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Heroin Overdose – dealing with overdoses, info, tips and analysis

Discussion in 'Heroin' started by Rightnow289, Dec 9, 2008.

  1. Rightnow289

    Rightnow289 Palladium Member

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    Aug 27, 2008
    Now first things first a heroin overdose can occur from injecting, snorting AND SMOKING! However it is highly unlikely if smoked as SWIY are highly likely to pass out before overdosing. Therefore the risk is greater with snorting and much greater from injecting. Most times when users overdose on heroin it is due to taking a break from using (being in prison or on holiday for example) and not reducing the amount used. Also occasionally an exceptionally strong batch of heroin can be on the streets which users are not used to which leads to overdose.

    Symptoms of a Heroin overdose include but are not limited to:

    • muscle spasticity
    • slow and labored breathing
    • shallow breathing
    • stopped breathing (sometimes fatal within 2-8 minutes)
    • pinpoint pupils
    • dry mouth
    • cold and clammy skin
    • tongue discoloration
    • bluish colored fingernails and lips
    • spasms of the stomach and/or intestinal tract
    • constipation
    • weak pulse
    • low blood pressure
    • drowsiness
    • disorientation
    • coma
    • delirium

    If someone that you are with

    • Try to pinch them on the ear or your nail into the bed of theirs and also try to rub their sternum (breastplate). If they react then they are still alert if they do not however:

    • PHONE an ambulance. Say you have an unconcious person and they will come straight away. Do not say drug overdose as this may bring police. Tell them what they have taken when they arrive.
    • Clean up SWIY shit (needles and stuff)
    • If nalaxone is available use it but beware when the awake they will be in violent withdrawals and will mos likely need hospital treatment or some benzos. Beware that they may come around and 20 minutes later the narcan has wore off they can collapse again.
    • Put them into the recovery position and check their airways to make sure they have no swallowed their tongue or have been sick and this is blocking their airway.
    • Check their pulse and see if they are breathing. If they have stopped breathing give them mouth to mouth (if you know how) or if their pulse has stopped try to restart their heart by giving CPR.
    • If you are worried about the cops take them outside but stay with them. (in the UK this is not necessary as the police will not come in most circumstances) Stay with them if you do this until the ambulance arrives and notify the crew what they have taken.

    • Do not inject them with a stimulant as this will only make matters worse it will not liven them up.
    • Do not inject them with salt or saline solution as this is also ineffective.
    • Also injecting milk is also a complete waste of time.
    • Leave them alone to get on with it or dump the body (Imagine it was SWIY)
    • Not tell the paramedics what they have taken as this could waste vital time. The paramedics will not grass SWIY up.
    • Kick them or do anything else to hurt them physically. Pinching the ears is just as good to see if they are alert
    • Dump them in a cold bath. This can lead to shock
    Remember an overdose doesn't have to be a death sentence if SWIY have the right person around

    Last edited: Apr 25, 2011
  2. kasbeq

    kasbeq Palladium Member

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    Jul 10, 2009
    Heroin Overdose – Guide on dealing with overdose , info ,tips, and analysis

    The aim of this thread is to raise awareness and to provide useful information about overdose and what to do if someone is overdosing in front of you.

    Some of us have already witnessed cases of overdose and some of us could do so in the future.

    Its now an established fact that majority of overdoses happens in presence of others , and that it’s extremely rare that death occurs immediately after the shot.
    So knowing what to do, reacting fast, could be the difference between life and death.

    Some useful facts :

    · Overdose is now the largest cause of death amongst injecting heroin users.

    · There is evidence that the majority of deaths attributed to overdose occur in the company of others.

    · Contrary to popular belief, the 'typical' overdose victim is not a young novice or inexperienced user. Eighty per cent of deaths were classified as dependent, regular users. Most fatal cases have been using heroin for a considerable amount of time prior to death. They do not, on the whole, appear to be novice users but older dependent heroin users. 17% of fatalities are recreational heroin users.

    · Instant death following heroin administration does not appear to be the norm ,in fact it appears to be fairly rare. 14% of cases were classified as instant, 22% estimated to have died over a period of time longer than 3 hours 52% on an interval of more than 3 hours
    The fact that most heroin-related fatalities appear to occur over a period of time presents an important opportunity for intervention.

    Many deaths happen because people who see overdoses often don’t know what to do to help

    Signs and symptoms

    Shallow breathing ,breathing becomes slow or even stops Low blood pressure ,weak pulse
    Coma, delirium, disorientation, drowsiness, muscle spasticity
    Turning blue, grey or very pale, bluish-colour fingernails and lips, a bad colour.

