Drug overdose

A drug overdose (or simply overdose or OD) is the ingestion or application of a drug or other substance in quantities greater than are recommended[3] or typically practiced.[4] An overdose may result in a toxic state or death.[4]

Drug overdose
US timeline. Drugs involved in overdose deaths
US yearly overdose deaths, and the drugs involved. Among the more than 72,000 deaths estimated in 2017, the sharpest increase occurred among deaths related to fentanyl and fentanyl analogs (synthetic opioids) with over 29,000 deaths.[1]
SpecialtyToxicology
Timeline. US drug overdose death rate by race and ethnicity
Timeline of US drug overdose death rates by race and ethnicity.[2] Rate per 100,000 population.

Classification

The word "overdose" implies that there is a common safe dosage and usage for the drug; therefore, the term is commonly only applied to drugs, not poisons, even though poisons are harmless at a low enough dosage. Drug overdoses are sometimes caused intentionally to commit suicide, parasuicide or as self-harm, but many drug overdoses are accidental, the result of intentional or unintentional misuse of medication. Intentional misuse leading to overdose can include using prescribed or unprescribed drugs in excessive quantities in an attempt to produce euphoria.

Usage of illicit drugs of unexpected purity, in large quantities, or after a period of drug abstinence can also induce overdose. Cocaine users who inject intravenously can easily overdose accidentally, as the margin between a pleasurable drug sensation and an overdose is small.[5] Unintentional misuse can include errors in dosage caused by failure to read or understand product labels. Accidental overdoses may also be the result of over-prescription, failure to recognize a drug's active ingredient, or unwitting ingestion by children.[6] A common unintentional overdose in young children involves multi-vitamins containing iron. Iron is a component of the hemoglobin molecule in blood, used to transport oxygen to living cells. When taken in small amounts, iron allows the body to replenish hemoglobin, but in large amounts it causes severe pH imbalances in the body. If this overdose is not treated with chelation therapy, it can lead to death or a permanent coma. The term 'overdose' is often misused as a descriptor for adverse drug reactions or negative drug interactions due to mixing multiple drugs simultaneously.

Signs and symptoms

Toxidrome[7]
Symptoms BP HR RR Temp Pupils bowel sounds diaphoresis
anticholinergic ~ up ~ up dilated down down
cholinergic ~ ~ unchanged unchanged constricted up up
opioid down down down down constricted down down
sympathomimetic up up up up dilated up up
sedative-hypnotic down down down down ~ down down

Signs and symptoms of an overdose vary depending on the drug or exposure to toxins. The symptoms can often be divided into differing toxidromes. This can help one determine what class of drug or toxin is causing the difficulties.

Symptoms of opioid overdoses include slow breathing, heart rate and pulse.[8] Opioid overdoses can also cause pinpoint pupils, and blue lips and nails due to low levels of oxygen in the blood. A person experiencing an opioid overdose might also have muscle spasms, seizures and decreased consciousness. A person experiencing an opiate overdose usually will not wake up even if their name is called or if they are shaken vigorously.

Causes

The drugs or toxins that are most frequently involved in overdose and death (grouped by ICD-10):

Diagnosis

Woodstock festival medical
A music fan who has had a drug overdose at the 2008 Woodstock Festival (Poland) is strapped into a wheeled cot by paramedics.

The substance that has been taken may often be determined by asking the person. However, if they will not, or cannot, due to an altered level of consciousness, provide this information, a search of the home or questioning of friends and family may be helpful.

Examination for toxidromes, drug testing, or laboratory test may be helpful. Other laboratory test such as glucose, urea and electrolytes, paracetamol levels and salicylate levels are typically done. Negative drug-drug interactions have sometimes been misdiagnosed as an acute drug overdose, occasionally leading to the assumption of suicide.[9]

Prevention

The distribution of naloxone to injection drug users and other opioid drug users decreases the risk of death from overdose.[10] The Centers for Disease Control and Prevention (CDC) estimates that U.S. programs for drug users and their caregivers prescribing take-home doses of naloxone and training on its utilization are estimated to have prevented 10,000 opioid overdose deaths.[11] Healthcare institution-based naloxone prescription programs have also helped reduce rates of opioid overdose in the U.S. state of North Carolina, and have been replicated in the U.S. military.[12][13] Nevertheless, scale-up of healthcare-based opioid overdose interventions is limited by providers' insufficient knowledge and negative attitudes towards prescribing take-home naloxone to prevent opioid overdose.[14] Programs training police and fire personnel in opioid overdose response using naloxone have also shown promise in the U.S.[15]

Management

CharcoalPO
Activated carbon is a commonly used agent for decontamination of the gastrointestinal tract in overdoses.

