Opiates and opioids are depressant pain relievers derived from, or chemically similar to substances found in the opium poppy. They include both naturally occurring and synthetic substances. Examples include morphine, heroin, oxycodone, fentanyl, etc. Read on to learn more about effects and risks including how to respond to an opioid overdose!
These effects are pulled from Erowid's page on Oxycodone. Other opioids may have a different intensity of effects.
Categories of effects come from Erowid
Positive
analgesia, reduction of pain
sedation, sleepiness
reduction of anxiety, feelings of relaxation
euphoria, mood improvement
Neutral
pupil constriction
sweating
slowed reaction time
changes in focus, attention, and thought
impaired thinking, confusion (less common)
loss of appetite
Negative
constipation
nausea, vomiting
dizziness, headache
itching
dry mouth
increased sensitivity to pain (usually after stopping use)
fatigue, weakness
nervousness
insomnia
fever
diarrhea (usually after stopping use)
clammy skin
light-headedness, fainting
acute withdrawal symptoms if physically dependent
seizures, convulsions
difficulty breathing
respiratory depression, respiratory arrest
Absent or slowed breathing
Cold, clammy, or discolored skin (blue lips or fingernails in lighter skinned individuals and grey lips or fingernails in darker skinned individuals)
Constricted (small) pupils. This is a response specific to opioids that may not be seen in other life threatening emergencies.
Snoring or gurgling sounds
Unresponsiveness. To test for responsiveness you can deliver a painful (but not harmful) stimulus including a sternum rub, or a pinch on the shoulder above the collarbone.
Do not give naloxone to someone who is unresponsive but just high without their consent!
Follow directions on naloxone packaging. For intranasal naloxone, insert the device into the persons nostril and direct it backwards (as if you are giving them a COVID test). Press the plunger firmly once. Do not attempt to slowly give the dose as it will not spray properly.
Only give a second dose after 3 minutes. Naloxone can take this long to work and giving someone several doses in a row can lead to intense discomfort for chronic opioid users.
One you’ve identified that a person is experiencing a drug overdose, either call 911 or if there is someone close by, ask them to call 911. The most important thing is getting someone naloxone, so prioritize that.
When calling 911, it is often best to avoid mentioning that the individual is using drugs as police may be sent in addition to EMS which can be traumatizing for some individuals and can lead to stigmatized care.
When speaking to the 911 operator, it’s best to say, “My friend is unconscious and is not breathing.” If they ask whether you know what happened, you can say that you aren’t sure or just describe their physical symptoms and ask for care advice.
When EMS arrives make sure to let them know that you have given the person naloxone.
Rescue breaths are vital for someone experiencing an opioid overdose. This is because opioids suppress respiration and the person is not getting enough oxygen.
CPR is good if you are uncertain how long someone has been without breathing. If you see someone overdose, their heart is likely still beating and CPR is probably not needed.
Steps for giving rescue breaths
Tilt the head back and make sure nothing is blocking the airway
Pinch the persons nose
Take a deep breath
Exhale into the persons mouth
Watch for their chest to rise
Repeat
Make sure to give one breath every five seconds: you can think “a breath for you, a breath for me.”
Many people who are revived using naloxone do not realize that they have overdosed and they may be confused or upset. Naloxone gets rid of someone's high and can send them into withdrawal which can be extremely uncomfortable and even dangerous for a chronic opioid user. This is part of why it’s important to call 911.
Make sure that the person does not try to use anymore drugs as they might go back into the overdose. Additionally, naloxone wears off after 30-90 minutes and it is possible for the person to go back into an overdose. Respect autonomy if they want to leave but try to stay with them until EMS arrives. If they want to go, offer them another dose of naloxone.
Take care of yourself and try to get support. Responding to an overdose can be scary.