Stimulant Overdose Signs: Call 911

Someone is awake, sweating, and holding their chest, and you are not sure this counts as an overdose because they can still talk. It can. A stimulant overdose is not the same emergency as an opioid overdose. CDC's stimulant guide says the person is often still conscious and may be breathing quickly, sometimes while overheating. An opioid overdose is slow or stopped breathing in someone you cannot wake. If you think you are seeing either one, use the number in the title. Say what you see, and give a specific address. For a mental health crisis that is not this emergency, call or text 988.

What follows repeats public recognition guidance from CDC. It is not a treatment protocol, and it is not a lesson in how to manage the emergency yourself.

What CDC counts as a stimulant overdose

CDC says a stimulant overdose is when the effects are so severe that health or safety may be at risk. The drugs it names include methamphetamine, cocaine, crack cocaine, and amphetamines such as medicines prescribed for ADHD. Some people use the words "stimulant toxicity" or "overamping" for the same kind of emergency. CDC uses "stimulant overdose" for harmful or life-threatening effects from stimulants, alone or with other substances, including death.

The effects vary with the person's health, the drug, the route, and the amount. Onset is generally quicker when a stimulant is smoked, snorted, or injected than when it is swallowed, and overdose can still happen by mouth. CDC says it is hard to know how much is too much. A nonfatal overdose can still need medical attention.

CDC's public stimulant page describes the group this way: stimulants include illegal drugs such as methamphetamine, cocaine, and ecstasy, and prescription stimulants for conditions such as ADHD. They affect the central nervous system and can cause cardiovascular complications, including stroke and myocardial infarction. They can affect the body's ability to regulate temperature and can lead to mental health problems. Long-term stimulant use is associated with cardiovascular disease, which can raise the risk of a stimulant overdose.

That same overview says prescription stimulants can be misused but do not tend to cause overdose. Read that next to the guide, not instead of it. The guide still lists prescribed amphetamines as stimulants that can produce a medical emergency, and it says the harmful amount is unpredictable. If the warning signs below are present, get emergency help. Do not sort the emergency by whether the bottle looks like a prescription.

Signs that need a clinician, not a guess

CDC lists serious signs and symptoms that need medical attention:

• Dilated pupils
• Dizziness
• Tremor
• Irritability
• Confusion
• Mood swings
• Nausea or vomiting
• Rapid breathing, a fast heart rate, or an irregular heartbeat
• Overheating or excessive sweating
• High blood pressure
• Chest pain or tightness
• Panic or extreme anxiety
• Hallucinations
• Psychosis

You do not need the whole list. CDC also says a stimulant overdose that has reached the point of being deadly often looks the same: blood pressure rises, heart rate rises, body temperature rises rapidly, toxic delirium appears, and seizures follow.

Get emergency help immediately if someone:

• Loses consciousness
• Stops breathing or cannot breathe effectively
• Has a high body temperature
• Has a seizure that lasts longer than five minutes
• Has trouble breathing after a seizure
• Has multiple seizures in a row
• Is having a seizure for the first time
• Has injuries that need medical care
• Shows a stroke sign, including numbness in the face, arm, or leg, a sudden severe headache, blurred vision, or sudden loss of coordination
• Shows a heart-attack or cardiac-arrest sign, including pain, pressure, or squeezing in the center of the chest, discomfort in the neck, arms, jaw, back, or stomach, or shortness of breath, lightheadedness, nausea, fatigue, or cold sweats
• Asks you to call for emergency help

CDC says these signs are examples, not a closed list. If you suspect a stimulant overdose, make that call even when you are unsure. The risk of injury or death may be lower when medical personnel can assess the person and intervene.

While you wait, CDC's seizure notes are limits, not a home treatment. Do not put anything in the person's mouth. Do not restrain their movements. Move nearby objects if you can do that safely. Then let emergency clinicians take over.

Naloxone is for the opioid part only

Slow breathing and naloxone are the subject of the opioid overdose guide. Do not copy that response onto a person who is awake, overheating, and breathing fast from a stimulant.

CDC is direct: naloxone does not reverse a stimulant overdose. Naloxone blocks opioid receptors. Stimulants work through other chemicals, including dopamine, serotonin, and norepinephrine. Blocking opioid receptors does not interrupt that.

There is a second fact that matters in the current drug supply. CDC says people who use stimulants may also take opioids, on purpose or because a stimulant product was contaminated or mislabeled. If there is any chance opioids are involved, including a person who is unconscious and not breathing, give naloxone and start rescue breathing if you know how. CDC says naloxone does not cause harm when no opioid is present. More than one dose may be needed if an opioid overdose does not respond within two to three minutes. The opioid guide covers that timing.

CDC says that after naloxone, signs of a stimulant overdose may become obvious in someone who used both. Overheating, agitation, or chest pain still need the ambulance. Naloxone is not a treatment for stimulant use disorder, and it is not a reason to skip emergency help.

Fentanyl in the stimulant supply is why the naloxone question comes up. CDC's guide says confirmed cases of fentanyl-contaminated cocaine and crack have been recorded, and that smoking rather than injecting does not protect someone if the stimulant was contaminated. People who do not use opioids regularly have lower opioid tolerance, so an unexpected opioid is especially dangerous. Those patterns are the fentanyl guide and the polysubstance guide.

What emergency care is for

CDC says that in clinical settings, the medicines most often used first for a stimulant overdose include benzodiazepines given by a health professional. Emergency clinicians may also treat a fast heart rate, high blood pressure, seizures, heart attack or stroke symptoms, and severe psychological effects. They may use active cooling, such as fans, misting, or ice in a medical setting. Those steps belong to trained staff. Do not give someone a benzodiazepine from a home bottle. Do not build a cooling plan and then delay the ambulance.

CDC's guide says it is informational, that it does not contain medical advice, and that it should not be used as the response in an emergency. The action it repeats is to call for emergency help.

Most, but not all, states have Good Samaritan laws for people who call for help. CDC says they vary and are not a single national rule. That limit is the Good Samaritan guide. Fear of a charge is not a reason to leave.

After the emergency

CDC says there are currently no FDA-approved medications for stimulant use disorder. The interventions it names as evidence-based are motivational interviewing, contingency management, community reinforcement, and cognitive behavioral therapy. Those treatments go further on the cocaine guide and the methamphetamine guide. They are not home schedules, and they are not a substitute for the emergency department tonight.

Treatment locations are listed on FindTreatment.gov. SAMHSA's helpline, 1-800-662-HELP (4357), refers people to local care. It is not a substitute for emergency help. CDC points readers to SAMHSA's Treatment for Stimulant Use Disorders for treatment information, and to that same helpline.

The scale is why a fast heartbeat is not a minor scare. CDC reports that in 2023, nearly 60,000 overdose deaths involved cocaine and/or psychostimulants with abuse potential, mostly methamphetamine. That was about 57 percent of 105,007 overdose deaths that year. Those counts include deaths in which other drugs were also present. They are not a prediction about one person.

Call or text (800) 653-9376 after the person is with emergency clinicians, if you want help finding ongoing care.

Additional Resources

Sources cited on this page:

• CDC: Stimulants and stimulant overdose
• CDC: A Stimulant Guide (2022)
• SAMHSA National Helpline
• SAMHSA FindTreatment.gov
• 988 Suicide & Crisis Lifeline

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