Stabilization of the victim's airway, breathing, and circulation (ABCs) is the initial treatment of an overdose. Ventilation is considered when there is a low respiratory rate or when blood gases show the person to be hypoxic. Monitoring of the patient should continue before and throughout the treatment process, with particular attention to temperature, pulse, respiratory rate, blood pressure, urine output, electrocardiography (ECG) and O2 saturation.[16] Poison control centers and medical toxicologists are available in many areas to provide guidance in overdoses to both physicians and the general public.

Antidotes

Specific antidotes are available for certain overdoses. For example, naloxone is the antidote for opiates such as heroin or morphine. Similarly, benzodiazepine overdoses may be effectively reversed with flumazenil. As a nonspecific antidote, activated charcoal is frequently recommended if available within one hour of the ingestion and the ingestion is significant.[17] Gastric lavage, syrup of ipecac, and whole bowel irrigation are rarely used.[17]

Epidemiology and statistics

US timeline. Total drug deaths
Total yearly U.S. drug deaths. More than 64,000 Americans died from drug overdoses in 2016, including illicit drugs and prescription opioids--nearly double in a decade.[1]

In the United States, more than 72,000 people died from drug overdoses in 2017, which was an increase of about 10 percent over 2016.[18] Since 2000, the U.S. drug overdose death rate has gone from 6.2 per 100,000 people in 2000 to 14.7 per 100,000 in 2014.[19]

The National Center for Health Statistics report that 19,250 people died of accidental poisoning in the U.S. in the year 2004 (8 deaths per 100,000 population).[20]

In 2008 testimony before a Senate subcommittee, Leonard J. Paulozzi,[21] a medical epidemiologist at the Centers for Disease Control and Prevention stated that in 2005 more than 22,000 American lives were lost due to overdoses, and the number is growing rapidly. Paulozzi also testified that all available evidence suggests that unintentional overdose deaths are related to the increasing use of prescription drugs, especially opioid painkillers.[22] However, the vast majority of overdoses are also attributable to alcohol. It is very rare for a victim of an overdose to have consumed just one drug. Most overdoses occur when drugs are ingested in combination with alcohol.[23]

Drug overdose was the leading cause of injury death in 2013. Among people 25 to 64 years old, drug overdose caused more deaths than motor vehicle traffic crashes. There were 43,982 drug overdose deaths in the United States in 2013. Of these, 22,767 (51.8%) were related to prescription drugs.[24]

The 22,767 deaths relating to prescription drug overdose in 2013, 16,235 (71.3%) involved opioid painkillers, and 6,973 (30.6%) involved benzodiazepines. Drug misuse and abuse caused about 2.5 million emergency department (ED) visits in 2011. Of these, more than 1.4 million ED visits were related to prescription drugs. Among those ED visits, 501,207 visits were related to anti-anxiety and insomnia medications, and 420,040 visits were related to opioid analgesics.[25]

US timeline. Number of overdose deaths from all drugs

U.S. yearly overdose deaths from all drugs.[1]

US timeline. Benzodiazepine deaths

U.S. yearly overdose deaths involving benzodiazepines.[1]

US timeline. Cocaine deaths

U.S. yearly overdose deaths involving cocaine.[1]

US timeline. Heroin deaths

U.S. yearly overdose deaths involving heroin.[1]

Timeline. Overdose deaths involving opioids, United States

U.S. overdose deaths involving all opioids. Deaths per 100,000 population.[26]

US timeline. Prescription opioid pain reliever deaths

U.S. yearly deaths involving prescription opioids. Non-methadone synthetics is a category dominated by illegally acquired fentanyl, and has been excluded.[1]

