Opioid overdose

Opioid overdoses can have catastrophic results, including brain injury. Brain injuries present new challenges and changes that can be difficult to cope with, particularly if the survivor is also trying to cope with substance use. It takes a long time to figure out the extent of the changes they have experienced and establish a continuing care plan that will help them with rehabilitation and the recovery process. The effects of the brain injury will change them as well. It’s a scary experience that can be hard to put into words or share with others and can have a huge impact on mental health and wellbeing.

This can feel incredibly lonely, but it’s important to remember that there are people and places that can provide support. Whether this is a family member, a friend, a support worker or even a local brain injury association , there are resources available to help a survivor succeed in their next steps.

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What are opioids?

Opioids are a drug used to manage pain, typically after surgery. They induce feelings of euphoria (happiness or ‘feeling high’). When prescribed by a doctor and taken in the recommended dosages, opioids can be safe. These prescriptions are often made with codeine, fentanyl, morphine, oxycodone, hydromorphone, or medical heroin.

Opioids can also be produced and obtained illegally and in a variety of forms. When obtained on the black market, opioid production is not controlled. Often these opioids contain unsafe doses of fentanyl or carfentanil. Carfentanil is specifically for large animals (like elephants), not humans. It’s approximately 100 times more toxic than fentanyl and 10,000 times more toxic than morphine. The smallest amount could cause an overdose.

How do opioid overdoses cause a brain injury?

An opioid overdose can cause damaging effects such as slowing breathing/heart rate and starving the brain of oxygen. The parts of the brain that use the most energy and oxygen are the most vulnerable. When loss of oxygen is more severe it can also damage areas of the brain that are fed by the smallest blood vessels that are furthest from the heart.  The medical term for partial oxygen deprivation is hypoxia. Hypoxia can worsen into anoxia when a person completely stops breathing.

Opioids have their effect by causing the brain to release dopamine in greater amounts. Dopamine is tied to feelings of reward and pleasure. When used over a long period of time, the brain adapts by reducing the number of receptors, a process known as tolerance. Opioids alter the brain and how a person responds to normal rewards in the environment. Things that would normally make someone feel good and happy may no longer be motivating. That is why some people may use drugs in a dangerous way, even though they know their opioid use is causing problems. This leads to a greater risk of overdose. Approximately 12 people die from opioid overdoses in Canada every day, having the biggest impact on Canadians aged 15-24 [1].

Currently there isn’t much research on individuals who acquire a brain injury through an opioid overdose. What is evident is that those who do survive an overdose from opioids can be left with catastrophic brain injuries that deeply affect the survivor and those close to them.

Substance use can continue to be a concern after a brain injury. The difficulties with attention, memory and judgment may make it more difficult to benefit from care. Substance use after brain injury can often interfere with the brain’s natural recovery and participation in treatment.

Effects of an opioid overdose

Depending on what parts of the brain are damaged and how long the brain was without oxygen, the survivor may experience [2]:

  • Limb weakness
  • Balance and coordination issues
  • Spasticity or rigidity in muscle tone
  • Abnormal, involuntary movements
  • Loss of vision
  • Memory loss
  • Speech and language challenges
  • Changes in cognitive abilities related to thinking and decision-making – this can affect future planning, work and social interactions
  • Changes in personality – this includes irritability, impulsiveness, and social impairments

The impact of overdose can range from subtle to severe. Some people may notice that they are more forgetful, less coordinated or have more trouble getting and staying organized. For survivors of many episodes of overdose, or longer and more severe anoxia, they may experience fundamental changes to their personality and abilities. Recovery does occur, but many changes may be lasting and require rehabilitation.

If you have had an opioid overdose and are experiencing subtle challenges, see the section below on ways to find help after an opioid overdose and brain injury

Substance use rehabilitation and brain injury

One of the existing challenges with treatment for substance use and brain injury at the same time is that current facilities/programs are not equipped to handle both. The majority of brain injury rehabilitation, community, and support programs require participants to be sober. Similarly, centres and programs that specialize in addiction support are not able to handle the complex needs of someone with a brain injury.

This does not mean that a support plan can’t be created – it just means that the survivor will need to work with caregivers and medical professionals with knowledge of what services are available.

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