A ‘death rattle’ in last OD moment

A DISEASE, NOT A MORAL FAILING

THEIR EYES narrow to pinpoints. Their bodies sag. They nod out. They slur their speech. Death approaches.

Users in the midst of a heroin or pill overdose then either lose consciousness or enter a trancelike state, only semiaware of their surroundings, experts said.

“They kind of know what's going on but they can’t interact,” said Dr. Indra Cidambi, founder of the addiction treatment Center for Network Therapy in New Jersey.

Their breathing slows as the flood of drugs dulls and eventually cuts off the signals from the brain that control the lungs. The heart and the other internal organs slow down.

“The skin becomes pale and turns bluish purple, or ashen if the person is dark-skinned,” Cidambi said. “They might vomit.”

The lungs swell and fill with fluid, and the brain swells as it’s deprived of oxygen. Frothy fluid from the lungs floods into the mouth.

In the final moment, they make a sound that resembles snoring or gurgling — what is known as the “death rattle.” Breathing stops.

Their skin becomes clammy. Their fingernails turn blueblack.

“If you are next to them it’s like they are in a deep sleep and then they are gone,” Cidambi said. “It’s scary.”

The final cause of death is usually respiratory depression caused by acute opioid intoxication, said Dr. Michelle Sloan, a New York city deputy chief medical examiner.

In essence, they just stop breathing. Their savior could be naloxone, an antidote sprayed into the patient’s nose, injected into a user’s muscle or taken intravenously, which counteracts the effects of the opioids. But it doesn’t always work.

Revived people can die later at the hospital. Sloan said addicts often mix drugs and that can dilute the effectiveness of the antidote.

“It depends on the dosage,” Sloan said. “Obviously it’s not going to work in everyone.”