    What to do (Keeping the person alive until ambulance comes)

    · Don’t panic
    • open the persons airways , check the mouth for (and remove) obvious obstructions , check that tongue is not blocking airway
    • Put them in the recovery position ( if they are breathing)
    • Dial emergency services and ask for an ambulance.
    • Stay with them until the ambulance arrives

    If they stop breathing give 10 breaths of mouth-to-mouth resuscitation. Then, if you haven’t done it already, call an ambulance.

    If you are giving mouth-to-mouth but find that they:

    • aren’t moving at all (look to see if their eyes are moving); or
    • are getting bluer or colder;
    Don’t waste time looking for a pulse.
    Start chest compression (sometimes known as heart massage) straight away.


    ( I have used 999 as a number for emergency services- but different countries have different E.S. numbers)

    What not to do
    Do not under any circumstance leave the scene without calling ambulance . Apart from putting someone at greater risk , you could end up in a lot of trouble Sometimes people don’t call ambulances because they are worried about the police coming as well. Many areas have developed policies so that the police don’t get called to all overdoses
    Making sure there is no shouting or panic in the background when you dial emergency services reduces the chances of the police coming. If you are really worried you could dial emergency services and just tell the ambulance control room you have found someone unconscious.
    If an ambulance is not called and someone dies, the police will come so that they can inform relatives and investigate the death.

    Remember calling an ambulance saves lives

    Common myths
    There are lots of myths about what you can do to bring someone round when they have overdosed.
    Remember- if someone has taken a lethal dose of drugs there is nothing you can do to wake them up, except call an ambulance. They can then be given naloxone ­ the heroin antidote.

    Myth 1 ‘Walking people around helps’
    Trying to walk people around may make things worse because it wastes time, and there is a risk they might fall, or get dropped. It is also possible that as the heartbeat increases with exercise, drugs will be absorbed into their bloodstream more quickly.

    Myth 2 ‘Putting people in cold baths wakes them up’
    If you have heard of people who woke up when they were put in the bath, it was because they were lucky and hadn’t taken a lethal dose. It was not because they were put in the bath. Putting people in the bath is dangerous because it takes time to run the bath - and they could die while it is filling. Even if they are alive when they are put in, they could easily drown or die of cold.

    Myth 3 ‘Hurting, hitting or burning can bring them round’
    You do need to know if someone is sleeping or unconscious. You can tell this by rubbing your knuckles on the middle of their chest. If this doesn’t wake them, they are unconscious and you need to call an ambulance and start first aid. Anything more drastic won’t make any difference to whether or not they come round, and could cause them serious injury!

    Myth 4 ‘Injecting people with salt water is an antidote to overdose’

    Some people think that giving an injection of salt water to someone who has overdosed will bring them round. Injecting salt water is dangerous because:

    • it wastes time that should be spent putting the person in the recovery position and calling for an ambulance; and
    • if, in the panic, the salt water is given in a used syringe, it could give them HIV or hepatitis!
    The idea of injecting people with salt water might have come from people seeing friends in hospital being given a saline (salt) ‘drip’ and thinking this was part of the cure. In fact the drip is put up to keep a vein ‘open’ so they can inject medication.
    The salt doesn’t affect the overdose at all.

    Common Beliefs About Overdose

    The fatal “overdose”
    The classical depiction of a fatal 'overdose', as the result of a quantity or quality (purity) of heroin in excess of the person's current tolerance to the drug, is the most long-standing and widely accepted explanation for death due to heroin. If this were the case, one might expect to find relatively high blood levels of morphine at autopsy in people whose tolerance had not diminished. However, morphine levels in studies where they have been reported have been skewed towards the lower end of the range. Only 74% of fatal heroin overdose cases had blood levels no higher than those detected in a similar group of heroin users who died of causes other than overdose (e.g. trauma, homicide).Monforte (1977) commented that : ... one must conclude that in the great majority of cases death was not a result of a toxic quantity of morphine in the blood

    This theory argues that death is not a consequence of any pharmacological activity of heroin per se, but is due to the presence of toxic contaminants in the heroin .Toxicological analyses have detected the presence of contaminants, usually quinine, either in heroin samples or at autopsy. reported the presence of quinine in 57% of cases in Michigan. However, in almost all cases, quinine levels at autopsy were well within therapeutic levels. Impurities may play a role in a proportion of heroin-related deaths. It would appear from the international literature, however, that this role may be relatively minor, and possibly subject to regional variation