See also

References

  1. ^ a b c d e f g Overdose Death Rates. And Archived 2015-11-28 at the Wayback Machine By National Institute on Drug Abuse.
  2. ^ NCHS Data Visualization Gallery - Drug Poisoning Mortality. From National Center for Health Statistics. Open the dashboard dropdown menu and pick "U.S. Trends". From the menus on the right pick all races, all ages, and both sexes.
  3. ^ Definitions Archived 2011-02-27 at the Wayback Machine Retrieved on 20 September 2014.
  4. ^ a b "Stairway to Recovery: Glossary of Terms" Archived 2011-07-09 at the Wayback Machine.
  5. ^ Study on fatal overdose Archived 2012-01-19 at the Wayback Machine in New-York City 1990-2000, visited May 11, 2008
  6. ^ "What to do with leftover medicines". Medicines Talk, Winter 2005. Available at "Archived copy". Archived from the original on 2009-10-24. Retrieved 2010-01-06.CS1 maint: Archived copy as title (link)
  7. ^ Goldfrank, Lewis R. (1998). Goldfrank's toxicologic emergencies. Norwalk, CT: Appleton & Lange. ISBN 0-8385-3148-2.
  8. ^ Chandler, Stephanie. "Symptoms of an opiate overdose". Live Strong. Archived from the original on 18 April 2012. Retrieved 17 May 2012.
  9. ^ "Column - Fatal Drug-Drug Interaction As a Differential Consideration in Apparent Suicides" Archived 2008-02-23 at the Wayback Machine.
  10. ^ Piper TM; Stancliff S; Rudenstine S; et al. (2008). "Evaluation of a naloxone distribution and administration program in New York City". Subst Use Misuse. 43 (7): 858–870. doi:10.1080/10826080701801261. PMID 18570021.
  11. ^ "Community-Based Opioid Overdose Prevention Programs Providing Naloxone — United States, 2010". Centers for Disease Control and Prevention. December 2010. Archived from the original on 2017-09-09.
  12. ^ Albert S, Brason FW 2nd, Sanford CK, Dasgupta N, Graham J, Lovette B. (June 2011). "Project Lazarus: community-based overdose prevention in rural North Carolina". Pain Medicine. 12 Suppl 2: S77–85. doi:10.1111/j.1526-4637.2011.01128.x. PMID 21668761.CS1 maint: Multiple names: authors list (link)
  13. ^ Beletsky L, Burris S, Kral AH (July 2009). "Closing Death's Door: Action Steps to Facilitate Emergency Opioid Drug Overdose Reversal in the United States". Center for Health Law, Policy and Practice, Temple University School of Law. doi:10.2139/ssrn.1437163. SSRN 1437163.
  14. ^ Beletsky L, Ruthazer R, Macalino GE, Rich JD, Tan L, Burris S (January 2007). "Physicians' knowledge of and willingness to prescribe naloxone to reverse accidental opiate overdose: challenges and opportunities". Journal of Urban Health. 84 (1): 126–36. doi:10.1007/s11524-006-9120-z. PMC 2078257. PMID 17146712.
  15. ^ Lavoie D. (April 2012). "Naloxone: Drug-Overdose Antidote Is Put In Addicts' Hands". Huffington Post. Archived from the original on 2012-05-18.
  16. ^ Longmore, Murray; Ian Wilkinson; Tom Turmezei; Chee Kay Cheung (2007). Oxford Handbook of Clinical Medicine. United Kingdom: Oxford. ISBN 0-19-856837-1.
  17. ^ a b Vanden Hoek, TL; Morrison, LJ; Shuster, M; Donnino, M; Sinz, E; Lavonas, EJ; Jeejeebhoy, FM; Gabrielli, A (Nov 2, 2010). "Part 12: cardiac arrest in special situations: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 122 (18 Suppl 3): S829–61. doi:10.1161/CIRCULATIONAHA.110.971069. PMID 20956228.
  18. ^ Sanger-Katz, Margot (2018-08-15). "Bleak New Estimates in Drug Epidemic: A Record 72,000 Overdose Deaths in 2017". The New York Times. Retrieved 2018-08-16.
  19. ^ Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014. Archived 2017-03-04 at Archive.today Morbidity and Mortality Weekly Report from the Centers for Disease Control and Prevention (CDC). January 1, 2016 article.
  20. ^ Referral Page - FASTSTATS - Accidents or Unintentional Injuries Archived 2017-07-15 at the Wayback Machine Retrieved on 20 September 2014.
  21. ^ CDC Expert, Leonard J. Paulozzi, MD, MPH Archived 2014-02-20 at the Wayback Machine Retrieved on 20 September 2014.
  22. ^ CDC Washington Testimony March 5, 2008 Archived July 15, 2017, at the Wayback Machine Retrieved on 20 September 2014.
  23. ^ "The Persistent, Dangerous Myth of Heroin Overdose" Archived 2015-03-23 at the Wayback Machine.
  24. ^ "Understanding the Epidemic | Drug Overdose | CDC Injury Center" Archived 2017-09-09 at the Wayback Machine.
  25. ^ "Prescription Opioid Overdose Data | Drug Overdose | CDC Injury Center" Archived 2017-01-18 at the Wayback Machine.
  26. ^ Chart from Opioid Data Analysis and Resources. Drug Overdose. CDC Injury Center. Click on "Rising Rates" tab. Centers for Disease Control and Prevention.

