Overdose Awareness and Withdrawal Information

Opioid Overdose Information: (1)

Deaths from overdose are most common for people with a history of chronic use or after a period of abstinence. Therefore, people coming out of treatment, detox, or incarceration are particularly vulnerable.

Heroin overdose can be quickly and safely reversed through the injection of Naloxone [brand name Narcan], a prescription drug used to revive persons who have overdosed on heroin or other opioids. Naloxone, an opiate antagonist, has long been administered by doctors and paramedics during emergency resuscitation after an opiate overdose and use of naloxone by drug users or their loved ones helps reduce opiate-related mortality.

Know Your Risk (2)

  • If you are taking drugs, try to be with other people. If you're alone and something goes wrong, no one can help.
  • Know your limits. If your body has been drug-free for a while and then you take drugs, you are more likely to overdose. Take less than usual.
  • Don't mix drugs. You're more likely to overdose if you combine an opioid, like a painkiller or heroin, with alcohol, cocaine, benzos, or other drugs.

Facts About Opioid Overdose

  • Opioid overdoses are preventable.
  • Opioid overdose leads to death by respiratory depression which usually takes 1-3 hours. There are a high number of both alcohol and opiate receptors on the brain stem which controls breathing. Do not put this vital part of your brain to sleep!
  • Most drug overdoses involve opioids, including heroin and prescription painkillers.
  • Prescription painkillers-such as oxycodone are a growing cause of drug overdoses.
  • Naloxone, or Narcan, is a medication that reverses the effects of opioid overdose. Make sure you and your loved ones have a narcan kit.
  • Most drug overdoses are witnessed, meaning someone else can provide and/or call for help.

What to Do in Case of an Opioid Overdose

  • Call 911.
  • Oxygen saves lives. If the person is not breathing, check airway and do rescue breathing. Tilt the person's head back, pinch their nose, and give one breath every five seconds. Chest should rise (not stomach).
  • Evaluate. Are they any better? Can you obtain and preprare naloxone quickly so they do not need to go very long without breathing assistance? 
  • If so, give naloxone (Narcan) if you have it. Spray half a dose of nasal naloxone into each nostril, or shoot injectable naloxone into the upper arm or thigh. Do not worry about air bubbles in the syringe - they are not dangerous in muscle injections.
  • Wait 3 to 5 minutes for the person to respond. Continue rescue breathing. If the person does not respond after 3-5 minutes, give a 2nd dose of naloxone.
  • Lay the person on their side in the rescue position, so they do not choke if they vomit. Wait for help to arrive

Withdrawal Information

Withdrawal effects are usually the opposite of the intoxicating effects. This means if someone uses stimulants for energy, the withdrawal symptoms include an energy crash/extreme fatigue. If someone uses inhibitory or calming chemicals, withdrawal will include anxiety, insomnia, and restlessness. These opposite effects are often the reason people return to using.

Withdrawal symptoms vary depending upon the person and the chemicals involved. Although withdrawal can be uncomfortable and painful, medical risks are primarily associated with alcohol and the sedatives/hypnotics (prescription sleeping pills, benzodiazepines, barbiturates).

Alcohol – Withdrawal can be very dangerous and death can occur due to risk of seizures and heart attacks. Withdrawal process may require medical oversight. See section below titled Alcohol Withdrawal for detailed information.

Hypnotics: (prescription sleeping pills, Benzodiazepines, Barbiturates) Requires slow titration and medical oversight. Rapid withdrawal can cause psychosis, convulsions and severe anxiety.

  • Sweating or increased pulse rate
  • Increased hand tremor
  • Insomnia
  • Nausea or vomiting
  • Transient visual, tactile, or auditory hallucinations or illusions
  • Anxiety
  • Grand mal seizures

Stimulants/Cocaine: Medical detox not needed but withdrawal can be very uncomfortable. The initial crash involves agitation, depression, and intense craving. Within days people experience fatigue, low energy, and decreased interest. Episodic craving, dysphoric (unpleasant) mood can last for weeks.
Opiates: (Morphine, Codeine, Oxycontin, Heroin) – Very uncomfortable withdrawal but medical detox is not necessary. A secure facility can provide support to get through the acute experience.

  • Increased pain sensitivity
  • Pupillary dilation/runny eyes
  • Dysphoric(unpleasant) mood
  • Stomach cramps/diarrhea
  • Severe muscle and bone aches
  • Yawning
  • Insomnia
  • Nausea or vomiting
  • Fever/Sweating

Opiates: (Morphine, Codeine, Oxycontin, Heroin) – Very uncomfortable withdrawal but medical detox is not necessary.  A secure facility can provide support to get through the acute experience.

  • Increased pain sensitivity
  • Pupillary dilation/runny eyes
  • Dysphoric(unpleasant) mood
  • Stomach cramps/diarrhea
  • Severe muscle and bone aches
  • Yawning
  • Insomnia
  • Nausea or vomiting
  • Fever/Sweating

Alcohol Withdrawal and How to Taper Off Alcohol[1]

Going to a detox program and receiving medical supervision is recommended, because alcohol withdrawal can cause heart attacks and seizures.  However, regardless of the risks, many people will not go to a detox center or seek medical intervention.  It is less dangerous for someone experiencing withdrawal symptoms to know how to taper, than for the individual to quit “cold turkey”.

