withdrawals from depressants of the central nervous system. The phenomenon of depression is always significant and is associated with a state of discomfort and emotional instability.

Alcohol withdrawal syndrome is characterized by tremors, anxiety, restlessness, depression, nausea, and malaise. It occurs 6 to 48 hours after alcohol withdrawal and disappears within 2 to 5 days if there are no complications. However, it can be complicated by seizures and can progress to delirium (known as “delirium tremens”).

Sedative withdrawal has many similarities with alcohol withdrawal. However, it can also be associated with muscle pain and cramps, perceptual distortions, and changes in body image.

Treatment Options for Addiction

What can you do against addiction?

A problematic use is a use that causes the person physical, psychological, emotional, family, and professional difficulties. Unfortunately, it is not always easy to realize this.

The prerequisite for any abstinence is an awareness of the disorder, and the intoxication must be set aside in order to assess the significance of the effects on personal, family, and professional life. It is also possible to assess one’s own dependence by trying to stop and see if one can bear it.

If you cannot stop on your own, you need help, because there are effective treatments, both psychological and medicinal.

What are the principles of addiction management?

Addiction management is global and is no longer limited to weaning patients, which is no longer the only therapeutic goal. The main objective is now to reduce the risks and harm associated with addiction (acute poisoning, overdoses, infectious contamination, risky or illegal behavior).

The treatment of addiction is a long-term endeavor. The aim must be, regardless of the addiction, to stop the “involuntary loss of control over consumption” and to maintain this suspension over time. Therefore, complete cessation of use or a significant reduction in use is a consequence of treatment and not a prerequisite.

Whatever the nature of the addiction, there are two main therapeutic phases that are now generally recognized: withdrawal and relapse prevention.

The use of certain medications enables a different strategy to be adopted, one that is not aimed at dependence but at collateral damage, particularly in relation to the toxicity of the substance or the addictive behavior: these are “substitution or risk reduction treatments”.

A distinction should be made between the drugs:

  • Abstinence drugs specifically reduce or suppress the manifestations of withdrawal.
  • Replacement drugs, which actually replace to reduce harm, but do not directly influence addictive behavior.
  • Opioid antagonists help reduce cravings and maintain abstinence, which requires behavioral change and require strong therapeutic cooperation and support.

How to wean a person suffering from addiction?

The treatment of addiction is multidisciplinary: in most cases, it is based on a combination of drug treatment, individual psychological support (cognitive-behavioral psychotherapy), and family and social support.

There is no “silver bullet” and treatment is often long and full of relapses. But success is always possible and depends largely on the person’s motivation to wean themselves and on the lasting improvement of their living conditions and self-esteem. It is often necessary to find a job again and get involved in social activities.

Alcoholics Anonymous-type groups are of great importance to achieve a lasting outcome. They provide support during and after withdrawal, thanks to the exchange of experiences between people who have experienced the same type of problems.

What medications can help with alcohol withdrawal?

Alcohol abstinence must be carried out as part of a specialized aftercare program with an alcoholism specialist, who will ensure that the treatment is tailored to the individual, that the necessary psychotherapeutic support is provided, and that referrals to self-help groups are made.

For alcohol withdrawal, doctors often use drugs from the benzodiazepine family, combined with vitamins. Many molecules are now available and their number will only increase as more discoveries are made each year. You can now rely on molecules that have already been validated by good scientific studies, especially acamprosate, naltrexone, and Nalmefene.

The recently marketed Nalmefene is a molecule that is only intended to reduce alcohol consumption. This drug is part of the new policy of “harm reduction”, a strategy aimed at reducing alcohol consumption to levels less harmful to the health of the alcoholic and to society, without stopping it completely. This policy is aimed at non-dependent or “low-” addicted consumers.

Baclofen goes in the same direction. This molecule is still being evaluated but has a preliminary recommendation for use. Baclofen is indicated both for maintaining abstinence after withdrawal in alcohol-dependent patients and for reducing alcohol consumption to a low level. Its use is not without risk because of the high doses often required. Baclofen has recently been associated with sleep apnea syndromes.

In all cases, comprehensive long-term medical-psycho-social support is the best way to improve the well-being of people with alcohol problems. Support from self-help organizations such as Alcoholics Anonymous can also be beneficial.