    Polydrug use theory
    A theory that warrants consideration in its own right is 'polydrug use theory'. Concomitant use of other drugs (polydrug use), particularly central nervous system (CNS) depressants such as alcohol and benzodiazepines, appears to be a common practice among heroin users. Co-administration of other depressant drugs can substantially increase the likelihood of a fatal outcome following injection of heroin, due to the potentiation of the respiratory depressant effects of heroin. Thus, in the presence of other CNS depressant drugs a 'normal' or usual dose of heroin may prove fatal. However, a large number of studies have reported the finding of multiple drug use at the time of death. Proportions of fatalities attributed to overdose that were positive for alcohol at autopsy . Percentage differed on different studies and it ranged from 29% to 75%.Report showed a significant inverse correlation between blood alcohol and blood morphine concentrations. Benzodiazepines have also been frequently noted at autopsy ranging from12% to 55%

    Route of administration is an important factor
    One behavioural factor that may become of increasing relevance in relation to overdose is route of administration. In the last decade, the smoking of heroin appears to have become more widespread as the preferred route of administration (e.g. Grund, 1993; Griffiths et al., 1994). Smoking heroin may be a less dangerous route of administration because the drug effect is achieved by repeated small doses rather than a single injection. In a Dutch study of non-fatal overdoses, only 6% of Surinamese heroin users reported having overdosed, compared to 29% of Dutch born users (cf. Grund, 1993). The relative levels of injecting for these groups were 4% and 37%, respectively, suggesting a link with route of administration and overdose

    Final conclusion
    The 'typical' heroin overdose death is of an older, heroin-dependent male who is not currently in drug treatment, i.e. an experienced heroin user, rather than a naive or recreational user. The circumstances of such a death are likely to involve the use of other CNS depressants taken in conjunction with heroin. A 'true overdose', involving only heroin, appears to form a minority of deaths attributed to overdose. It is perhaps time to reconsider the term 'overdose' in view of the reported morphine levels in fatalities and the frequently detected presence of other drugs, a point that has been made by other authors (Manning et al., 1983; Fugelstad, 1994). Continuing use of this term to explain all heroin-related deaths is inadequate because it implies that an amount of heroin in excess of the person's tolerance for opioids is the underlying cause of death in all cases. The implication of this term is neither clinically useful, nor scientifically correct, for a substantial proportion of fatalities, as it ignores the contribution of other drugs to the mechanism of death.

    ADERJAN, R., HOEMANN, S., SCHMITT, G. & SKOPP, G. (1995) Morphine and morphine glucuronides in serum of heroin consumers and in heroin-related deaths determined by HPLC with native fluorescence detection, Journal of Analytical Toxicology 19, 163-168.
    BADEN, M. M. (1971) Narcotic abuse: a medical examiner's view, Legal Medicine Annual (New York, Appleton Century Crofts).
    BALL, J. C. & Ross, A. (1991) The Effectiveness of Methadone Maintenance Treatment (Baltimore, Springer-Verlag).
    BASELT, R. C., ALLISON, D. J., WRIGHT, J. A. SCANNELL, J. R. & STEPHENS, B. G. (1975) Acute heroin fatalities in San Francisco, Western Journal of Medicine, 122, 455.
    BUCKNALL, A. B. V. & ROBERTSON, J. R. (1986) Deaths of heroin users in a general practice, Journal of the Royal College of General Practitioners, 36, 120-122.
    CHAN, L. T. F., PROLOV, T. & VERMA, S. C. C. (1988) Morphine tissue concentrations in fatal cases in New South Wales, 1986-1987, Paper presented at the 9th Australian and New Zealand Forensic Science Society Symposium, Brisbane, 1988.
    CHERUBIN, C., McCUSKER, J., BADEN, M., KAVALER, F. & AMSEL, Z. (1972) The epidemiology of death in narcotic addicts, American Journal of Epidemiology, 96 11-22.
    COTTRELL, D., CHILDS-CLARKE, A. & GHODSE, A. H. (1985) British opiate addicts: an I 1-year follow-up, British Journal of Psychiatry, 146, 448-450.
    DARKE, S. & HALL, W. (1995) Levels and correlates of polydrug use among heroin users and regular amphetamine users, Drug and Alcohol Dependence, 39, 231-235.
    GUTIERREZ-CEBOLLADA J., DE LA TORRE, R., ORTUNO, J., GARCES, J. & CAMI, J. (1994) Psychotropic drug consumption and other factors associated with heroin overdose, Drug and Alcohol Dependence, 35, 169-174.
    HAARSTRUP, S. & JEPSON, P. W. (1988) Eleven year follow-up of 300 young opioid addicts, Acta Psychiatrica Scandinavia, 77, 22-26.
    NATIONAL INSTITUTE ON DRUG ABUSE (1994) Epidemiologic Trends in Drug Abuse, December 1994 (Rockville, US Department of Health and Human Services).
    WALSH, R. A. (199 1) Opioid drug accidental deaths in the Newcastle area of New South Wales, 1970-1987, Drug and Alcohol Review, 10, 79-83.
    ZADOR, D., SUNJIC, S. & DARKE, S. (1996) Heroin-related deaths in New South Wales, 1992: toxicological findings and circumstances, Medical Journal of Australia, 164, 204-207

