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In 2022, approximately 34,000 people in the U.S. lost their lives to overdoses involving stimulants, accounting for nearly 32% of all drug overdose deaths that year. A significant challenge with stimulants is that the signs of a stimulant crisis and overdose, often referred to as "overamping," differ from the common symptoms of what is considered a “typical” overdose (often associated with opioids), which presents with respiratory depression and loss of consciousness.
Recognizing and promptly addressing the symptoms of overamping is a critical aspect of harm reduction and prevention, as it can help prevent the situation from escalating.
In this article, we will explore the definition of overamping, its clinical manifestations, and the appropriate responses to manage it effectively.
- Overamping refers to a stimulant overdose where the body becomes overwhelmed, often presenting as extreme agitation, paranoia, or severe physical symptoms.
- Unlike opioid overdoses, overamping involves overstimulation rather than sedation, with risks like seizures, overheating, and cardiovascular strain.
- Early recognition and response, including cooling measures and calling 911 for severe symptoms, are vital to managing overamping effectively.
What is overamping?
Overamping is the term used to describe what is considered to be an “overdose” of stimulants. [2][3] It’s a state where the effects of the stimulant used become too much for the body to handle, but what that means can differ from person to person. [3]
For some, overamping is a physical experience—your body just doesn’t “feel right.” [3][4] For others, it’s more psychological, involving distress and a loss of connection with reality. [3][4] Often, though, it’s a mixture of both.
Overamping is complex due to its subjectivity and the varying degrees of intensity. One person might experience it as a bad trip, while another might see it as just part of the event or even find it enjoyable. This unpredictability underscores the need for caution and vigilance when dealing with stimulant use, where what feels tolerable one day might spiral into harm or even death the next.
Is overamping the same as overdose?
While overamping falls under the broader definition of an “overdose” (your body being overwhelmed by a drug), it doesn’t fit the typical image of an overdose. Unlike opioid overdoses, which often involve sedation, unconsciousness, and respiratory depression, overamping is marked by overstimulation—a rapid heartbeat, racing thoughts, rising body temperature, and intense paranoia or panic. [4]
Some may argue, “That’s not really an overdose,” but overamping is still an overdose in the sense that the body can no longer handle the drug safely. The term “overamping” was introduced by harm reduction advocates to highlight how stimulant crises are unpredictable, don’t always depend on dosage, and rarely involve respiratory failure. This distinction is crucial for understanding the unique nature of overamping and feeling knowledgeable about it.
Overamping reflects the erratic nature of stimulants: The same dose that feels manageable one day might trigger an emergency the next. This distinction emphasizes the need for tailored harm-reduction strategies and interventions designed to provide support and reassurance in the face of such unpredictability.
What drugs can cause overamping?
Drugs that can cause overamping are primarily stimulants. They include: [6][7][8][9][10][11][12]
- Methamphetamine (Meth, Crystal, Ice, Crank, Ice, Tina)
- Cocaine (Coke, Blow)
- MDMA (Ecstasy, Molly)
- Synthetic Cathinones (e.g., Mephedrone)
- Amphetamines (e.g., Adderall, Dexedrine)
- Ritalin (Methylphenidate)
- Crack Cocaine (Crack, Rocks, Base)
- Khat
- Novel Synthetic Psychoactive Agents (NSPs, e.g., Flakka)
- Polydrug use, where the effect of the stimulant is enhanced
Signs of an overamp
As discussed, overamping causes psychological symptoms and/or physical symptoms, and they often present at the same time. These signs and symptoms are possible with an overamp.
Mental signs & symptoms: [3]
- Confusion
- Hypervigilance
- Intense panic
- Hallucinations/delusions
- Extreme paranoia
- Extreme agitation
- Increased aggressiveness
- Suicidal ideation
- Suspiciousness
Physical signs & symptoms: [3]
- Jerking movements
- Unable to stay still (restlessness)
- Chest pain
- Irregular breathing
- Elevated body temperature
- Sweating
- Passing out
- Teeth grinding
- Fast, racing heartbeat
Severe effects of overamping
Stimulant use causes a surge of neurotransmitters in the brain (especially dopamine and norepinephrine), leading to increased alertness. Other effects can include a racing heart and higher body temperature. While some may find these effects energizing, they can also strain the cardiovascular system and cause severe side effects.
If someone experiences the following severe symptoms of overamping, call 911 immediately for help: [3]
- Heart attack (crushing chest pain or intense sweating)
- Seizure
- Overheating with body temperature over 104 degrees (40 degrees Celsius)
- Stroke (numbness, or weakness, or paralysis of part of the body, facial droop, or the inability to speak)
- Extreme loss of contact with reality (psychosis)
Reacting to an overamp: What to do
Start by assessing the situation:
- Is medical help needed? Call 911.
- Help the person calm down and give them water to drink.
Responding to overheating (hyperthermia)
Overheating can be deadly. It is crucial to watch for signs and act fast. Symptoms of hyperthermia are: [3]
- Hot, dry, or red skin
- Nausea, vomiting, dizziness, or fainting
- Rapid heart rate and confusion in severe cases
Steps to cool down
- Use ice packs, mist, and fans to help lower body temperature.
- Provide water or sports drinks to support hydration.
- Apply cool, wet cloths to armpits, knees, or forehead.
- Open windows for fresh air.
When to call 911
- Body temperature reaches 104°F (40°C)
- The person is unconscious or confused
Responding to stroke
Strokes happen suddenly due to a blood clot or bleeding in the brain.