Further reading

  • Nelson, Lewis H.; Flomenbaum, Neal; Goldfrank, Lewis R.; Hoffman, Robert Louis; Howland, Mary Deems; Neal A. Lewin (2015). Goldfrank's toxicologic emergencies. New York: McGraw-Hill, Medical Pub. Division. ISBN 0-07-143763-0.
  • Olson, Kent C. (2004). Poisoning & drug overdose. New York: Lange Medical Mooks/McGraw-Hill. ISBN 0-8385-8172-2.

External links

27 Club

The 27 Club is a list consisting mostly of popular musicians, artists, or actors who died at age 27. It originated with a claimed "statistical spike" for the death of musicians at that age, but this has been repeatedly disproved by research.

It remains a cultural phenomenom, documenting the deaths of celebrities, some noted for their high-risk lifestyles. Names are often put forward for inclusion, but because the club is entirely notional, there is no official membership.

Bad trip

A bad trip (drug-induced temporary psychosis, psychedelic crisis, or emergence phenomenon) is a frightening and unpleasant experience triggered by psychoactive drugs, especially psychedelic drugs such as LSD and magic mushrooms.

The features of a bad trip can range from feelings of mild anxiety and alienation to profoundly disturbing states of abject terror, ultimate entrapment, or complete loss of self-identity. Psychedelic specialists in the therapeutic community do not necessarily consider unpleasant experiences as threatening or negative, instead focusing on their potential to greatly benefit the user when properly resolved. Bad trips can be exacerbated by the inexperience or irresponsibility of the user or the lack of proper preparation and environment for the trip, and are reflective of unresolved psychological tensions triggered during the course of the experience.It is suggested that, at a minimum, such crises be managed by preventing the individual from harming oneself or others by whatever means necessary up to and including physical restraint, providing the patient with a safe and comfortable space, and supervising the intake until all effects of the drug have completely worn off.

Crime in New Mexico

This article refers to crime in the U.S. state of New Mexico.

Drug detoxification

Drug detoxification is variously the intervention in a case of physical dependence to a drug; the process and experience of a withdrawal syndrome; and any of various treatments for acute drug overdose.

A detoxification program for physical dependence does not necessarily address the precedents of addiction, social factors, psychological addiction, or the often-complex behavioral issues that intermingle with addiction.

Gone Too Far (TV series)

Gone Too Far is a 2009 American reality television series, featuring Adam Goldstein, better known as DJ AM, intervening to help people struggling with drug addiction. MTV debuted the show on October 12, less than two months after DJ AM—an ex-addict himself—died from a drug overdose. Eight episodes were made in its single season.

Harry McGilberry

Harry McGilberry (January 19, 1950 – April 3, 2006) was an American R&B and soul singer and latter-day bass singer for The Temptations between 1995 and 2003.

Born Harry McGilberry, Jr. in Philadelphia, Pennsylvania, McGilberry was a member of the R&B group The Futures and later the Temptations, replacing ailing bassist and former P-Funk member Ray Davis to join the quintet in 1995 and recorded the albums Phoenix Rising, Ear-Resistible and Awesome with them.

McGilberry was fired from the group in 2003 by Temptations leader Otis Williams for a reported drug habit (he was replaced by Joe Herndon of The Spaniels). He later joined a Temptations splinter group, 'The Temptations Experience', replacing the then recently departed Ray Davis.

McGilberry died of an apparent drug overdose on April 3, 2006 at the age of 56. He was known by family members and friends as "Boom-Boom".

