When Prescribed Doesn’t Mean Risk-Free: Understanding Medication and Overdose

When we hear the word overdose, many of us immediately associate it with illicit drugs or substance addiction. However, an overdose simply means that the body has been exposed to more of a particular drug than it can safely process, and this can include medicines that have been legitimately prescribed to treat pain, anxiety, sleep disorders and a wide range of physical and mental health conditions.

Prescription medication plays an essential role in modern healthcare and, when used as directed, medicines can be both safe and effective, but a prescription from a healthcare professional does not automatically mean a medication is entirely without risk.

Accidental medication overdose can happen in many different circumstances, and understanding how it happens, which factors can increase risk, and how to manage medication safely can help prevent avoidable harm. Additionally, knowing what to do in the event of an overdose can help ensure that medical help is administered as quickly as possible. 

Overdose Is Not Always What We Imagine

One of the challenges surrounding overdose awareness is the persistent idea that it only affects people who use illicit drugs or have a substance use disorder.

In reality, overdoses can involve prescribed medicines, over-the-counter medication, alcohol, illicit substances, or combination of several of these. They can also be accidental.

Someone taking medication exactly as prescribed may never consider overdose prevention as being relevant to them. Similarly, a family member helping an older relative manage several prescriptions may focus on whether the medication has been taken, but not on whether different medicines, doses, or other substances could affect each other.

How Can an Accidental Medication Overdose Happen?

There is no single scenario that leads to an accidental overdose. Sometimes it can be as simple as someone forgetting they have already taken a dose and taking another. In other cases, several factors may combine to increase the risk. Problems can arise when someone takes more medication than prescribed, takes doses too close together or combines medications without understanding how they may interact. 

Additionally, some prescribed medicines require extra care, making medication safety paramount in many situations, such as:

• Opioids, such as morphine, oxycodone, codeine and tramadol, are commonly prescribed for pain relief. In excessive amounts, they can slow or suppress breathing and may cause profound drowsiness or loss of consciousness.
• Benzodiazepines, including diazepam, lorazepam and temazepam, may be prescribed for severe anxiety, muscle spasms, seizures or insomnia. They depress activity within the central nervous system, and the risk can increase significantly when they are combined with alcohol, opioids or other sedating medicines.
• Gabapentinoids, such as gabapentin and pregabalin, are used for conditions including neuropathic pain and epilepsy. They can cause sedation and, particularly when taken alongside opioids or other central nervous system depressants, may increase the risk of breathing difficulties.
• Some antidepressants, particularly older tricyclic antidepressants such as amitriptyline, can be dangerous when taken in excessive amounts and may affect the heart, nervous system and level of consciousness.
• Paracetamol is widely used and generally considered safe when taken at the recommended dose, but taking too much can cause serious liver damage. Importantly, someone may initially feel relatively well even after taking a harmful amount.
• Certain sleeping medications and sedatives can cause excessive drowsiness, confusion and respiratory depression, particularly when combined with other medicines that have a sedating effect.

Combining medicines that have sedating effects can increase risk further, while alcohol can compound those effects even when the medication itself has been legitimately prescribed, which is why healthcare professionals need to understand which medications have been issued, what is actually being taken and whether anything else needs to be considered.

When Circumstances Change, Risk Can Change Too

Medication management isn’t static. A prescription that has been part of someone’s life for months or years would still need to be reviewed in the context of their current health and circumstances, including:

• Different healthcare professionals introducing a new prescription. 
• Dosages changing. 
• Someone using over-the-counter medicines or supplements without realising they could interact with their existing medication. 
• Physical health changing, which can affect a person’s ability to metabolise particular medicines.

Tolerance is another important consideration, particularly with opioids and certain sedatives. If someone has stopped taking a medication for a period of time, their level of tolerance may have reduced, so returning to a dose they previously tolerated can therefore carry greater risk. 

Changes in mental health, alcohol consumption or substance use can also affect how safely medication is taken and managed, making regular reviews important, particularly when someone’s health, treatment or circumstances have altered. 

Multiple Medications and the Importance of Seeing the Whole Picture

Managing medication can become increasingly complex when someone is living with several physical or mental health conditions, and older adults are one group for whom this can be particularly relevant. 

