Signs and Symptoms of Opioid Use

It is important for people to be able to recognize when someone is using opioids so that they can respond if needed. Below are some of the most common signs and symptoms of opioid use:

Key Concepts:

• • In the short term, opioids can relieve pain caused by injuries or chronic conditions and make people feel relaxed and happy or “euphoric”. However, opioids can also have harmful effects, including:

• • • • Drowsiness
      • Confusion
      • Nausea
      • Constipation
      • Slowed breathing

• • Opioid misuse can cause slowed breathing, which can cause hypoxia, a condition that results when too little oxygen reaches the brain.
  • Hypoxia can have short and long-term effects, including coma, permanent brain damage, or death.
  • If someone is “high” or under the influence of drugs like heroin, or opioids/pills, they may show some of the following signs and symptoms:

• • • • Pupils will contract and appear small (pupils look like points of a pin)
      • Muscles are slack and droopy
      • Scratch a lot due to itchy skin
      • Speech may be slurred
      • They might “nod out” (a slang term - to become sluggish, causing people to fade in and out of consciousness)
      • They might be out of it, but they will respond to outside stimuli (pain, etc.)

Adapted from the following sources: https://nida.nih.gov/publications/drugfacts/prescription-opioids; harmreduction.org/issues/overdose-prevention/overview/overdose-basics/recognizing-opioid-overdose

Opioid Withdrawal Symptoms

Opioids can cause physical dependence, which means that the person relies on the drug to prevent withdrawal symptoms. How long it takes to become physically dependent on opioids varies with each person. When the person stops taking the drugs, the body needs time to recover, causing withdrawal symptoms. Withdrawal can occur any time long-term use is stopped or cut back.

How severe and how long a person suffers from withdrawal symptoms also varies from person to person. It depends on how long the person has been using, how long it takes their body to process and get rid of the drug, and their overall health status. Opioid withdrawal symptoms usually start within 12 hours after a missed dose, peak at 36–72 hours, and gradually taper off over the following 4–7 days. With some opioids such as methadone and fentanyl, withdrawal may be refractory, meaning it lasts longer than the typical 4-7 days.  Withdrawal from these drugs could last up to 10 days or more.

Opioid Withdrawal Symptoms
Aches and Pain	Irritability
Muscle Spasms/Twitching	Insomnia
Tension	Hot Flashes/Chills
Tremors	Heart Pounding
Abdominal Cramps	Lacrimation (Teary Eyes)
Nausea	Sweating
Vomiting	Rhinorrhea (Runny Nose)
Diarrhea	Dilated Pupils
Anxiety	Yawning
Restlessness	Gooseflesh (Goosebumps)

Recognizing an Opioid Overdose

It is important for individuals to understand what an opioid overdose is and how to recognize the signs of an overdose so that they can act quickly. Below is some information as well as some of the most common signs and symptoms of opioid overdose.

Overdose (OD) happens when a deadly amount of a drug or combination of drugs overwhelms the body. Opioid overdoses happen when there are so many opioids, or a combination of opioids and other drugs in the body that a person does not respond to stimulation (shaking, shouting, etc.) or is not breathing well, if at all.

Signs and Symptoms of an Opioid Overdose
Loss of consciousness	Awake, but unable to talk
Body is very limp and/or unresponsive to outside stimulus	Breathing is very slow, shallow, erratic, or has stopped
For lighter skinned people, the skin tone turns bluish purple	Fingernails and lips turn blue or purplish black
For darker skinned people, skin tone turns grayish or ashen	Choking sounds, or a snore-like gurgling noise
Face is very pale or clammy	Vomiting
Skin feels cold and clammy	Pupils are tiny
Pulse (heartbeat) is slow, erratic, or not there at all	Signs of substance use, such as paraphernalia

Adapted from the following sources: narcan.com/patients/what-is-an-opioid-overdose-emergency; harmreduction.org/issues/overdose-prevention/overview/overdose-basics/recognizing-opioid-overdose/

Responding to an Opioid Overdose

Naloxone and How it Works

Naloxone is a medicine that quickly stops an opioid overdose. This drug should be given to any person who shows signs of an opioid overdose, or when an overdose is suspected. Naloxone comes in two forms (nasal spray and a medicine to inject into a vein or muscle).