What medications can help with opiate withdrawal?

In the case of opiate withdrawal, treatment consists of two phases, with a first phase of abstinence and prevention of the “withdrawal syndrome” and a second phase of “maintenance therapy” to prevent a relapse.

In the case of withdrawal, the most effective approach is to prescribe long-acting oral opioids such as methadone and buprenorphine, which can alleviate withdrawal symptoms and gradually lead to total abstinence. This is preferable to withdrawal with the help of alpha2-adrenergic agonists such as clonidine, which should always be combined with anxiolytics, non-steroidal anti-inflammatory drugs, and antidiarrheal agents.

Once the withdrawal is achieved, the prescription of naltrexone, a mu-opioid receptor antagonist, can prevent relapse.

This management should be carried out as part of a specialized follow-up with an addict to ensure individualized treatment adjustment, the necessary associated psychotherapeutic management, and referral to support groups.

What drugs can help with cannabis abstinence?

In the case of cannabis, it is not so much the physical dependence that makes it more difficult to quit but rather the psychological dependence.

In general, methods based on behavioral therapy have proven to be a safer way to stop cannabis use. Multidimensional family therapy involving parents and siblings also offers good results in cannabis abstinence in young people.

While therapies have their limitations, some medications can alleviate withdrawal symptoms to some extent for certain signs, such as mirtazapine or nefazodone. With Divalproex or bupropion, the effects are less pronounced. Oral dronabinol, the synthetic equivalent of psychotropic THC, appears promising.

What drugs can help with cocaine withdrawal?

There is no specific cocaine substitution treatment such as methadone for heroin.

There is initially a short period of abstinence (three or four weeks) with a prescription of N-acetylcysteine (a product usually used to break bronchial mucus) in high doses, combined with some sessions of motivational psychotherapy.

Once this stage is reached, the relapse prevention phase, which lasts at least a year, begins, based on drug treatment and behavioral and cognitive therapy. The drugs used are mainly topiramate, an anti-epileptic drug, and disulfiram, the latter being used mainly in patients who are also alcohol dependent. Modafinil, a narcolepsy treatment, is currently under investigation. Antidepressants are not indicated, except in cases of associated depression.

Promising vaccines continue to be actively sought, especially to prevent relapses, which can sometimes occur 5-10 years after withdrawal.

What medications can help with smoking cessation?

Substitution treatments (nicotine patches) in combination with psychological support are effective in quitting smoking.

Certain molecules can be useful in combination (bupropion, antidepressants).

It seems that electronic cigarette makes it possible to reduce the complications associated with smoking and is interesting for nicotine withdrawal.

What is an overdose?

An overdose is a situation in which the body is confronted with an excess of one or more drugs that it can no longer metabolize.

All medicines can cause an overdose, including prescription drugs. The signs depend on the type of drug consumed and its effect on the body.

An overdose most often occurs when the drug addict takes the wrong dose, when the purity of the product is higher, or when the person combines several drugs.

An overdose is life-threatening and some simple measures can prevent death.

When should an opiate overdose be considered and what should we do?

An opioid overdose should be considered in the cases of intoxication with natural opioid substances: opium, morphine, methadone, and codeine, as well as with synthetic substances: heroin, buprenorphine, oxycodone, and fentanyl.

An opioid overdose should be considered in the presence of the following symptoms: pupil contraction, cardiac depression, loss of consciousness, and respiratory depression.

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The combination of opioids + alcohol + sedatives increases the risk of respiratory depression and death and is often found in fatal overdoses.

The treatment is based on the call for help and the basic rules of first aid: put the person in a safe lateral position, watch while waiting for help, and possibly perform assisted ventilation (mouth-to-mouth ventilation at a rate of 2 breaths every 5 seconds).

When the rescue team arrives, treatment will be based on oxygenating the person, preparing an infusion, and administering an antidote, Naloxone, in progressive doses until a breathing rate of more than 12 is achieved. Naloxone is available in the form of a nasal spray (Narcan), which simplifies and improves emergency outpatient treatment of opiate overdoses.

When should acute alcohol poisoning be considered and what should be done?

