Despite what we know about how overdoses can kill, there is scant literature regarding chronic health outcomes for people who have survived multiple overdoses.
Drug overdoses are a leading cause of preventable deaths in the United States. We know the dangers of overdoses; generally, they can kill. Opioids make up a large percentage of these deaths. In 2016, opioids made up 69 percent of drug overdose deaths. For people ages 25 to 64, drug overdoses cause more deaths than car accidents. Overdoses caused by opioids can be reversed if quickly countered with naloxone, an opioid antagonist.
In states like Massachusetts, opioid overdose deaths are on the decrease, but overdose emergency calls are on the rise. More people are surviving, but only 3 out of 10 people are receiving medical treatment for substance use disorder. What is happening to the other 70 percent of individuals?
It is technically possible to overdose on nearly any recreational or medicinal drug available.
Cocaine overdose can involve seizures, heart attacks, strokes, and/or stop a person’s breathing. Amphetamine overdose can lead to seizures, cardiac arrest, and/or a huge spike in body temperature. Psychologically, high doses of stimulants can cause severe psychosis. MDMA overdoses have some similarities to stimulant overdoses, including increased body temperature, kidney failure, and hypertension. Alcohol overdoses most often occur when a person engages in binge drinking which can lead to breathing problems and interfere with cardiac functioning.
The Mechanics of an Overdose
Heart problems and oxygen deprivation are two common symptoms of an overdose that we see in many drug-related deaths. But what happens to the brain during an overdose? Are there lasting effects? Can an overdose cause permanent brain damage?
The body is being poisoned during an overdose, and it’s usually not obvious to the person who ingested the substance. Someone who has just taken a lethal amount of opioids is unlikely to recognize what’s happening, although others may. As described by Maggie Ethridge for Vice, signs include “extreme drowsiness, cold hands, cloudy thinking, nausea and/or vomiting, and especially slowed breathing (fewer than ten breaths per minute).”
Once ingested or injected, an opioid makes a beeline through your heart and into your lungs. While in the lungs, your blood gets a dose of oxygen and that “now opioid-rich blood is pushed out to the rest of the body, where it plugs into the system of opioid receptors all over your body.” As the opioids enter the brain, they cause the neurotransmitter dopamine (the feel-good chemical) to overflow. That’s where the feeling of euphoria comes from. After repeated use, reaching that blissful state becomes harder, requiring increasingly larger doses of the same drug.
If you’ve overdosed, the next thing that will happen is that your brain’s basic systems that control breathing will be affected and your breathing will slow before stopping entirely. Circulatory functioning is next to be affected; your heart rate will slow as the opioid dampens neurological signaling in the brain. As your oxygen levels reduce, your heart begins having irregular rhythms and this can lead to a cardiac arrest.
Opioids are a depressant, decreasing heart rate and breathing. Overdosing on opioids essentially causes the central nervous system to go into such a depressed state that the body forgets to breathe. Without enough oxygen (hypoxia), the brain can become severely damaged. The longer someone goes without oxygen, the worse the damage can be.
Certain parts of the brain are more sensitive to the immediate effects of oxygen deprivation. The frontal lobe is particularly at risk of damage when experiencing anoxia (zero oxygen reaching the brain), resulting in problems with executive functioning. Executive functioning refers to a set of mental skills in the areas of working memory, inhibitory control, and cognitive flexibility. If a person experiencing an overdose has a seizure, this can cause further damage to the brain.
Toxic Brain Injury
Substance use disorders and brain injuries go hand in hand. An estimated 25 percent of people who enter brain injury rehabilitation have had problems with drug use and half of people entering substance use treatment have experienced a brain injury. Each of these conditions makes the other worse.
Toxic brain injury is a term that has been coined to encapsulate the type of injuries that occur after an opioid overdose. It is also referenced under the category of acquired brain injuries, which include instances of brain damage that occur after someone is born but are not connected to degenerative or congenital diseases.
The white matter of the brain can sustain damage from repeated oxygen deprivation. The consequences of toxic brain injury increase if someone experiences multiple non-fatal opioid overdoses. Despite what we know about how overdoses can kill, there is scant literature regarding chronic health outcomes for people who have survived multiple overdoses. What research does exist focuses on brain injuries due to hypoxia/anoxia.
From what we do know, certain areas of the brain are most likely to be harmed and can “lead to the development of severe disability.” These areas affect neurological processes; short-term memory loss, disorientation, even acute amnesia have been observed. Survivors may develop physical problems such as loss of control over bodily functions, lack of coordination, nerve damage and subsequent reduction in the ability to use a certain limb or body part, or even paralysis. Less severe but still serious symptoms include slower reaction times, motor skill disturbances, memory problems, and overall “diminished physical functioning.”
Only 3 out of 10 people who overdose on opioids and survive seek medical treatment for addiction. For every reported overdose death, there “may be five nonfatal overdoses, many of which go unreported.”
This isn’t to say that anyone who has ever survived an overdose has brain damage, but rather that more research and advocacy needs to focus on surviving overdoses and how to best move forward with healing and increasing rates of recovery.
NASHIA (National Association of State Head Injury Association) recommends that substance use disorder treatment services should be available and accessible for people who have sustained a brain injury. They also recommend that medical providers regularly screen patients for a history of brain injury and to ensure that people can receive treatment for any cognitive, behavioral, and/or physical disabilities due to a brain injury.
Reducing overdoses is a critical aspect of preventing these kinds of chronic injuries. Once a person has one overdose, they’re more likely to have another, and that likelihood increases with each overdose. When available and implemented, harm reduction principles work to reduce this likelihood and improve outcomes. There is no one-size-fits-all approach to recovery from substance use disorder that will work for everyone. Harm reduction strategies like widespread use of naloxone improve the long-term health effects of an overdose.