SCPHN provides nasal naloxone in the form of Narcan. Narcan Nasal Spray is a brand of nasal naloxone that is used to reverse an opioid overdose. Narcan is easy & safe to use, & is available without a prescription through local pharmacies & community-programs. You can find more information on Narcan here. Below is an image outlining steps to responding to an overdose. Directions on administering Narcan can be found in the box with each dose & can be found here.

 

Step 1: Identify person has overdosed and is unresponsive	Look for breathing and responsiveness Determine if they are not breathing, skin turning blue/gray, not responsive Look for signs of overdose* (*See table above)
Step 2: Try to wake the person	Use verbal and/or physical stimulation: Shake them and shout Sternal rub – rub your knuckles on the breastbone in the middle of the chest where the ribs meet If person responds: Lay them on their back Tilt head back Provide neck support Keep them awake & alert If person does not respond: Do not waste time trying to continue waking them Put person in recovery position if you must leave them for any reason (lay them on their side, bend their knee, turn their face to the side) Get Help
Step 3: Call 911	If you think person has overdosed: Call 911 before giving Naloxone If you’re not alone, ask someone else to call 911 Trained medical professionals are key to survival (other health issues can happen during an overdose) Give as much information as possible to 911 operator Tell 911 operator if Naloxone has already been given
Step 4: Give Nasal Narcan	Lay person on back Stick device all the way up one nostril Press red plunger firmly to give full dose *Wait 2-3 minutes between doses of Naloxone before administering another
Step 5: Perform Rescue Breathing (if the person can’t breathe on their own)	Place the person on their back. Tilt their chin up to open the airway. Check to see if there is anything in their mouth blocking the airway – and if so, remove it, do a finger sweep. Pinch their nose with one hand, place your mouth over the person’s mouth, and give two even, regular sized breaths. Blow enough air into their lungs to make their chest rise. If you don’t see their chest rise out of the corner of your eye, tilt the head back more, make sure you’re plugging their nose, and make sure you have a good seal over their mouth. After 5 seconds, breathe again. Give one breath every 5 seconds until the person starts breathing on their own or until emergency responders arrive. REPEAT When/if the person starts to breathe regularly on their own, roll them into a recovery position on their side. If they are not responsive to stimulation, not breathing, and have no pulse after receiving naloxone and rescue breathing, then they need cardiopulmonary resuscitation (CPR) via a trained bystander and the emergency medical system Adapted from the following sources: harmreduction.org/issues/overdose-prevention/overview/overdose-basics/responding-to-opioid-overdose
Step 6: Do not leave the person alone	If person can’t walk or talk it is important that they go to the hospital Stay with person and keep them awake Check breathing and heartbeat/pulse frequently Do not leave person Provide Supportive Messaging Inform them that they’ve overdosed and they’ve been given Naloxone Inform them that it lasts 30-90 minutes and they may still overdose Inform them that should seek medical attention

Narcan is an essential part of every first aid kit. Additionally, you can make Naloxone easily accessible in case of emergency by installing a NaloxBox at your business or organization. NaloxBoxes are hard acrylic boxes mounted to a wall that provide 24/7 access to naloxone. Installation of NaloxBoxes in public locations, along with other emergency devices such as automated external defibrillators (AEDs), can normalize access to naloxone, which can reduce the stigma often associated with opioid overdose. Find our NaloxBox Fact Sheet here.

SCPHN can provide Narcan and/or NaloxBoxes free of charge to organizations and businesses anywhere in Strafford County. Use the Request Form below.

Training is available to help provide education on how to reverse an opioid overdose.

UNH has a Community First Responder Program that provides a free, self-paced online training on how to administer Nasal Narcan. Click here or on the image to be brought to UNH's program website:

You can also request an in-person training through our partners at NH Harm Reduction Coalition, or you can reach out to our team to discuss your training needs.