    Last edited: Oct 5, 2009
  3. dyingtomorrow

    dyingtomorrow R.I.P.

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    Oct 16, 2008
    Re: Heroin Overdose – Guide on dealing with overdose , info ,tips, and analysis

    Very useful post Kasbeq - thanks!

    BTW SWIM LOVES the clothing of the apparently stereotypical ODed addict. That's exactly what SWIM looks like when he's running around like a heroin thug, except with either a hoodie or wifebeater! Whoever made that knows their addicts. Heheh, sorry, couldn't help but laugh.
  4. kasbeq

    kasbeq Palladium Member

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    Jul 10, 2009
    Re: Heroin Overdose – Guide on dealing with overdose , info ,tips, and analysis


    Swim needs some feedback from members , he believes that there is a lot of room for improvement on his original post.
    Please let swim know if any part of post was incorrect, if swim has missed on something, any ideas on how to improve the post, if the way it was presented needs changing. Swim would like to hear swiy-s opinion so that he can edit/ improve the quality of post .
    He thinks this info will raise awareness and could be very useful if one finds himself in a OD scenario.

    Inspiration for this post came from swi Helen’s thread “User held naloxone overdose kits soon to be available across Wales

    She attended some training and was giving feedback and she mentioned and I quote : “One of the main overdose myths that were identified in the session was something that swim had heard and seen many times before, and she didn't even realise how dangerous it was: When someone goes over, it is very dangerous to try and get them to walk around. Swim has heard this mentioned as a way of "bringing someone out of an OD" many times, and has witnessed people attempting to walk the person around the room, to try and get them to wake up a bit. This is very dangerous.”

    This made swim think about a time that he did the same thing to a friend who was OD-ing and although he did this with best intentions – he didn’t realise that it was a dangerous decision.

    As a result swim compiled info to create a thread that could help readers in the future and not act on instinct but on knowledge.

    So – please help, and have your say as this could potentially help someone in a life or death situation.

    Another reason why I need feedback is because English is not my first language and I need to know if I made any sense

    Many many thanks
  5. Helene

    Helene Gold Member

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    Jul 27, 2009
    Re: Heroin Overdose – Guide on dealing with overdose , info ,tips, and analysis

    Ooh thank you Kasbeq!

    Swim will have a proper think and see what she can add to this thread, when her head is working a little better.

  6. Spucky

    Spucky Palladium Member

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    Feb 9, 2009
    AW: Re: Heroin Overdose – Guide on dealing with overdose , info ,tips, and analysis

    If a Swiny find a Victim of a OD. it is always important to check the Tongue!
    Many Times the Tongue-Muscle collapsed and for the Victim
    it become impossible to get Air!
    Also look for Vomit or/and "Choopers"/ aka false Teeth!

    Do this before you put someone into the recovery position!

    Edit: i forget a important point too:
    In the EU. we have now more and more centralized Emergency Call Centers,
    this lead to misinterpretations of the real Location.
    If you made a Emergency Call always mention the real address: City- Village, Street, House, Floor
    and maybe even a Telephone-Number for Re-Calls!

    And many Times a OD. comes with Seizures, be prepared and remove dangerous things like chairs, Boxes, etc.!
    Try to cover the Head by a Sweater, Towel or Jacket!

    Try to get other People involved, send someone to the Entrance, Corner, Traffic-light.
    Every minute you save will help to prevent Braincells!

