Cocaine and Stimulant OD’s

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) decreases in bright light;

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

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

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

● body stiffness and rigid limbs; and

● intense headache (that lasts more than a few minutes)

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 psycho-stimulant 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).

It might seem hard telling the difference between the above symptoms as they do indeed mimic many of the usual intense stimulant style symptoms. But really, all you need to do is use your common sense. If the person displays these symptoms and appears unreachable or ‘disconnected’, or you sense that things have gotten progressively more serious -it is always safer to reach out for help by ringing the emergency services than trying to deal with it on your own.  I know it can be dodgy to do this in some countries, even the US, but if this is the case, prepare a story to deflect attention from yourself and sit with the person till help arrives, after all, you could have just found them sitting there aye?!

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 and a brief word below); ● 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.


Having a seizure is possibly one of the more common signs of a cocaine overdose and it can happen from snorting or injecting too much cocaine (or ingesting it to fast). Lack of sleep and food and repeated lines or hits of cocaine or speed, can lead to a drug induced seizure. Now they CAN be dangerous -especially if more than one occur (such as one after the other) but most often they are your bodies way of telling you you have reached the maximum you can tolerate -everyone has a ‘seizure threshold’ a level where your body says ‘enough already!’. It is a point of toxicity where your body effectively cannot cope with the substances you have given it and your brain has a tiny fireworks display; short circuiting and basically shutting down. We have a lot of info on drug induced seizures here and its a very popular page on our website. So don’t worry, you are not alone if this has happened to you -and there are things you can do to protect yourself in future. But it IS a warning sign -once you have had a seizure, your ‘seizure threshold’ is lowered and you may be at risk of another one if you repeat the behaviour. So read up, arm yourself against becoming vulnerable to fitting and take it seriously. Your body is talking to you -so listen!

Click here for the BP info on seizures.

In short -if your friend has a seizure:

1) You can protect them from injury by holding them gently but firmly enough so they don’t hurt themselves whilst convulsing, but never hold them unnecessarily, you could do damage or you may get hurt.

2) Don’t move or lift them unless they are in danger and NEVER put anything in their mouth or try to open it. Spoons to stop people swallowing tongues are a MYTH, DONT DO IT!

3) When the convulsions cease, put them in the recovery position (see fig 6). Stay with them until they awake properly, speak calmly and reassuringly to them and try to make sure the first person they see is a loved one or friend rather than a stranger. Don’t give them anything to drink until they are fully awake. Leave them to rest as long as they need to in a quiet room. It is extremely exhausting for the body. You may need to commence mouth to mouth if their breathing hasn’t returned to normal from their overdose.

Call an ambulance if:

It is the persons first seizure,

Or it accompanies an overdose,

Or the person has two, three or more fits/seizures without regaining consciousness between them,

Or they take longer than 15 minutes to regain consciousness

It is always important however, they advise their doctor about the seizure, at least to rule out any other causes such as a virus, tumour or other problem.


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. 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.

    • Hi Jo,
      As you know, we are NOT doctors here to answer your questions, but from an experienced harm reduction/health advocate, I would say that the pain you are experiencing in your back might be from tension; tensing your muscles up to the point that they start to ache. If this happens again, get a buddy to gently touch your shoulders and back and give it a soft squeeze -or even better, a massage! But even a soft squeeze around areas such as shoulders, neck, top of arms, (or all down your arms) and a soft circling around the lower back area, it can be over your clothes, but a gentle smallish circle movement around the lower, and upper back. You can sit up or lie down for this. Another thing that can help is heat. So if you get a hot water bottle (even make one using a bottle with fairly hot water in it), and lie with your back against a chair and put the bottle (wrapped in a tea towel etc) behind you in the place that is sorest. If this helps, well you will know it is tension. However, if the pain is LOWER back pain, a constant dull ache across the lower part of your back -it could be kidneys and a sign that you need more water and have become dehydrated. Always drink plenty of water when taking stimulants. If you inject your coke -it could also be a sign of your kidneys struggling to filter out possibly shitty quality cocaine (or too much!). Again -go back to the water – NOT alcohol as that will dehydrate you all the more. Good luck friend!


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