Cocaine and Stimulant OD’s

Recovery position

The all important RECOVERY POSITION that everyone on the planet should know how to do. It keeps the victim in a safe position, ensuring the airways are clear and giving the person the best chance of breathing.

Cocaine and Stimulant Overdoses

Heart Problems: This is a condition one may be seeing more of these days – the heart giving out in various degrees from to much Goddamn coke/crack. Sometimes, with the stimulants, it can feel like you’re having a heart attack and God knows we’ve all been there – but with someone speaking calmly and slowly to you, trying to relax you and helping refrain everyone from the additional panic, can do wonders and ‘bring down’ those who might totally freak out or pass out. Encourage people not to pour too much coke into a spoon for injection -some people seem to be addicted to pushing themselves right to the edge -and there are numerous ‘party tricks’ around coke smoking and injecting that all encourage people to see how far out they can sit in space -before coming back to earth. However, try and encourage a bit of restraint – if its your house people are fixing in you can demand it! As it will be you that will have to pick up the pieces should something go wrong so try and demand a level of consideration, people usually listen if it comes down to having to go elsewhere to have their fix!

Just How Serious is the Situation Getting?

How can you tell when a stimulant overdose is happening?  For a start, there are many variations of a stimulant overdose, and they manifest in many different ways, many of them can be very serious, others will just need a caring friend to ‘bring down’ their stress and anxiety levels.

Here, we are going to talk about ‘Acute Psychostimulant Toxicity‘ and what it means for the person concerned -and what you can do to help. It is very serious, and you will need to get the person to hospital.

There are a number of physical signs and symptoms that may indicate a person is suffering from ‘acute psychostimulant toxicity’.  If you witness these symptoms on your self or your buddy, it may well indicate  an impending medical emergency  -that the person is suffering from a degree of psychostimulant toxicity and it will need to be addressed by a medical professional.

Acute toxicity is produced by excessive extracellular noradrenaline, dopamine and Serotonin physiology resulting in an alpha-adrenergic and beta-adrenergic sympathomimetic toxidrome.

These physical signs include:

● increased pupil size that does not (or only sluggishly) decrease in bright light;

● hot, flushed and sweaty skin which may indicate a fever (i.e. above 38O C);

● rapid breathing; ● jerky movements of limbs; ● shaking in lower limbs, progressing to the upper body;

● racing pulse; ● chest pain; ● jaw clenching;

● body stiffness and rigid limbs; and

● intense headache.

If any of the above signs have become obvious, then alternative emergency medical attention must be now be sought for the person, meanwhile try to keep them as calm and as cool as possible until help arrives.

The worry is, that if a person is toxic or has a poisonous level of psychostimulant in their system, a range of behaviours including escalating psychosis, acute paranoia, aggression, marked agitation or violence may start to become evident, often escalating quickly, or over a period of days as more and more stimulant drugs are consumed (sometimes without the necessary sleep or feed).

When in this state of ‘toxicity’, an individual’s behaviour may pose a risk to the  safety of themselves or others. Medical help is advised now because individuals suffering from acute psychostimulant toxicity become at heightened risk of experiencing some real nasties:

● seizures (fits -see our page on drug induced seizures); ● severe muscle spasms; ● life-threatening temperature increases; ● stroke; ● possible death by cardiac arrest (heart attack); and/or ● possible death by organ failure due to a drug-induced very high body temperature that stops vital organs (e.g. kidneys) from performing functions necessary for life (Dean & Whyte).

While you wait for the ambulance (unless you are taking them to the hospital yourself or by taxi) you can take some measures to help things, such as mechanical cooling, which may need to be started quickly if their body temperature rises rapidly. You can do this cooling down of the person by:

● cold or wet packs placed under arm pits, on head and back of neck;        ● removal of restrictive clothing; ● a cooling fan; and ● cool, oral fluids.

At all times it must be recognised that psychostimulant toxicity is a medical emergency and medical intervention must be implemented as soon as possible, in an environment that reduces the risk of increasing the person’s agitation and associated medical complications. Therefore,  avoid police at the scene -and if they attend, explain to them the situation and the importance of them not using unnecessary force as it will escalate things further. The transport to the emergency department should be undertaken by an ambulance and not, if possible, the police.

Medical intervention usually consists of prompt adequate sedation. Sedation of individuals with psychostimulant toxicity at the scene,  when it is available, achieves several important aims, such as keeping the person themselves safe, medical intervention possible, and other safe.

Subsequent treatment in the emergency department includes the medical management of individual symptoms as they arise. This may involve mechanical cooling of the body to ensure that the risk of organ failure due to overheating is reduced. Particular medications to control blood pressure, pulse rate and other complications may need to be administered; and regular monitoring of patient progress will be required. So, you can see how serious things have actually gotten when at this stage of the game which is why it is never safe to assume that because it is just stimulants, serious medical intervention won’t be needed at some point.