    And last but not least:

    Don`t ask in the Forum for Help!!!
    Last edited: Oct 5, 2009
  7. kasbeq

    kasbeq Palladium Member

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    Jul 10, 2009
    Re: Heroin Overdose – Guide on dealing with overdose , info ,tips, and analysis

    Swi - Spucky
    I edited the bit about clearing airways and checking the mouth for obstructions.
    It was great advice.

    the second part was a bit unclear to me
  8. Spucky

    Spucky Palladium Member

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    Feb 9, 2009
    AW: Heroin Overdose – Guide on dealing with overdose , info ,tips, and analysis

    a.) sometimes the Emergency lose Time because the go to the wrong Place in a different Town!
    "To get People involved" means send someone to a Landmark like a Traffic-Sign to wait for the Ambulance,
    it will be very helpful for them!

    b.) Injections of Heroin can be epileptogen!
    ("Epileptogen" means "Triggering of Seizures")

    C.) Sometimes People lose important Time because they are asking ie. here
    what to do, this is not right.
    If there is a OD. don`t waste any time,
    the Way to go is call the Emergency ASAP.!

    I hope this help to understand :vibes:
    Last edited: Oct 5, 2009
  9. BumpBump

    BumpBump Silver Member

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    Aug 1, 2007
    Re: Heroin Overdose – Guide on dealing with overdose , info ,tips, and analysis

    ok swim has seen quite a few overdoses in his time.
    Swims first sign would probably be the noise they person makes. Its like they are being strangled/ or some say its like a donkey. Usualy turning purple/blue and possibly their mouth open and tounge out gasping for breath.

    Swim has seen people bring someone in an OD round by shouting at them(usualy their name) grasping them by the chin and shaking their head/ OR slaps round the face(not inflicting any damamge)?. This of course if most likley that they had not a fatal dose/ but swim has seen it done do it might be worth a try. s
    If swim dose not succed in the first few minutes then call for an ambulance!

    Swim complimetns kasbeq in his collective information, and wonders if any experienced H swimmers would like to give any first hand experience of O/D's?
  10. EyesOfTheWorld

    EyesOfTheWorld R.I.P.

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    Oct 6, 2008
    Re: Heroin Overdose – Guide on dealing with overdose , info ,tips, and analysis

    Would like to second Spucky's very inportant advice, that when one has an overdose victim on one's floor, that is NOT the time to come on Drugs-Forum and ask for advice! Seems obvious enough, but have seen some questionable posts here that seem like they could have come from someone with a blue friend right next to them.
    DO, however, read up well on overdose safety both here and anywhere else harm reduction info is posted or printed. Any IV drug user should be well familiar with what to do in event of an overdose, as anyone that shoots opiates for a long time WILL eventually be put in a situation where knowing their shit could save someone's life. Be safe.
  11. dyingtomorrow

    dyingtomorrow R.I.P.

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    Oct 16, 2008
    Re: Heroin Overdose – Guide on dealing with overdose , info ,tips, and analysis

    From what SWIM has seen, and had happen to him as related by others, the first thing that happens when someone shoots too much heroin is the lips and eyelids turn blue/purple. When this happened to SWIM he didn't need hospitalization, but it seems to be right on the cusp of a serious OD situation.
  12. Ill~Will

    Ill~Will Silver Member

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    Oct 26, 2009
    Re: Heroin Overdose – Guide on dealing with overdose , info ,tips, and analysis

    When swim's brother in law OD'ed swim drove him straight to the hospital,
    which luckily is only a mile away. swim did not have to talk to any police
    and they were able to save him.
  13. Spucky

    Spucky Palladium Member

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    Feb 9, 2009
    AW: Re: Heroin Overdose – Guide on dealing with overdose , info ,tips, and analysis

    Okay, one Mile is not too far but normally it`s not a good choice to drive someone with an OD to the Hospital!

    Normally this situation will be too much, even for the most experienced Driver,
    also the Victim sit in a very bad position
    that will support a Breathing-Depression and it`s possible that
    Vomit reach the lungs,
    Seizure can be very dangerous for the Driver, etc.!

    And don`t forget the Panic ;)
    Maybe the Driver will harm other People!
    Last edited: Oct 27, 2009
  14. Ill~Will

    Ill~Will Silver Member

    Reputation Points:
    Oct 26, 2009
    Re: AW: Re: Heroin Overdose – Guide on dealing with overdose , info ,tips, and analys

    no doubt, swim was panicking for sure, swim layed him on his stomach/side in the truck, and was slapping his face, yelling at him, anything to try and get him to be responsive. When swim reached the emergency entrance at the hospital he yelled for help and helped the doctors get him on a stretcher, when swim felt the limpness of the victim he lost it and started throwing up in the parking lot. This was an intense experience for swim because he didn't want to have to tell his sister that her man was dead.
    Not something swim wants to ever have to experience again. Nowadays swim does the lowest amount possible to achieve the feeling he wants, especially with product he hasn't used before. Even if it means not getting an awesome rush.

