Nodding Out
Nodding out refers to a person moving in and out of consciousness after misusing sedating drugs like opioids. When nodding out occurs because of drug use, adverse consequences may occur.
What Is Nodding Out?
In the context of substance misuse and addiction, nodding out refers to sedation of the central nervous system (CNS) after taking opioids or other depressants.
The CNS is responsible for many life-supporting functions and vital organs, including the lungs and heart. Suppressing the CNS puts a person into a trance-like state, limiting their breaths and heartbeats. A person may also feel reduced pain, blood pressure, and body temperature.
Outwardly, nodding out appears like falling asleep, except the person may be sitting straight up or in the middle of a conversation when they fall out of consciousness. Someone who nods out while sitting up may have their mouth wide open and will likely tilt their head forward or backward. Their eyes may also roll back, or the lids may close. These symptoms may also appear while performing other activities, like cooking, cleaning, working, or driving, all of which are dangerous.
Drugs That Cause Nodding Out
Opioids are the most common drugs that cause someone to nod out. Specific illicit and prescription opioids include the following:
Some people with substance use disorders (SUDs) mix two or more opioids simultaneously, like heroin and fentanyl or oxycodone and fentanyl, to increase their effects. Others mix opioids with other illicit or prescription drugs. The combination increases the effects of sedation and nodding out. Examples of dangerous drug mixtures include:
- Alcohol and opioids
- Xylazine and fentanyl
- Xylazine and other opioids
- Benzodiazepines and opioids
- Antidepressants and opioids
Nodding out can also occur among people mixing opioids with cocaine or methamphetamine. There were nearly 11,000 overdose deaths involving benzodiazepines and opioids in 2022, and over 5,800 involving antidepressants and opioids.
Dangers Of Nodding Out On Heroin Or Opioids
Nodding out on heroin, fentanyl, or other sedating drugs can lead to dire circumstances, including overdose and death. Examples of the dangers include immediate and long-term dangers.
Immediate Dangers
Immediate dangers are those that happen soon after consuming fentanyl or opioids. Injecting opioids can lead to much quicker nodding-out symptoms than if someone smokes or snorts them. Any form of use can lead to adverse consequences, such as the following.
Respiratory Failure
Opioids suppress breathing. For some, this can mean their breathing is slower or shallower; for others, it can mean breathing stops altogether.
Brain Damage
Opioids that cause someone to nod out leads to the brain not getting enough oxygen. Not getting enough oxygen can cause damage to some or all parts of the brain.
Injuries And Accidents
When someone nods out while performing other tasks, like driving or household chores, they are at risk for accidents and injuries. Someone who nods out while driving may have an automobile accident, causing severe injury or death to themselves or others. Examples of other accidents and injuries include falling and hitting their head, nodding out while smoking and catching their surroundings on fire, or being unable to supervise small children who may encounter danger.
Health Problems
Nodding out often occurs when people inject opioids. Sharing needles can lead to many health problems, including abscesses, infections, and diseases. Anyone misusing opioids like fentanyl is at risk of weakening their immune system, leading to frequent illnesses.
Overdose
Taking too much of an opioid can lead to overdose and, potentially, death. An overdose occurs when the opioids suppress the CNS so much that the vital organs quit functioning. Nodding out can lead to a coma, which may at first appear as if the person is sleeping. Overdoses involving nodding out on heroin, fentanyl, or a mix of sedating drugs must be quickly treated with naloxone, a reversal substance that restarts organ functioning.
Long-Term Dangers
Nodding out due to the use of prescription and illicit opioids interferes with how a person functions at work, home, school, and socially. A person may experience any or all of the following:
- Loss of relationships
- Mental health conditions
- Loss of employment or academic studies
- Financial problems
- Legal consequences
In addition, there are long-term consequences to a person’s physical health, including:
- Bowel dysfunction
- Hormone deficiencies
- Cellular and humoral immunity weakening
- Tumor growth
- Serious complications of infections
- Sleep disturbances
- Fertility struggles
Long-term consequences of nodding out on opioids can also lead to having a high tolerance or needing more of the drug to feel the desirable, euphoric sensations. Consequences may also include dependence and addiction.
What To Do When Someone Gets The Nods
When someone nods out, the best thing you can do is be prepared for worst-case scenarios. For some with an opioid use disorder, nodding out doesn’t lead to dire consequences. Many others are not so fortunate. Those around them, when they are nodding out, must know the signs that represent an emergency, such as an overdose. If you notice any of the following symptoms, an overdose is likely occurring:
- Their body goes limp
- They are nonresponsive to your efforts to wake them
- Their skin pales and turns blue or purple
- Their skin feels cold or clammy
- Their fingertips and lips may turn blue
- You hear vomiting or gurgling sounds
- It isn’t easy to find their pulse or hear their breaths
When an overdose occurs, you must call emergency services for help. The 911 operator will walk you through the proper life-saving steps.
Another crucial action is to administer naloxone (Narcan) to the person overdosing. It will restart vital functions like breathing. Instructions are on the medicine container, but it is typically given as a shot into the thigh or a nasal spray into the nose. Some people may require more than one dose. Even when revived with Narcan, the person needs to be evaluated by medical professionals.
Is Nodding Out A Sign Of Addiction?
Nodding out on heroin or other opioids can be a sign that someone has an addiction. However, nodding out is not usually the only symptom.
The Diagnostic and Statistical Manual for Mental Disorders states that a person has a substance use disorder when they meet at least two of the following in the previous 12 months:
- Opioid use continues despite worsening physical or psychological health
- Opioid use continues despite social and interpersonal consequences
- Avoids social or recreational activities to use drugs for nodding out
- Is unable to fulfill duties at school, home, or work properly
- Spends much of their time obtaining, misusing, or recovering from opioids
- More opioids are taken than intended or for more extended periods
- Opioid cravings occur
- Inability to decrease the amount or stop the use of opioids
- Tolerance to opioids develops
- Opioid use continues despite the dangers it poses
- Withdrawal occurs, or the user continues to take opioids to avoid withdrawal
Meeting two or three of these statements means you have a mild addiction, three to four is a moderate addiction, and six or more signal a severe addiction.
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Get Help For Opioid Addiction
Nodding out is a sign of a more severe problem, such as an addiction to opioids or drastic misuse of a substance. There are immediate and long-term risks to your physical and mental health when using drugs that cause you to nod out. While some risks may seem minor, others can lead to overdose, coma, or death.
Help is available to anyone with an addiction to heroin, fentanyl, or any other drugs. If you or someone you know can benefit from learning more about what drugs make you nod out or treatment options, contact a treatment provider today. Calls are always free and confidential. They can answer your rehab-related questions and explore your rehab options to help you get back to living the life you deserve.