What to do if your friend overdoses

Unfun fact: drug poisoning deaths in England and Wales are currently at the highest levels since records began in 1993. Despite this, it seems like nobody’s teaching anyone what to do in a drug-related emergency – or what overdosing even looks like anyway. The British education system teaches us many things – Pythagoras theorem, how many wives Henry VIII had, how to throw a javelin – but they tend to leave out important practical shit like this.

What should you actually do in a drug-related emergency? Well, Adam Waugh from drug checking charity The Loop delivers training on how to deal with overdoses to festivals and nightclubs, so he’s got some answers.

A lot of it is common sense. Someone’s unconscious? Get medical help. Someone’s fucked out of their head? Keep a close eye on them. But it doesn’t hurt to be reminded. If you’re going to take drugs, be one of the people who does it with the knowledge of what to do in the, albeit unlikely, event that it all goes wrong

The main message that Waugh drills in is that, regardless of what drugs have been caned and in what quantities, if you think a mate might be in even a little bit of trouble, don’t fuck around – just get them help.

​“One of the biggest causes of harm in overdose-related situations is friends delaying getting help,” he tells THE FACE. ​“In a lot of these incidents, the medical teams can de-escalate it. But with a big delay it’s more likely that the person could potentially suffer serious long-term harm.

​“If you’re taking drugs and you don’t have a medic there who can actually do the assessment, I think the starting point is just err on the side of caution,” he continues. ​“If someone seems unwell or feels like they’re unwell or has an impending sense of doom, there’s no harm in getting help.”

If you’re at a festival or a nightclub, this is often a simple case of speaking to the closest member of staff who has a radio – it could be a security guard, a steward, or someone working on a bar. If you’re at a house party or on the street, getting help means ringing an ambulance.

In most places, the police are only called to an overdose if there’s been a death or there’s a child involved. And medical professionals are there to help – they’re not going to search you or get you kicked out of an event. Waugh says that the medical tents at festivals are so efficient with dealing with drug-related incidents that they can often check someone over and, if they’re OK, discharge them within 20 – 30 minutes.

Alcohol is so deeply ingrained in our society that people forget it’s a drug that you can overdose on. ​“People do drink excessive amounts of alcohol and die of alcohol poisoning,” Waugh says. ​“So in any circumstances where someone is completely unconscious, you can’t rouse them, you’d be immediately thinking that they need medical attention.”

What about if someone is just pissed out of their head, stumbling around and mumbling nonsense like a toddler? ​“Usually in that circumstance it wouldn’t necessarily warrant calling an ambulance,” he says. ​“Provide them with a sick bucket and let them get the vomit out. And if they want to lie down, put them into the recovery position and keep an eye on them, checking on them at regular intervals.” (This is to prevent them from drowning on their own vomit.)

The same advice also goes for other downers, such as benzos and opioids. With opioids specifically, medical professionals and (sometimes) users carry a drug called naloxone, which can reverse the effects of an overdose.

People look messy as fuck on ket. There’s no getting around that. How can you tell the difference between a normal user and someone who needs serious help?

If someone takes a K‑hole dose or an anesthetic dose of ketamine, the vast majority of times they’re going to be alright,” Waugh says. ​“But I think you can distinguish between K‑holes. There are K‑holes where someone is lying on the floor but they might be wriggling around, there’s some level of movement. Often, if you put your hand on them and you give them a firm shake, they will respond. The person might open their eyes, look confused for a second and then go back in their K‑hole.”

They’re not going to be very responsive – there’ll be no breezy chats about the latest Netflix doc – but they’re not unconscious either. In this case, simply keeping an eye on someone and escalating your response if the situation changes can be sufficient.

But then there is the higher dose K‑hole, which I’m going to call The Mega K‑Hole. ​“This is where someone is completely unconscious and is not responding to anything,” Waugh explains. If this happens to a mate, it’s time to call an ambulance. ​“The more unconscious and less responsive someone is, the higher the risk.”

“Some drugs are quite forgiving if you take too much and other drugs less so,” Waugh says. And G [GHB or its cousin GBL, which converts to GHB in the body] falls into the latter category. ​“G is a drug that if someone takes too much the likelihood of that overdose being something that could be fatal or cause serious harm is quite high.” If someone’s ​“G’d out” (slipped into unconsciousness after taking the drug), get medical attention, either through staff at an event or ringing 999. ​“Listen for further instruction from the emergency call handler,” Waugh says. ​“If the person’s unconscious and not breathing, obviously call 999 and also start CPR.”

While depressant drugs such as alcohol and G slow your central nervous system down, stimulants such as coke and MDMA speed it up. That means there’s a different set of warning signs you should look out for.

​“Cocaine is pretty toxic to the heart. In the majority of cocaine-related heart attacks or medical emergencies, the person might initially have some sort of chest pain,” Waugh says. ​“So if someone has chest pain, they should seek medical help – in particular, crushing chest pain and pain that spreads from the chest out down an arm or anything like that.”

Apparently, it’s more difficult to spot someone in trouble on ecstasy. ​“With MDMA, it’s not as straightforward as ​‘this is an overdose’ or ​‘this is not an overdose’,” Waugh says. ​“It’s more a spectrum of toxicity. With someone who’s overdosing on MDMA, it’s often just a more extreme version of someone who’s high on MDMA.”

What should you look out for? ​“Their eyes might be rolling back in the head, they might be having some extreme gurning and they’ll often have some very strong muscular movements. They might be delirious, unaware of where they are, or they might have lost consciousness.” So, if someone’s jaw is practically detached from their face, play it safe and get help.

​“People talk about if someone is ​“red and rigid” as a sign of an MDMA-related medical emergency,” Waugh continues. “[That’s when] someone might not necessarily be sweating, but when you touch their skin, they feel very hot, and their muscles are rigid – you’ll often see the person’s hand is clenched and, if you unfurl their fingers, they’ll clench them back together.” Again, a potential medical emergency.

Perhaps someone’s taken a psychedelic and the tingling euphoria, fantastical visuals and brief spurts of astounding insight have turned into something dark and sinister. In this case, it actually might be better to stay away from medical environments.

​“Often a hospital isn’t going to be the best environment for the person to be,” Waugh says, citing bright lights, white walls and beeping machines as things that could further freak out an already freaked-out person. Instead, you should basically just be a calming and reassuring presence.

​“Tell them that they’re safe and maybe remind them that they’ve taken a drug and it will wear off,” he advises. It can also be helpful to change environments. ​“If you’re in a particular room, you could go outside, get the person to take their shoes off and put their feet on the grass, have a drink of water, or change the music.”

In the long-term, sometimes people actually benefit from experiences like this. ​“In the psychedelic space, they say ​‘difficult experience’ not ​‘bad trip’,” says Waugh. ​“Sometimes these trips are difficult and overwhelming, but if the person works through it, and if you as a friend were able to support them through that experience, often afterwards, it can actually be quite an important experience for them.”