McGilberry is buried at Eden Cemetery, Collingdale, Delaware County, Pennsylvania.

Hemoperfusion

Hemoperfusion or haemoperfusion (see spelling differences) is a method of filtering the blood extracorporeally (that is, outside the body) to remove a toxin. As with other extracorporeal methods, such as hemodialysis (HD), hemofiltration (HF), and hemodiafiltration (HDF), the blood travels from the patient into a machine, gets filtered, and then travels back into the patient, typically by venovenous access (out of a vein and back into a vein).

In hemoperfusion, the blood perfuses a filter composed of artificial cells filled with activated carbon or another microporous material. Small molecules in solution within the serum (such as the toxin) cross the membranes into the microporous material (and get trapped therein), but formed elements (the blood cells) brush past the artificial cells just as they brush past each other. In this way, the microporous material's filtering ability can be used without destroying the blood cells.

First introduced in the 1940s, hemoperfusion was refined during the 1950s through 1970s, and then introduced clinically for the treatment of poisoning in the 1970s and 1980s. It is sometimes used to treat drug overdose, sometimes in conjunction with the other extracorporeal techniques previously mentioned.The US Food and Drug Administration (FDA) defines sorbent hemoperfusion as follows:

″(a) Identification. A sorbent hemoperfusion system is a prescription device that consists of an extracorporeal blood system similar to that identified in the hemodialysis system and accessories (876.5820) and a container filled with adsorbent material that removes a wide range of substances, both toxic and normal, from blood flowing through it. The adsorbent materials are usually activated-carbon or resins which may be coated or immobilized to prevent fine particles entering the patient's blood. The generic type of device may include lines and filters specifically designed to connect the device to the extracorporeal blood system. The device is used in the treatment of poisoning, drug overdose, hepatic coma, or metabolic disturbances.″

Hemoperfusion is also used in the treatment of specific intoxications, such as valproic acid, theophylline, and meprobamate.Despite its availability, this technique is only infrequently utilized as a medical process used to remove toxic substances from a patient's blood.

Intoxication

Intoxication — or poisoning, especially by an alcoholic or narcotic substance — may refer to:

Substance intoxication:

Alcohol intoxication

LSD intoxication

Toxidrome

Tobacco intoxication

Cannabis intoxication

Cocaine intoxication

Caffeine#Caffeine intoxication

Stimulant#Effects

Water intoxication

Drug overdose

Inhalant abuse#Administration and effects

Intoxication (film), a 1919 German film directed by Ernst Lubitsch

Intoxication (album)

"Intoxication", a song by Disturbed from Believe

"Intoxication", a single by Shriekback from their Go Bang! album

Kris Kross

Kris Kross was an American hip hop duo formed in the early 1990s that consisted of Chris "Mac Daddy" Kelly and Chris "Daddy Mac" Smith. The duo was discovered by Jermaine Dupri in 1991 and hit worldwide status the following year with their smash hit debut single, "Jump", which topped the Billboard Hot 100 for eight weeks and was certified double platinum as a single. They went on to release three studio albums, with their debut album Totally Krossed Out topping the US Billboard 200, and their following albums, Da Bomb and Young, Rich & Dangerous making it into the Top 20. The duo were also noted for their signature fashion style of wearing their clothes backwards. Chris Kelly died of a drug overdose in 2013.

List of deaths from drug overdose and intoxication

Drug overdose and intoxication are significant causes of accidental death, and can also be used as a form of suicide. Death can occur from overdosing on a single or multiple drugs, or from combined drug intoxication (CDI) due to poly drug use. Poly drug use often carries more risk than use of a single drug, due to an increase in side effects, and drug synergy. For example, the chance of death from overdosing on opiates is greatly increased when they are consumed in conjunction with alcohol. While they are two distinct phenomena, deaths from CDI are often misreported as overdoses. Drug overdoses and intoxication can also cause indirect deaths. For example, while marijuana does not cause fatal overdoses, being intoxicated by it can increase the chance of fatal traffic collisions.Drug use and overdoses increased significantly in the 1800s due to the commercialization and availability of certain drugs. For example, while opium and coca had been used for centuries, their active ingredients, morphine and the cocaine alkaloid, were not isolated until 1803 and 1855 respectively. Cocaine and various opiates were subsequently mass-produced and sold openly and legally in the Western world, resulting in widespread misuse and addiction. Drug use and addiction also increased significantly following the invention of the hypodermic syringe in 1853, with overdose being a leading cause of death among intravenous drug users.Efforts to prohibit various drugs began to be enacted in the early 20th century, though the effectiveness of such policies is debated. Deaths from drug overdoses are increasing. Between 2000 and 2014, fatal overdoses rose 137% in the United States, causing nearly half a million deaths in that period, and have also been continually increasing in Australia, Scotland, England, and Wales.