    Swim still hasn't overdosed, and doesn't plan on it (but who does?)
  15. Thor1394

    Thor1394 Silver Member

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    Oct 25, 2009
    Re: Heroin Overdose – Guide on dealing with overdose , info ,tips, and analysis

    This is a great and informitive post. Take it from SWIM his best friend died of an overdose and has witnessed 3 which luckily all survived. They all started off the same within a minute or two they were unconcious and started struggleing for breath. They then turned pale white with blue lips. In 2 cases that SWIM witnessed they stopped breathing yet no one there did anything but stare at them and freak out. I honestly believe if SWIM was not there he would have lost two more friends. SWIM is not trained for CPR but SWIM immediatley began mouth to mouth just mimicking what he has seen on tv and after moments they all began breathing again. All swimmers friends depend on them to act quickly and do the right thing in order to save their lives. Lets keep all our swimmers safe and here with us.
  16. Helene

    Helene Gold Member

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    Jul 27, 2009
    Re: Heroin Overdose – Guide on dealing with overdose , info ,tips, and analysis

    Threads like this are so important for the basic reason that overdose management by untrained/ uneducated witnesses is often inept, flawed, counterproductive or downright dangerous.

    Examples of dangerous malpractice include:

    Injecting with salt-water (saline)
    Immersion in cold baths
    Injecting with cocaine
    Slapping, shaking or punching
    Walking the victim around
    Pouring cold water on them

    None of the above should ever be attempted as a means of reversing an overdose.

    If you suspect someone to be OD-ing DO NOT slap, hit or shake them, or otherwise attempt to "shock" them out of it.

    Shaking or slapping someone who is OD-ing is dangerous for the same reasons as walking them around the room when they begin to regain consciousness.

    This extra, unnecessary movement will cause the as-yet unabsorbed heroin in their blood-stream to move around their body to their brain faster, thus causing them to overdose further when it hits the receptors. If you think someone is OD-ing, you want to aim to keep them as still and as quiet as possible.

    To try and get their attention, instead you should first shout their name. If they do not respond, pinching the earlobe is the recommended way of trying to establish if they are conscious or not. If there is no response, call an ambulance and follow the steps outlined below (Airways, Breathing, Circulation, recovery position, naloxone if available)

    The ABC Procedure:

    A is for AIRWAYS open

    B is for BREATHE for your casualty

    C is for CIRCULATE the blood by chest compression

    Oh, and we'll just add D for DON'T PANIC AND DO A RUNNER.

    Your first response must always be to call an ambulance. But if someone has stopped breathing, you need to remember and administer these life saving procedures.

    Artificial ventilation (mouth to mouth/ kiss of life etc) is quick and efficient and should prevent the casualty from deteriorating any further until help arrives. Resuscitation should be continued even if you are in doubt about whether the casualty is being revived.

    When the person goes over.....

    First you need to check the breathing of the casualty. When someone has stopped breathing they will almost certainly be unconscious. In order to check breathing, place your ear above the persons mouth and look along the chest and abdomen. If they are breathing you will see and feel and breaths or chest movements. If breathing is regular then place the person in the recovery position until help arrives or they wake up. Keep checking on them regularly.

    NOW; if checking to see if the casualty is breathing, pinch their earlobes, put your cheek to their mouth to feel any breaths. If they are breathing 4 or less times a minute – they are in serious trouble. If you have established that the person is not breathing, or not breathing enough, but still has a pulse, you then move on to

    The ABC procedure:

    (If there are no breaths and no pulse move straight to C immediately)

    A - Opening the persons AIRWAY.

    The unconscious persons airway may be blocked or narrowed which would make breathing difficult or impossible. Blocked airways happen for a few reasons; the head may be tilted forward, narrowing the air passage; muscular control in the throat can be lost, allowing the tongue to slip back in the throat - or since reflexes are impaired, saliva or vomit may lie there also, again blocking the airway. Any of these situations can lead to death and your mouth to mouth will not be effective anyway unless you check the airway first.

    With an open airway, your casualty may start breathing spontaneously. Many peoples lives are saved by this action alone.

    They should then be placed in the recovery position if you're satisfied the breathing is regular enough.

    Clearing the AIRWAY

    How to clear the airway?

    1- Place one hand under the neck, the other on the forehead and tilt the head backwards. This extends the neck and opens the air passage.

