Thursday, November 08, 2012

How Not to Die a Tragic Death from a Drug Overdose

Whitney Houston, Michael Jackson, Heath Ledger, Amy Winehouse, Anna Nicole Smith -- I imagine you know what these celebrities all have in common: they've died from accidental overdoses.

In the first 20 years of my career, I can't recall hearing a single story of an accidental overdose resulting in the death of a young person that I knew, a friend knew, or a patient told me about.  Maybe I've forgotten them, but if so, it's because they were spaced well apart and there weren't memorable trends. One close friend had a young relative, a substance abuser, overdose and end up in an ICU, but he lived.  Somehow, in the past year, I've been hearing more and more stories of tragic deaths of young people, full of life and promise, who partied just a little too hard and stopped their lives in it's tracks.  Not suicides, just a little too much of whatever the substances might be.  

So young people party.  They drink, they smoke weed, and sometimes they pop pills or shoot drugs (though please do note that IV drug use is not considered to be "recreational.")  Given that this is the reality of some people's youths, and these stories are heart breaking, let me offer some words of wisdom.  It's not just the hardcore addicts who are dying, it's not just the shooters, and often the deaths are caused by medications with legal uses.   And the horror of the deaths is not just their tragedy, but the guilt that gets left behind, by the person who left the victim alone, who noticed they seemed off but not enough to call an ambulance, by the person who didn't think much of an unanswered call or text and gets to wonder if they had done something differently, if their friend might have lived.  It's all horrible.

Here are my words of wisdom:

Only take one substance.

Don't drink and take drugs.  Don't do it even if you've done it 2,413 times and it was fine all those times,  Many people who die accidentally have lots of experience with it and have never died before.

Don't mix drugs.  Benzodiazepines may be relatively safe, but once you take your Xanax, add a little oxycontin, and have a beer, you may be in for a very long sleep.  Xanax/Valium/Ativan/Klonopin (benzos) and Oxycontin/Oxycodone/heroin/methadone/morphine/MS contin/percocet/percodan/darvocet/demoral (opiates)  --- these medications have effects that are more than additive and they cause respiratory depression and have unpredictable effects.  This combination of xanax/alcohol/pain killers seems to be especially popular and especially lethal.  Cocaine and stimulants are also a really bad idea.

If you've had a drug problem, quit using, and have been clean for more then a few days, your body starts to heal, and if you relapse, it will take much less drug to get the same effect,  Taking your old dose of medication can be lethal.  This is a major reason why death rates are so high soon after prisoners are released from jail -- they hit the streets and take their former dose of drugs -- it's much more than their body can handle after being clean.

Don't drink on an empty stomach.  Food slows absorption.  The body is made to resist dying from alcohol poisoning -- it's why people throw up, it keeps them from absorbing too much alcohol.  You can overwhelm this safety mechanism if you drink too fast.  

---Don't do shots.  See the above logic.  It's hard to kill yourself drinking beer alone, but I've heard of people doing 21 shots on their 21st birthday or drinking an entire bottle of straight vodka as part of a frat initiation.  This can kill you.  If you must do shots, don't do them on an empty stomach, let a fair amount of time pass between shots, and drink a non-alcoholic drink in between to slow the process down. 

----If you must drink heavily, do it with friends and stay with each other, don't lose your drunk friends.  Don't leave someone who has passed out alone, roll them on their side so that if they vomit they don't aspirate it (aspirate = breathing your puke into your lungs, a common reason people die after heavy drinking or overdosing).  If someone can not be aroused after drinking, call an ambulance! It's better to be embarrassed than to be dead.  Remember, you don't have to be an alcoholic to die of alcohol poisoning.

-----Don't drink and drive.  There is a cab driver out there who needs your business. 
-----Don't drink and go on the roof.
-----Don't drink and walk on railroad tracks.

If you take prescription drugs for medical reasons, don't increase the dose without checking with your doctor first.  If you're not sure if it's safe to combine prescription drugs, ask your doctor or call a pharmacist (any pharmacist, look for a 24 hour pharmacy and call and ask to talk with the pharmacist.)

And probably the best advice: don't abuse drugs or alcohol.  

If you take prescription pain killers, sedatives, or stimulants,  know where they are, and know that someone else can't access them.  These medications aren't meant to be shared.