While prohibited drugs are generally viewed as being the most dangerous, the misuse of prescription drugs are linked to more deaths in several countries. Cocaine and heroin combined caused fewer deaths than prescriptions drugs in the United Kingdom in 2013, and fewer deaths than prescription opiates alone in the United States in 2008. As of 2015, the drug most likely to cause fatal overdose in Australia was diazepam (Valium). While fatal overdoses are highly associated with drugs such as opiates, cocaine and alcohol, deaths from other drugs such as caffeine are extremely rare.This alphabetical list contains 604 notable people whose deaths can be reliably sourced to be the result of drug overdose or acute drug intoxication. Where sources indicate drug overdose or intoxication was only suspected to be the cause of death, this will be specified in the 'notes' column. Where sources are able to indicate, deaths are specified as 'suicide', 'accidental', 'undetermined', or otherwise in the 'cause' column. Where sources do not explicitly state intent, they will be listed in this column as 'unknown'. Deaths from accidents or misadventure caused by drug overdoses or intoxication are also included on this list. Deaths from long-term effects of drugs, such as tobacco-related cancers and cirrhosis from alcohol, are not included, nor are deaths from lethal injection or legal euthanasia.

List of pop musicians who died of drug overdose

This is a list of pop musicians who died of drug overdose along with the date, age at time of death, location, and name of drug.

Mad Season (band)

Mad Season was an American rock supergroup formed in 1994 as a side project of members of other bands in the Seattle grunge scene. The band's principal members included guitarist Mike McCready of Pearl Jam, lead singer Layne Staley of Alice in Chains, drummer Barrett Martin of Screaming Trees and bassist John Baker Saunders. Mad Season released only one album, Above, in March 1995. Its first single, "River of Deceit", was a radio success, and Above was certified a gold record by the RIAA in June.

The band went on a semi-permanent hiatus in 1996 due to the band members' conflicting schedules and Staley's problems with substance abuse. Attempts were made in the late 1990s to revive the group without Staley, and material for a follow-up release to Above had been worked on; however, the band dissolved following the death of bassist John Baker Saunders in 1999 from a drug overdose. Staley also died of a drug overdose three years later. Martin and McCready have since made two short partial reunions, one in 2012 and one from 2014 to 2015. A special edition box set containing a remastered edition of Above and various unreleased material was released in March 2013.

Opioid overdose

An opioid overdose is toxicity due to excessive opioids. Examples of opioids include morphine, heroin, fentanyl, tramadol, and methadone. Symptoms include insufficient breathing, small pupils, and unconsciousness. Onset of symptoms depends in part on the route opioids are taken. Among those who initially survive, complications can include rhabdomyolysis, pulmonary edema, compartment syndrome, and permanent brain damage.Risk factors for opioid overdose include opioid dependence, injecting opioids, using high doses of opioids, mental disorders, and use together with alcohol, benzodiazepines, or cocaine. The risk is particularly high following detoxification. Dependence on prescription opioids can occur from their use to treat chronic pain. Diagnosis is generally based on symptoms.Initial treatment involves supporting the person's breathing and providing oxygen. Naloxone is then recommended among those who are not breathing to reverse the opioids effects. Giving naloxone into the nose or as an injection into a muscle appears to be equally effective. Among those who refuse to go to hospital following reversal, the risks of a poor outcome in the short term appear to be low. Efforts to prevent deaths from overdose include improving access to naloxone and treatment for opioid dependence.Opioid use disorders resulted in 122,000 deaths globally in 2015, up from 18,000 deaths in 1990. In the United States over 49,000 deaths involved opioids in 2017. Of those about 20,000 involved prescription opioids and 16,000 involved heroin. In 2017 opioid deaths represented more than 65% of all drug overdose related deaths in the United States. The opioid epidemic is believed to be in part due to assurances in the 1990s by the pharmaceutical industry that prescription opioids were safe.