In a Nutshell:

Psychostimulant toxicity is a potentially lethal condition and is a medical emergency;

● it is difficult to discriminate between mental health problems (psychosis) and drug intoxication, so respond to both in the same way; ● the first priority is to get urgent medical assistance: ➺ call an ambulance; OR ➺ take the individual to the closest emergency department;

➺ use calming communication techniques to reduce the individual’s agitation (may help to stop rapid increase in body temperature);

● Acute psychostimulant toxicity can lead to a number of serious physical complications including seizures, cardiac arrest and organ failure. ● Restraint of individuals who present with psychostimulant toxicity has been linked to sudden death, so make sure any police present are aware that this person is suffering from  a psychosis, which could be drug related or a mental health issue.

Click here to see some of the other ways this issue is dealt with in hospital, in particular, how Dr’s may deal with and treat the clinical manifestations of psychostimulant toxicity, what depressant drugs are used as well as what can be used to deal with paranoid and hallucinatory behaviour.


Angina Pectoris can be mistaken for a heart attack as it is a similar feeling in the chest and can be brought about by to much stimulant type drugs. Normally these attacks will only last a few minutes and the pain will stop if you rest and calm yourself as much as you can. The signs are pain in the chest spreading down the shoulder to the arm and fingers (even the throat and across to the other arm). Skin may become ashen and lips blue, one feels short of breath and generally weak. The aim here is to calm the person and place them in a position where the heart is able to work most effectively.

Put the person in a half sitting half lying position, supporting their back and under their legs.

Put the person in a half sitting half lying position, supporting their back and under their legs, using either yourself as support or by lying them back against cushions or on the floor against a sofa.

1) Help the casualty to sit down. Support this position by placing a jacket or blanket behind them and add padding under the knees.

2) Reassure the person and loosen clothing around their neck, chest and waist. If the symptoms persist and/or worsen, an ambulance will be necessary.

Crack Lung: Crack lung is relatively newly recognised and is believed to be a short term acute reaction to crack smoking – usually from when large amounts have been ingested, the pipe is perhaps too short or is allowed to push smoke that is too hot to the lungs, and people find themselves with shortness of breath, pain when breathing, feeling like they may be having some kind of heart or serious asthma attack. However it will pass in a couple of hours and the best way to avoid it is to pace yourself, dont use a short, hot pipe, and follow harm reduction tips for smoking crack, for example using glass pipes and electric lighters with no carbon filings.

Heart Attacks can occur for similar reasons – usually to many stimulant drugs which can cause great strain on the heart or stop the heart altogether {cardiac arrest). OR it may occur with someone who has Deep Vein Thrombosis where a clot may break off, travel to the heart and obstruct a coronary heart muscle (coronary obstruction/ thrombosis). Both these can have serious consequences.

Symptoms are a crushing, vice like pain in the centre of the chest (sometimes described as severe indigestion) which may spread to the throat, arms, jaw or back. Dizziness, ashen face and lips, profuse sweating, breathlessness, irregular pulse and unconsciousness, may develop.

1) If conscious, gently support and place casualty in a half sitting position with head and shoulders supported and knees bent. DO NOT allow the casualty to move.

Ring an ambulance immediately

2) Loosen any clothing around waist, chest and neck.

3) If breathing has STOPPED begin resuscitation immediately, going through the steps outlined for chest compressions (CPR)

4) If the person becomes unconscious but is breathing normally, place them in the recovery position while you await the ambulance.

NOTE; If you need to drive them to hospital then be sure they maintain their treatment position – but only drive them if you cannot get an ambulance quickly.

A CARDIAC ARREST will mean the person becomes unconscious and breathing and heartbeat will stop. No pulse will be felt at neck. Commence resuscitation (Chest compressions)  immediately  and call ambulance telling them of a suspected heart attack.


Remember, if someone does die, you are entitled to mourn and grieve just like everyone else, just because it was an overdose doesn’t mean you aren’t allowed to be a part of remembering, celebrating and mourning their life & loss. But remember you can be especially vulnerable to overdosing yourself after losing someone close; it can be very tempting to use drugs to block out the hurt and pain.

TAKEN FROM BP ISSUE 4 and updated in 2011

Leave a comment

1 Comment

  1. Jo

     /  March 2, 2016

    I’ve shot up cocaine last few times in about 2 weeks and my back tends to really throb and aches, even to move little bit. What causes this? I’m not much for stimulates so I really doubt I’ll be doing it much longer. Also do people feel nesauous or puke when doing coke? Within couple mins of doing the shot I have a trash can at the ready.


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