    2- Transfer your hand from the neck to push the chin upwards and the tilted jaw will lift the tongue, again clearing the airway.

    3- Clear the airway of any foreign material like loose teeth, dentures, vomit etc by turning the casualty's head to the side, hook two fingers together and sweep them through the mouth. Don't spend to long here though.

    Move on to B.

    B - BREATHING for the casualty

    The air we exhale contains about 16% of oxygen which is easily enough to sustain life. Mouth to mouth ventilation makes it easy to watch the casualty's lungs for movement - showing that they are filling, and also shows up the changes in skin pallor. Hopefully the skin will move from a bluey/grey colour back to a more normal colour. It is easiest to carry this all out when the casualty is on their back but it should be started immediately no matter what position.


    1- So, kneeling alongside the chest area, with the head turned back to the tilted back position, block the persons nostrils with two fingers and open your mouth wide - take a deep breath and seal your lips around their mouth.

    2- Looking along the chest, blow into the casualty's lungs until you can see the chest rise to maximum expansion.

    3- Move your mouth well away from the casualty and breathe out any excess air. Watch the chest fall and take in a fresh breath. Repeat inflation.

    Give the first 4 inflations as quickly as possible without waiting for complete lung deflation between breaths.

    4- Check the casualty's pulse to make sure the heart is beating. This must be checked now and after every three minutes until the person resumes breathing normally, If the heart is not beating now - go straight to C and chest compressions.

    You check for a pulse by placing you hand around the hollow in the front of the neck (between the voicebox and adjoining muscle). The wrist is unreliable in this instance so use the neck/throat area.

    5- If the heart is beating normally, continue to give inflations at a normal breathing rate - 16-18 times per minute until natural breathing is restored. Then place them in the recovery position (see above post).

    That's all there is to it. You just continue mouth to mouth and checking the pulse every 3 minutes.

    C - Assisting the casualty's CIRCULATION

    If mouth to mouth alone is unsuccessful and the heart does not continue beating, you must perform -

    External Chest Compression in conjunction with mouth to mouth ventilation.


    Without the heart to CIRCULATE the blood, oxygenated blood cannot reach the casualty's brain. Some people may avoid this procedure because they may be unsure of where to apply the pressure and fear breaking the persons ribs - which can happen if done incorrectly. But remember the person in cardiac arrest is already clinically dead. CPR can only help. Even if it's not done "letter perfect" it will probably provide some benefit to the victim. Better to have a broken rib or two than be dead.

    Evidence shows that there is enough oxygen reserves in the blood for approximately 5 minutes, and the emphasis is on circulating the blood to get the oxygen to where required:

    1- Kneel alongside the person and ensure the airway is open as described earlier.

    2- Place two hands in centre of chest and press down, measurement is no longer required.

    3- Do not apply pressure over the ribs, bottom end of the breastbone or the upper abdomen.

    4- Perform 30 chest compressions at a rate of 100 per minute (to find the right rate count aloud), to a depth of 4 - 5 cms: allow the chest to come back up completely after each compression.

    5- Give 2 rescue breaths taking 1 second each - ensuring the airway is open and that the mouth is sealed. This minimises disruption to giving chest compressions. Make no more than two attempts at rescue breaths each time, before returning to chest compression

    6- Check the face colour and pulse after the first cycle of 30 compressions. Check heartbeat every 2 minutes.

    Stop as soon as the casualty starts breathing again.

    N.B: Recommendations for CPR compression ratio have recently changed. Please note the new recommended ratio for chest compressions to rescue breaths is 30:2.

    If the casualty doesn’t start to breath again, it is suggested that you continue CPR until the ambulance personnel are in a position to take over, someone arrives with a defibrillator, or if you are suffering from fatigue resulting in you not being able to continue.

    Please remember that it is suggested that if another first aider is available that you change places every 2 minutes - this ensures that the quality of the compressions is maintained.

    Throughout this whole procedure you must realise that your efforts are giving the collapsed person a chance of survival.


    Continue mouth to mouth alone then, until normal breath returns to the person. They may need casual assistance to breathe, so give it to them when necessary until help arrives. Place in recovery position when satisfied that they are breathing normally.