Red Hot Skate Rock

Red Hot Skate Rock is a 30-minute music film filmed on September 20, 1987 by Vision Street Wear at the Vision Skate Escape in Los Angeles. The film features an 8-song performance by the Red Hot Chili Peppers during the band's The Uplift Mofo Party Plan tour and includes skate demos by skateboarders Tony Hawk, Steve Caballero, Chris Miller and many more pro skaters. To date, Red Hot Skate Rock was the first and only officially released video recording of the original Red Hot Chili Peppers lineup. Guitarist Hillel Slovak died of a drug overdose less than a year later and Irons would quit shortly after Slovak's death.

Red Hot Skate Rock was released on VHS in 1988 though has since gone out of print. Vision released the film on DVD in 2002 through their website under the name Vision Classic Street Wear: Classic Sk8 volume 2 and features other skate videos from the 80's, which is also out of print and extremely hard to find.

Ron McKinnon

Ronald McKinnon (born August 8, 1951) is a Canadian politician, who was elected to represent the riding of Coquitlam—Port Coquitlam in the House of Commons of Canada in the 2015 federal election. He is a member of the Standing Committee on Justice and Human Rights and the Standing Committee on Health.

A supporter of electoral reform, McKinnon has proposed Canada adopting a ranked pairs voting system.In the 42nd Canadian Parliament McKinnon introduced Bill C-224, the Good Samaritan Drug Overdose Act in the House of Commons on February 22, 2016. The bill amends the Controlled Drugs and Substances Act to grant immunity for possession of controlled substances when someone calls for emergency medical assistance when someone is experiencing a drug overdose, so fear of arrest will not prevent people from seeking the necessary medical care. The bill was adopted on May 4, 2017 with all parties supporting the bill.

Speedball (drug)

Speedball (or powerball) is a mixture of cocaine (a stimulant) with heroin or morphine (a depressant), taken intravenously or by insufflation. Speedball is a dangerous mixture, often more potent than the sum of the parts due to drug synergy. The original speedball used cocaine hydrochloride mixed with morphine sulfate, as opposed to heroin. Speedball may also use pharmaceutical opioids, benzodiazepines, or barbiturates along with stimulants. However, since opioids and sedative-hypnotics have different objective and subjective effects, stimulant-depressant mixtures are known by the slang term "set up". A cocktail of drugs containing an opioid can cause a strong physical dependence and withdrawal symptoms.

State Property 2

State Property 2 is a 2005 American crime film directed by Damon Dash and produced and distributed by Lionsgate Entertainment. A sequel to 2002's State Property, the film stars rap artists and other musicians such as Cam'ron, The Diplomats, Beanie Sigel, N.O.R.E., Kanye West, Mariah Carey and others. Championship boxers Bernard Hopkins and Winky Wright appear in cameo roles. Dash directed the film and co-created its story with Adam Moreno, who wrote the screenplay. The film marks the final appearance of Ol' Dirty Bastard.

At the very end the closing credits of the film, "R.I.P. Ol' Dirty Bastard (1968-2004)" appears on the screen. This is a dedication to Ol' Dirty Bastard, who died the previous year of a drug overdose.

Through the Years (Jethro Tull album)

Through the Years is a compilation album by the progressive rock band Jethro Tull. It is something of a retrospective; with songs from many different periods in the band's history. It is not a greatest hits album; as it has many songs not on such albums (Such as "Quizz Kid", "Still Loving You Tonight" and "Beastie".) It has material spanning all over the band's existence, from their first album to Roots to Branches. The liner notes contain a short history of Jethro Tull, starting humorously with the question "Didn't Jethro Tull die of a drug overdose?"

¡Viva Zapata!

¡Viva Zapata! is the second album by the American punk band 7 Year Bitch. It was released June 28, 1994 on Seattle-based C/Z Records. It was their first record to feature new guitarist Roisin Dunne who had replaced Stefanie Sargent in 1992. The album's title is in tribute to The Gits' vocalist, and friend of the group, Mia Zapata, who was raped and strangled to death in July 1993. Some of the songs on this album relate to Zapata's murder directly (such as "M.I.A.", which encourages vigilante justice for her killer) as well as Sargent's death by drug overdose ("Rock A Bye").

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