DISCLAIMER: The information about how to taper off alcohol is for informational purposes only and is not a substitute for medical advice.  It is safest to withdraw under medical supervision.

Some people can just quit drinking alcohol without having significant withdrawal symptoms.  Other people, however, may suffer significant withdrawal symptoms when they suddenly stop drinking.  Alcohol withdrawal is potentially fatal, so if experiencing significant alcohol withdrawal symptoms when stopping drinking, it is important to gradually detoxify from alcohol rather than quitting all at once.  One can gradually detoxify by either by using alcohol itself or by using medications.

Who is likely to have significant alcohol withdrawal symptoms?

  • People who have stayed intoxicated several days in a row
  • People who have gotten intoxicated every night for a month or more
  • People who have drunk small amounts throughout the day for a month or more
  • People with a history of alcohol withdrawal symptoms

What Are Withdrawal Symptoms?

Withdrawal symptoms can be classified into three categories: mild, moderate, and severe.

  • Mild or minor alcohol withdrawal usually occurs within 24 hours of the last drink and is characterized by tremulousness (shakes), insomnia, anxiety, panic, twitching, sweating, raised blood pressure and pulse, and stomach upset.
  • Moderate or intermediate alcohol withdrawal usually occurs 24 to 36 hours after the cessation of alcohol intake.  Its manifestations include intense anxiety, tremors, insomnia, seizures, hallucinations, high blood pressure, and racing pulse.
  • Severe or major alcohol withdrawal known as delirium tremens (DTs) usually occurs more than 48 hours after a cessation or decrease in alcohol consumption.  It is characterized by disorientation, agitation, hallucinations, tremulousness, racing heart, rapid breathing, fever, irregular heartbeat, blood pressure spikes, and intense sweating.  When untreated, about one person in five will die of DTs.  Some people refer to shakes as DTs, but this is inaccurate.

Even mild or moderate withdrawal can be dangerous for people with high blood pressure or weak hearts, because withdrawal raises blood pressure increasing the risk of heart attack or stroke.  People with high blood pressure should seek medical consultation and need to taper.

A taper is needed if the following symptoms occur upon stopping:

  • Hands are visibly shaky
  • Excessive sweating
  • Rapid or irregular pulse (a pulse of over 100 beats per minute is a danger sign)

How to taper?

People taper off by using alcohol or by getting prescription medications from their medical providers.

Beer is the best form of alcohol to use for or tapering.  Attempts to taper off using wine or hard liquor are difficult because these have higher alcohol content than beer.  Try to limit drinking to no more than necessary.  Drink just enough to keep the sweats and shakes under control.  Gradually reduce the consumption of beer as the taper continues.  If the withdrawal is not too extreme, the taper should only take a day or two.  Some tapers may take longer – three days or even a week.  If symptoms of withdrawal persist, it is a sign that the taper is not done.

It is also very important when tapering, to prevent dehydration and to replenish lost vitamins.  Medical detox may rehydrate with an IV and may also give vitamin shots.  If doing a self-detox, be sure to drink lots of fluids and to take vitamins.  Gatorade® is a good choice because it has balanced electrolytes.

Setting up a taper schedule:

It is very important to set up a taper schedule, which corresponds to the amount consumed and the amount of withdrawal one might have as a result.  The first step in setting up a taper schedule is to estimate the daily baseline consumption of alcohol.

It is very important to estimate the baseline alcohol consumption in terms of standard drinks in order to set up a taper schedule.  For reference: a standard (750-milliliter [ml]) bottle of wine at 12% alcohol contains 5 standard drinks.  A 750-ml bottle of 80-proof alcohol contains 17 standard drinks.  A liter of 80-proof alcohol is 23 standard drinks.

If drinking 20 or more standard drinks a day, then it is recommended that on the first day of the taper, drink one beer per hour starting in the morning for a total of 16 beers.  On the second day, drink one beer every hour and a half for a total of ten beers.  Then continue to taper down by reducing the amounts by two beers per day until down to zero.

If the baseline alcohol consumption is less than 20 drinks per day, reduce consumption by two standard drinks per day.  For example, if drinking an average of 12 drinks per day then the taper schedule can be 10 beers the first day, 8 the second, 6 the third, 4 the fourth, 2 the fifth, and 0 the sixth day.  Likewise, if the average consumption is 6 standard drinks per day, one can set a taper schedule of 4, 2, 0.

Some people choose to taper more quickly by cutting the amounts in half.  For example, 20, 10, 5, 2, 0.  But if you start having withdrawal symptoms, the taper is too fast and should slow down.  Monitoring pulse and blood pressure is a very good idea while tapering.

Only people who are tapering down from very large quantities of alcohol such as a liter of vodka per day will need to start drinking in the morning in order to taper.  If tapering from smaller quantities and feeling no withdrawal symptoms until afternoon or evening, then wait until the time the symptoms appear to begin to taper.  Remember, drinking is not for pleasure; the alcohol is medicine, so only drink what is needed.

Taper using medications:  Medical providers use benzodiazepine such as Valium or Librium.  In some states medical personnel are required by law to admit anyone suffering from alcohol withdrawal to an inpatient detox facility.  In other states, the person may be allowed to attend an outpatient detox program or be given a prescription for benzodiazepines for self-detox.


[1] Anderson, K. (2010) How to Change Your Drinking (Hamsnetwork.org).



  1. Harm Reduction Coalition
  2. New York City Dept. of Health

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