Overdose - Clinical Manifestations

Generally, with overdose, the effects of drugs are exaggerated, ADRs become more pronounced, and other unexpected reactions may be observed. Large overdoses of some medications may cause only minimal ADRs; yet, with other medications even smaller overdoses may cause severe toxicity, to include death. A single dose of some medications can be lethal to a young child. Although clinical manifestations of drug overdose vary, the signs and symptoms in Box B are suggestive of medication-induced toxicity in general.

Box B. General Signs and Symptoms of Drug Overdose.

Patient’s skin may be hot and dry; or cool and sweaty
Patient may complain of nausea, vomiting, abdominal pain, and diarrhea
Patient may be sleepy, confused, or in a coma (cannot be aroused)
Breathing may be rapid or slow; deep or shallow
Blood pressure and pulse rate may be increased or decreased; in some cases the pulse may be absent (e.g., not palpable); body temperature may be elevated
Organs specific toxicity: for example, chest pain may suggest damage to the heart or lungs

From 1999 – 2023, about 806,000 people in the U.S. died due to an opioid overdose.¹⁷ Since 2013, there has been a dramatic increase in overdose deaths due synthetic opioids (e.g., fentanyl and fentanyl analogs), which have saturated the illegal drug market.¹⁷ An opioid overdose can reliably be identified by the presence of three clinical signs and symptoms referred to as the “opioid overdose triad”: (1) pinpoint pupils (miosis), (2) unconsciousness, and (3) respiratory depression (less than 12 breaths/min).¹⁸

Combining opioid analgesics with alcohol and other central nervous system (CNS) depressants increases the risk of respiratory depression and death. Indeed, opioids, alcohol, and sedatives are often present in fatal drug overdoses. Risk factors for overdose with prescribed opioid analgesics include middle age; history of substance abuse, including prescription and illicit drugs and alcohol; comorbid mental and medical disorders; high opioid dose (particularly with added benzodiazepines); methadone use; benzodiazepine coprescribing; antidepressant coprescribing; and unemployment.¹⁹ A history of substance abuse, high prescribed dosage, male gender, older age, mental health conditions, concurrent prescriptions of other CNS depressants (e.g., benzodiazepines), and lower socioeconomic status.

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