The consumption of a lot of alcohol in a short period of time has an even more serious effect on the body and brain. In high doses (“binge drinking”) alcohol can lead to respiratory arrest, low blood pressure, seizures, vomiting with regurgitation to the lungs, and death.

An alcoholic coma is an emergency that if left untreated can lead to death.

Acute alcohol poisoning is a form of overdose and must be treated as such.

Acute alcohol poisoning should be considered in case of disorientation, loss of coordination, vomiting, convulsions, slow or irregular breathing (less than 8 breaths per minute), pale or slightly blue skin, low body temperature (“hypothermia”), stupor (the person is conscious but unable to respond) or loss of consciousness.

Call for help and follow the basic rules of first aid: place the person in a safe side position, and observe the person while waiting for help. If they need assisted ventilation, do a mouth-to-mouth with 2 breaths every 5 seconds.

If the person is conscious, do not let them leave, sleep, drink more alcohol or coffee, and do not give them a cold shower. Instead, sit the person down and try to keep them conscious.

When an overdose with tranquilizers be considered and what should be done?

Benzodiazepines and barbiturates have a similar effect to alcohol on the central nervous system (depressants). These tranquilizers are usually prescribed to improve sleep, but if taken in excessive amounts or in combination with other drugs, they can affect bodily functions such as breathing and heart rate, and can even lead to brain damage and death.

The diagnosis is made based on a combination of symptoms of depression of the nervous system (confusion, drowsiness, coma), respiratory system (slow breathing or “bradypnoea”), and cardiovascular system (lower blood pressure (“hypotension”) and slower ( “bradycardia”) or faster ( “tachycardia”) heart rate.

Blood levels of benzodiazepines are of little value because serum levels are not proportional to the amount ingested.

After hospitalization, basic resuscitation with oxygenation and infusion is started. It is usually too late for gastric lavage, but decontamination of the digestive tract is possible. Administration of a benzodiazepine antagonist at the level of brain receptors (flumazenil ) may be considered.

When should an overdose with stimulants be considered and what should be done?

Stimulants (cocaine, crack cocaine, ecstasy, and MDMA) are a class of drugs that increase the level of attention and heart rate and create a feeling of energy and self-confidence.

An overdose of these products can lead to anxiety, agitation, panic attacks, and confusion with disorientation, paranoia, psychotic episodes, and aggression. There is also hot skin with redness, headache, stomach cramps, chest pain, muscle stiffness, tremor or cramps, uncontrolled movements, or seizures.

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You should call for help and apply the basic rules of first aid: put the person in a safe side position, and watch them while waiting for help.  If they are having difficulties breathing mouth-to-mouth ventilation at a rate of 2 breaths every 5 seconds may be needed.

When to consider an amphetamine overdose and what to do.

Amphetamines such as “speed” (low purity) and especially “crystal” or “ice” (purest form) put a  person at risk for heart attacks, strokes, seizures, and psychotic episodes.

An amphetamine overdose can cause chest pain, disorientation or confusion, severe headaches, seizures, elevated temperature (“hyperthermia”) without sweating, difficulty breathing, agitation with paranoia, hallucinations, and loss of consciousness.

Call for help and apply the basic rules of first aid: Put the person in a safe side position, and observe the person while waiting for help. If they are having difficulties breathing, mouth-to-mouth ventilation at a rate of 2 breaths every 5 seconds may be needed.

When should an overdose of new psychoactive substances be suspected and what should be done?

New psychoactive substances or “synthetic drugs” are chemicals that act in a similar way to ecstasy, cocaine, and methamphetamine. They come in the form of pills, powders, or additives added to cannabis. Their image of safer drugs is wrong and can lead to overdose.

The signs of these overdoses vary from drug to drug, but the following signs may be present: muscle stiffness with muscle cramps, tremors and chills, high fever, nausea and vomiting, shortness of breath, or respiratory arrest or coma. There may also be psychological signs such as agitation, confusion, paranoia, fear, panic, and aggression.

Call for help and apply the basic rules of first aid: Put the person in a safe side position, and observe the person while waiting for help. If they are having difficulties breathing mouth-to-mouth ventilation at a rate of 2 breaths every 5 seconds may be needed. In case of a very high fever, the person can be uncovered to cool down.





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