    Last edited: Nov 9, 2009
  17. forwhomthebelltolls

    forwhomthebelltolls Newbie

    Reputation Points:
    Oct 18, 2009
    Re: Heroin Overdose – Guide on dealing with overdose , info ,tips, and analysis

    thanks swi-helene... very awesome post

    just wanted to add that nasal narcan(naloxone) can be obtained from needle exchanges in some areas. theyll have you watch a video, show you how to use it, and give you two 'units'. swim got his in boston, but check around your area.

    could save someones life, or someone could save yours.
  18. thebige


    Reputation Points:
    Apr 14, 2008
    Re: Heroin Overdose – Guide on dealing with overdose , info ,tips, and analysis

    Swim thinks everyone should make some effort to learn CPR,ya never know if swiy may need to preform it.....not just for a overdose but it maybe for your mother,father,child or infant.
    Something else one could try if the person does not respond to verbal commands is to give a quick "sternum rub"....basicly use your knuckles and rub up and down on the persons sternum/breastbone with enough pressure to be annoying.And if your lucky you will get a loud Oooooowwwwww! from them.If not move on with your procedure.
    After preforming a visual check /finger sweep of the mouth and adjusting the head to see if there is spontaneous breathing.....If you are alone it would be a good time to start thinking about calling for a ambulance about now.Because even if it only takes 5 or 8 minutes for them to get there,to you it will feel like eternity for them to show up.
    If you can remember,unlock your front door to provide access for them.
    Remember that you stand a chance of getting some vomit and whatever is living in the patients saliva in your mouth,and if you are gung-ho you can purchase a one way fluid barrier that will offer you protection against bodily fluids.They are small and some come on a key chain so you will always have it around.

    If swiy administers Narcan/naloxone to the person that has ODed,don't be surprised if/when they come around and figure out what has just happened...it is not unheard of for the person to get angry at you for wrecking their high and interrupt what they considered a really good nod........
    Swim feels it would be wrong not to preform CPR if someone is afraid that they will do it incorrectly......as said above you might break a rib or puncture a lung....but better that then not trying.Swim doesn't know about other countries but the US has "good Samaritan laws" that will help protect you from legal ramifications,as long as you do the procedure to the best of your knowledge and did not intend do do any harm by trying to help.

    Please keep in mind that YOUR safety comes first,and if you choose (for example) to not to do respirations for the person and only do compressions.Because you feel the risk of obtaining a disease from this person endangers your safety or life.Then, if swim is not mistaken, swiy cannot be held responsible (legally)for that persons outcome.
    Sounds harsh,but that would be a decision that you would have to make and live with.You may enjoy your dope,but is it worth it to run the risk of bringing a disease home to your husband,wife or children?..............
    This last statement may sound bad,but swim felt it is another important decision that needs to be considered when deciding to preform a procedure like this.............
    Although that would be a personal decision that you would have to make and ultimately live with.

    Quick Edit.................Swim responded to this post,early in the AM and it was after a sleepless night.So if anything is hard to interpret or understand please forgive........
    Next posts will be submited working under a clearer head,Thanks all....bige
    Last edited: Oct 31, 2009
  19. ergoamide

    ergoamide Titanium Member

    Reputation Points:
    Dec 28, 2005
    Re: Heroin Overdose – Guide on dealing with overdose , info ,tips, and analysis

    One important thing to remember whenever you have a shot is to watch the way your sitting/lying down. The reason for this is if your lying down and your lying over one of your legs the circulation to that leg is cut off. You know when you wake up in the morning and you have a dead leg coz your lying on it same thing. The difference between it happening when ya sleeping and when your high is that your body won't tell you to wake up. If this happens there's a chance you could lose your leg, it happened to a friend of swims and he almost lost his arm aswell as he was lying on it to. So the thing to remember is everytime your having a shot is to make sure if you OD, whether a minor or major OD, that your circulation won't be cut off accidentally. I figured this was the best thread as it applies not only to someone about to have a shot but also to anyone finding someone OD'ed although if you put them in the recovery position it shouldn't be a problem.
  20. adzket

    adzket R.I.P.

    Reputation Points:
    Mar 10, 2005
    Re: Heroin Overdose – Guide on dealing with overdose , info ,tips, and analysis

    in swims area we have been given the antidote drug naloxone. it will only be given to injecting users who have large habbits or are being treated on a methadone treatment program. they are given two lots of the drug to be eather given to a close friend or relative to be able to come and administer quickly plus one dose kept in fridge in house so if another emergancy service respond before the ambulance for instance when fire bregade can get there quicker that an ambulance as well as gain entry to the house they can administer it quickly. the person who is given the piscription has to have hospital paper work to get replacements for what is used. also eather they can show responsible person how to administer or they can arangeappointments threw there substance missuse team to be showen by a train medical proffesional. when swim and friend went they where trained on an orange to get feel for pin going threw skin.