The other day, I told you what not to do in the event that someone you are with overdoses on opiates. Here’s what you actually should do:

1 – Get Their Attention. Yell their name. Shake their shoulders. No response at all? Try again.

2 – Sternum Rub.  Yes, this is exactly what it sounds like: using your knuckles, you rub the possible overdose victim’s breast bone, up and down. It’s not pleasant for the person on the receiving end, but it’s a common practice used to rouse those who’ve had too much of anything.

3 – Get Help. If neither of these measures works, then call 911 immediately. As soon as they answer, tell them if the victim is not breathing, then answer the questions that they will most likely ask: the substances taken, how much, when the last dose was. They may also request information about the person’s age and weight. If you have a pill bottle with the prescriptions that the person took, hold onto it and give it to the paramedics when they arrive.

The emergency attendant will most likely ask you to stay on the phone with him or her until help arrives. If for some reason you have to leave the victim alone, turn them on their side so that they don’t choke if they vomit.

4 – The Naloxone Option. Some people who regularly use drugs to get high (as opposed to those who use them only in an attempt to manage pain and inadvertently overdose) often choose to keep naloxone on hand in case of a situation like this. If you have this available and the person is not breathing, then give them a few breaths CPR-style before administering the shot. If the person is breathing, give them the naloxone. Use .4cc of the drug and inject it into a large muscle like the thigh. If they don’t respond within three minutes, inject another .4cc into the muscle. In between, if they aren’t breathing, keep administering CPR.

**It’s important to remember that naloxone does not flush the offending drugs out of the system though it will put the victim into immediate withdrawal. When the naloxone wears off, if the drugs are still in the system, overdose is again a possibility. Stay with the person and try to keep them from taking more drugs to mitigate the withdrawal symptoms and make sure that they don’t overdose again.

So to continue this string of posts in my self-proclaimed Overdose Awareness Week, today we are going to tackle the topic of risk factors. Knowing the risks that you are taking is crucial when it comes to preventing an undesired outcome, and with opiate overdose, there are 5 specific things that are red letter risks. Want to avoid an opiate overdose? Then pay attention.

1 – Chronic Illness. Do you have diabetes? HIV/AIDS? What about liver disease or heart disease? If you do, then you have a lower immune system than someone without these conditions and this lowered immune system is tricky. It changes your tolerance for a drug without notice. You could use the exact same dose every day for years and overdose, seemingly, without cause. The extra trouble here is that if you are using and not taking care of yourself, you may not know that you are developing one of these silent and deadly diseases. Liver disease and heart disease are especially dangerous, so get to the doctor for exams and pay attention to your body, noting any changes that could signify that something else is going on.

2 – Other Issues of Lower Tolerance. If you haven’t been taking pills (or insert your opiate of choice here) for awhile for whatever reason and suddenly decide to again, your tolerance is going to be significantly different than the last time you used. Expecting to “pick up where you left off” and taking the dose you were at when you quit can land you smack in the middle of an overdose. This is why people who are just out of jail or who relapse after detoxing or trying to get clean are common victims of opiate overdose.

3 – Mixing Different Drugs. If you are currently taking a prescription for opiate painkillers and do other drugs on top of it, even in small doses, you are raising your risk for an overdose. For example, one dose of a benzodiazepine like Xanax may be relatively mild but take it on top of a dose of methadone or codeine and you’re going to find it difficult to keep your eyes open. Or breathe.

4 – Depending on the Strength of Street Drugs. The bag of heroin you bought yesterday will most likely not be the same quality or strength of the one you buy today. Contrary to what many think, the more pure or uncut it is, the more dangerous in terms of overdose. Different parts of the country, different cities, different dealers all offer something different so the same size shot from any one of them will be largely different from another.

5 – Doing it Alone. Take any one or combination of the above risks and do it without someone else around and you’ve just compounded your risk for overdose. With someone else there, you can have (and be) a voice of reason. And if things get out of hand or dangerous, then one of you may be able to call paramedics in time to keep the situation from turning deadly.

Want to completely wipe out your risk for overdose? Get clean, safely and on your own terms, with Suboxone. Follow the treatment plan that you and your Meditox doctor come up with together and let someone else know what you’re doing so that they can keep you accountable. Take responsibility for yourself. No high is worth dying for.

In the world of urban myths, drugs hold court, with stories that range from their potency and effect to a number of various crimes that have been undertaken in their name or under their influence. Most of these myths are harmless, but the ones that pertain to crazy home remedies for opiate overdose are extremely dangerous. You may have heard them. Hey, you may have started them. I’m here to stop the madness.

1 – Somebody came up with the idea that if you inject someone who is overdosing on an opiate drug with a salt water solution, milk or an upper like meth amphetamine or cocaine that you will miraculously bring them back to health. No. No, no, no, no, no, NO.

NO.

Don’t inject anyone with anything if they are overdosing on any drug but especially if they are overdosing on an opioid-based prescription painkiller. It doesn’t work and, worse, it wastes time. In an overdose situation, time is of the essence. You need to call 911 immediately, do CPR if necessary and wait for the paramedics to arrive.

2 – Many are under the impression that to induce vomiting is to reverse the effects of a pain pill overdose. Unfortunately, it’s not that simple. The pills are already digested if they’re overwhelming the respiratory system, so it may not help. It may also exacerbate the situation. Vomit is by nature, well, chunky. It can block the airway and choke someone who is barely or unconscious. Better to wait for the paramedics to arrive. They can decide how best to stop the action of the opiate: a shot of naloxone, stomach pump, charcoal and/or laxative.

3—Make them drink water. Or milk (what’s with the milk?). Again, no and for same reasons that you should avoid the first two myths: it won’t work, it wastes time and they could choke. Anytime someone calls 911, they always advise that you not eat or drink anything. If a surgical procedure is needed, so, too, is anesthesia. And if you vomit while under anesthesia…. Better to have an empty stomach.

Things like trying to help the person walk around or putting ice on their skin is only helpful if they are not overdosing. An overdose victim will most likely be unable to respond to stimuli of any kind, so if they are truly overdosing, dragging them around isn’t going to help anything and looking for ice only wastes time.

For more helpful information on how to handle overdose and other aspects of harm reduction, check out the Harm Reduction Coalition.