The belief that ‘it won’t happen to me; I know what my body can handle’ must change if fewer people are to die from accidental overdoses.
“This mindset is often rooted in a sense of invincibility. Individuals may believe their body can handle a certain amount of a substance, or they may underestimate the risks involved with using new or different drugs,” says addiction expert Adèl Grobbelaar, who heads SANCA Wedge Gardens treatment in Johannesburg.
As the world marks International Overdose Awareness Day on 31 August, Grobbelaar stresses that a person’s physiological state is constantly changing – and so are the drugs themselves. Illness, fatigue and even diet can alter how a substance affects the body. At the same time, the composition of street drugs is highly unpredictable: A new batch can be far more potent than the last, or laced with a highly addictive opioid such as fentanyl. “The ‘it can’t happen to me’ attitude prevents people from taking precautions or seeking help, and it puts them at a much higher risk of a fatal overdose,” she says.
Mental health link
Grobbelaar notes that substance use is often closely linked to mental health. Many people use alcohol or other drugs to self-medicate depression, anxiety, trauma or chronic pain. While under the influence, inhibitions fall and judgement is impaired, which can increase the likelihood of acting on suicidal thoughts. “It is a critical mistake to dismiss a suicide threat, regardless of how often it’s made,” she says. “The threat itself signals immense distress and a cry for help. Every threat should be taken seriously, with immediate support from a mental health professional or a crisis hotline.”
Medical triggers
Hidden health conditions can also turn a typical dose into a medical emergency. An overdose is not only about the amount consumed; it is also about the body’s capacity to cope. Someone may be unaware of a congenital heart defect or respiratory problem that a substance can trigger. For example, stimulants such as methamphetamine (meth) can dramatically increase heart rate and blood pressure – potentially fatal for a person with an undiagnosed heart condition – while depressants can suppress breathing in someone with a respiratory issue. “The interaction between substances and unknown medical conditions can be deadly, which is why awareness of one’s health and the risks of use is so important,” Grobbelaar says.
Hidden dangers
Asked which substances are most commonly linked to overdoses locally, she cautions that any drug – illicit or prescribed – can cause harm. The specific danger with street drugs is uncertainty: They are frequently mixed with unknown and hazardous chemicals. “We’ve seen drugs like ‘cat’ (methcathinone) laced with heroin or even toxic agents such as battery acid, which vastly increases the risk of overdose and other severe health complications.”
Opioids, including heroin, present a particular danger after a period of abstinence. “A significant risk factor is relapse at a previous dosage,” Grobbelaar explains. “Tolerance drops during sobriety, and what once felt ‘manageable’ can become lethal.” Central nervous system depressants, for example, sleeping tablets, tranquillisers and alcohol, are especially dangerous in combination because they compound each other’s effects, sharply slowing heart rate and breathing. Stimulants such as ‘cat’ and methamphetamine drive heart rate and blood pressure up, which can precipitate a heart attack even in people with no known cardiac disease. Cannabis edibles carry different risks: Because the effects are delayed, users may repeatedly dose, leading to a far stronger and more distressing reaction than intended. While not typically fatal, severe impairment, panic and risky behaviour can follow.
Overdose signs
Recognising the signs of overdose can save lives. With opioids (for example, heroin, morphine and codeine), the person is likely to be unresponsive or ‘nodding off’, with pinpoint pupils, weak muscles, slow heart rate and depressed breathing. Emergency services can administer naloxone, which rapidly reverses opioid overdoses. Call for help immediately and begin CPR if the person is not breathing until emergency services arrive.
Stimulant overdoses look different because the drugs speed up the central nervous system. With substances such as methamphetamine, ‘cat’ and cocaine, warning signs include a racing pulse, very high blood pressure, elevated body temperature, seizures, agitation, anxiety and paranoia. The immediate response is again to call emergency services. While waiting, try to keep the person calm and reduce overheating, for example, by moving them to a cooler environment and using cool (not ice-cold) compresses to lower the temperature.
Emergency response in SA
On the question of naloxone access in South Africa, Grobbelaar says emergency services and hospitals do have the medication, but community access is limited. “Internationally, compact naloxone nasal sprays are widely used by police, first responders and even families. They can be administered by anyone and do not require medical training. This option is not yet available in South Africa, which delays lifesaving intervention,” she says.
Could supervised consumption sites save lives here? “Yes, supervised sites definitely save lives,” Grobbelaar says, “but given corruption and the current state of many health facilities in South Africa, I’m not sure we are ready.”
If she could change one policy tomorrow, she would prioritise making naloxone nasal spray available to frontline responders and to families of people who use opioids. She would also require all emergency units to report near-overdoses and severe intoxications that lead to physical harm to SANCA National and the Department of Social Development, with mandatory referral to counselling or rehabilitation, even if involuntary.
“No one is immune. Learn the signs, call for help, and don’t wait – the right response at the right moment can be the difference between life and death.”