Symptoms (FAST)
FAST is an acronym that represents a validated stroke recognition and action program commonly used in emergency response guidelines. The following table summarizes the key points on recognizing stroke symptoms according to the FAST approach: [3]
| FAST Symptom | What to Look For |
|---|---|
| F - Face | One side of the face droops when smiling or appears uneven |
| A - Arms | Weakness or numbness in one arm |
| S - Speech | Slurred, confused, or difficulty speaking or understanding |
| T - Time | Symptoms appear suddenly, and every second counts; Call 911. |
Responding to a seizure
Seizures are caused by abnormal brain activity and hypoxia, which can lead to severe consequences. Signs of seizure are: [3]
- Temporary unconsciousness or stopped breathing
- Falling to the ground
- Drooling, grunting, twitching, or jerking movements
What to do
- Remain calm.
- Turn them on their left side (recovery position) with something soft under their head.
- Clear the area around them of sharp objects.
- Avoid restraining them or putting anything in their mouth.
Call 911 if
- The seizure lasts more than 5 minutes (status epilepticus).
- The person has multiple seizures and doesn’t wake up between seizures (also status epilepticus).
- It is their first seizure, or they are injured.
Responding to a suspected heart attack
Even drug-related heart attacks can look similar to non-drug-related ones. [3]
Symptoms
- Chest pain or pressure, which may be mild, moderate, or severe
- Pain spreading to the neck, jaw, arm, back, or stomach
- Shortness of breath, nausea, or feeling very tired with minimal exertion
What to do
- Call 911 immediately.
- If the person is unconscious and not breathing, start CPR (if properly trained) or follow instructions given over the phone.
Calling 911 can save lives, but it’s normal to feel hesitant due to the legal repercussions if it is a drug-related emergency.
In the U.S., most states have Good Samaritan Laws that protect people from arrest or prosecution for minor drug possession when calling 911 during an overdose emergency.
Tips
- Put drugs or paraphernalia out of sight.
- Stay calm and describe the person’s physical symptoms (e.g., “They’re unconscious and not breathing”).
- Provide the address and hang up.
Chemsex and overamping
Chemsex refers to the intentional use of specific drugs to enhance, prolong, and sustain sexual experiences among men who have sex with men, often lasting for hours to days. Chemsex usually involves methamphetamine (meth), GHB/GBL, and sometimes other substances, like MDMA or ketamine, in some areas. While these drugs can intensify physical and emotional sensations, they also pose serious health risks. One of the most dangerous outcomes is overamping.
Overamping usually happens during chemsex due to the following reasons specific to this practice: [14]
- Meth is often used in large quantities during chemsex, especially when injected (slammed) for an intense, immediate rush (the ‘flash effect’)
- Prolonged sexual activity
- Polydrug use
- Sleep deprivation
- Dehydration
Treatment for stimulant misuse
Treatment for stimulant misuse can take place in various settings, such as clinics, mental health programs, and inpatient or outpatient addiction treatment programs. Harm reduction strategies and programs may also assist in minimizing the risks associated with stimulant misuse. It’s important to understand the options available when choosing a treatment program.
For some, a short-term, structured break from stimulants can help manage early withdrawal symptoms. While this can aid recovery, it’s not complete treatment. Ongoing support is necessary to address cravings and establish new behaviors. [15]
Therapy
Behavioral therapies are currently the most effective approaches for treating stimulant use disorder. Several common methods are used, which are presented in detail next. [15][16]
- Contingency Management (CM): CM involves receiving something of value, such as a gift card, voucher, or chance to win a prize, as a reward for achieving a specific and measurable desired behavior. In this case, the most common measure used to assess the desired behavior is a negative urine drug test for stimulants when implemented to treat stimulant use disorder.
- Motivational Interviewing (MI): MI is a short-term intervention that helps people overcome ambivalent feelings and insecurities. In the process, people become motivated to change their behavior and reduce or stop their stimulant use.
- Cognitive-Behavioral Therapy (CBT): CBT involves short-term psychotherapy aimed at modifying a patient’s thoughts and behaviors to reduce stimulant use. Its effectiveness in treating other substance use disorders has also been well documented.
- Community Reinforcement Approach (CRA): One behavioral therapy approach commonly used in combination with CM is the CRA. CRA was initially developed for alcohol use disorder and was later adapted for stimulant use disorder, particularly for cocaine use. The goal of CRA is to identify behaviors reinforcing stimulant use and make a substance-free lifestyle more rewarding than one that includes drugs and alcohol.
Medications
Currently, there are no FDA-approved medications for stimulant use disorder. However, some mental health medications may help specific individuals. Methylphenidate, which is commonly used for ADHD, has been studied for reducing stimulant use. It was found to be safe for treating cocaine dependence but not effective in significantly reducing cocaine use.
For amphetamine and methamphetamine dependence, other studies showed some success. In clinical trials, methylphenidate treatment resulted in a higher percentage of amphetamine-negative urine samples compared to those without the medication, suggesting modest benefits for these substances.
Many people use stimulants as a means to cope with other life challenges. Addressing these areas can help reduce stimulant use, such as: [14][16]
- Housing programs
- Employment assistance programs
- Assistance with other health problems, like mental health services
- Building a support network or community
- 12-step programs, like Narcotics Anonymous (NA) and Crystal Meth Anonymous
By combining and tailoring these approaches, people can find a treatment plan that works for them.
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