Seniors are more likely to live with multiple long-term health issues, which can make management more demanding, and age-related changes can also affect how the body processes certain medicines. In practice, this may mean managing several prescriptions, taking medications at specific times, following different dosing instructions and coordinating treatment prescribed by multiple specialists. Over-the-counter medicines can add another layer of complexity, particularly if they are introduced without being discussed with the wider care team. 

Careful medication management is equally important for people living with co-occurring health conditions, particularly when several healthcare professionals or services are involved in their treatment. 

This is where coordinated care becomes particularly valuable. Viewing medication as part of a person’s overall treatment plan rather than a collection of individual prescriptions can help healthcare professionals identify potential risks and ensures everyone involved in someone’s care can see the complete picture.

Medication Safety Without Worry

Raising awareness about medication overdose is not about creating fear, and when used appropriately, prescription medication plays an essential role in managing symptoms, supporting recovery and maintaining health.

As part of safe medication management, it can be helpful to consider the following questions:

• Is it clear what medication is for and how it should be taken?
• Is the correct dose being taken at the prescribed time?
• Do all the healthcare professionals involved know which medications are currently being taken?
• Have all over-the-counter medicines and supplements been included when discussing medications with healthcare professionals?
• Could alcohol interact with any of the prescribed medications?
• Have any medications or dosages changed recently?
• Is the person finding it increasingly difficult to take their medication as prescribed?
• Are they taking more medication than prescribed or feeling that they need a higher dose to achieve the same effect?
• If someone helps manage their medication, do they have accurate and up-to-date information?

If taking medication as prescribed has become difficult, if doses are being missed or repeated, or if there are concerns about dependence or increasing use, it is important to discuss this openly with a qualified healthcare professional.

If someone is concerned about their, or someone else’s medication use, or the possibility of dependence, they should speak to their GP, pharmacist or another qualified healthcare professional. However, medication should not be stopped or altered without professional advice unless emergency medical guidance advises otherwise.

The Role of Professional Medication Management

Professional medication management is not simply about making sure the correct dose is taken on time. It can include reviewing how medicines are being used in practice, checking that instructions are understood, monitoring for adverse effects and identifying when further medical input may be needed.

It can also help reduce the risk of errors where medication routines are complicated by memory problems, changes in cognition, poor mental health or periods of instability. In these situations, support may involve organising medication, documenting what has been taken and helping ensure that concerns are escalated appropriately.

Clear communication is also important. When several professionals are involved in someone’s care, accurate records and timely updates can help prevent confusion, duplication or conflicting instructions.

The aim is not to remove independence, but to provide the level of oversight that is appropriate for the individual concerned and their circumstances.

What to Do if You Suspect an Overdose

If you think someone may have taken an overdose, seek medical help immediately. Do not wait for symptoms to worsen or assume they can simply sleep it off, as some effects can develop or worsen over time.

Call 999 if the person is unconscious, having difficulty breathing, has stopped breathing, is having a seizure, or you believe they may have taken a potentially harmful amount. If you are unsure whether something they have taken could be harmful, contact NHS 111 for urgent advice.

While waiting for medical support:

• Stay with the person and keep monitoring their breathing and level of consciousness.
• If they are unconscious but breathing, place them in the recovery position.
• If they are unresponsive and not breathing normally, call 999 and begin CPR. The emergency call handler can guide you through what to do.
• Do not try to make them vomit or give them anything to eat or drink.
• Gather any medication packets, containers or prescription information you can find so that healthcare professionals know what may have been taken.
• Tell the ambulance crew as much as you know about the medication or other substances involved, including approximately how much was taken and when.

If an opioid overdose is suspected and naloxone is available, administer it according to the instructions provided and still call 999. Naloxone can temporarily reverse the effects of an opioid overdose, but emergency medical treatment is still essential. If you are concerned that you or someone else may have taken too much medication, it is always better to seek professional advice than to wait for symptoms to appear.

For many, taking medication is part of everyday life, and most medicines can be used safely when taken as prescribed. While a suspected overdose can be frightening, particularly when you are unsure what has been taken or how serious the situation may be, the most important thing is to seek help immediately. 

Knowing the risks and getting prompt medical advice or emergency treatment can reduce the risk of serious harm and ensure the person receives the right care as quickly as possible.