athiestjoe
Passenger
- Sep 24, 2024
- 410
There's still a lot of questions and inquiries about ODs, and people asking about what things may facilitate a successful attempt. Let's be clear, ODs are rarely fatal. Why? For a couple of reasons: (1) modern medications are designed to be very safe, as manufacturers aim to avoid deaths that would hurt their reputation and business; and (2) the number of pills needed to cause a fatal overdose is so high that most people would vomit (or have other serious side effects) well before reaching that point. In many cases, surviving an OD may lead to long-term health issues rather than death. It's essential to approach this topic thoughtfully, as many contemplating ODs seem to do so impulsively. Deciding to CTB is something that should be carefully thought about, done with a full set of facts, and not something based on a mere whim of whatever is inside the medicine cabinet or at the reach of one's fingertips.
This discussion focuses on the LD50 values of various medications, excluding specific polydrug combos and protocols from things like PPH/PPEH or similar books. I included a cross section of some common medications including some benzodiazepines and antidepressants, to some OTC ones, allergy medications, and some specialty ones for things like heart and blood pressure, all to illustrate why ODs often fail. I think the reason will become extremely clear. Despite alarming headlines about the opioid crisis, statistics show that the chance of dying from an overdose on commonly used medications is outstandingly low. This is largely due to individual responses, established safe dosage ranges, and high LD50 values (the higher the LD50, the harder it is to die from a drug, i.e., a possible indicator that they are made 'safe' on purpose).
About LD50: The LD50 (lethal dose for 50% of the test population) indicates the dose that would be fatal for half of those exposed. It is important to note there is never going to be a direct human LD50, LD50s are determined based on laboratory animals such as rats, mice, sometimes rabbits and guinea pigs. This inherently means that there is not going to be definitive data that directly correlates to humans, and there are some flaws in using LD50, however this is how pharmaceutical companies achieve having their medications marked as safe for human consumption thus is used here. Generally, if the immediate toxicity is consistent across the various animal species tested, humans are likely to experience a similar level of immediate toxicity. However, when LD50 values differ among species, estimations and assumptions must be made to determine the estimated, reliable lethal risk for humans. Based on the review of evidence and outcomes it is then evaluated as "safe" for the market. To note, for a human, even at the LD50 level, individual factors—such as age, health, underlying conditions, tolerance, etc, and whether the drugs are legitimate or counterfeit—play significant roles and affect the LD50 potential assumptions. The table below has the LD50, which is the mg per kg, followed by the common dosage and then a hypothetical analysis.
Methodology Used: For purposes of this study, I have chosen to go with rats for consistency purposes as sometimes there are only IP (intraperitoneal, not oral) doses for mice which would create a table which has a lot more disclaimers about the ranges. Typically (but not always), the mice dose is lower but even if these numbers were reduced it does not affect the final outcome which will be discussed later on. It is important to disclaim this since this is a single species review however, the source material is linked so everyone is able to make their own reasonable conclusions on the data. In the calculations, I did use the full weight in kg when converting from lbs, but in the table display a rounded number for easier reading.
For educational/informational purposes, consider a hypothetical scenario involving a 125-pound (56.70kg), 150-pound (68.03 kg), and a 175-pound (79.38kg) person and what that LD50 looks like.
Benzodiazepines
Hypnotic Sleep Medications
Antidepressants
Antipsychotics
Anticonvulsants
Stimulants
Muscle Relaxants
Cardiac and Blood Pressure Medications
Opioids
Miscellaneous Prescriptions
Over-the-Counter (OTC) Medications
(A greater than symbol (>) indicates that the toxicity endpoint being tested was not achievable at the highest dose used in the tests; items marked * have several competing ranges so included both for context, and items marked ** are examples of medications which take several days before death if the LD50 or greater is even achieved although others do I am flagging Tylenol and Advil due to the OCT availability factor).
My calculations might not be perfect, and this is purely informational—definitely not a suggestion or encouragement—if anything, this is discouragement due to what these results show; not because I don't wish it was a feasible method, but because the data proves why it is not reliable. Some are listed with a "greater than", as the exact LD50 varies. There are also indeed differences with some medications which cannot be reliably gathered from this data set: such as lethality in humans happening at a higher or lower rate than test subjects since metabolic, absorption, or processing differs at different levels. Nonetheless, LD50 remains the approach but clearly yields more ambiguity and risk factors for failure to come into play. Some figures were rounded slightly for math purposes. Please also note that to the extent different LD50 studies by manufacturer had variation, only one source is included here, everyone can independently verify each credential. But I tried to not pick too many without good, consistent LD50 data.
Considering that many would likely vomit before reaching that point, it is extremely unlikely for anyone to come anywhere near LD50; and even then, it's still just a 50% chance and taking into account some biological factors which may decrease or increase based on human vs laboratory animal studies. Potential tolerance is also a factor for human. However, this sample chart should make it clear why ODs fail.
But aren't there cases of people dying from MUCH smaller doses of these drugs? Yes, of course. There are all sorts of one-off cases known as the lowest-reported dose in humans (lowest dose causing lethality aka LDLO). But they are just that, the lowest known dose ever published, not the baseline nor the reliable quantity. There are generally other circumstances like allergies, underlying health issues, the subject being a child, etc in those lowest reported death scenarios which does not give a more objective review to consider. There are always exceptions and extraordinary situations. Those results are not repeatable in a reliable way. Which is why the toxicity to death threshold is used from the LD50, not the lowest reported dose. Also, plenty of people far exceed those lowest reports and live (especially if there a tolerance).
What sort of data is there about ODs? Don't people still die of medication ODs? Yes, there have been cases of people dying from lower amounts, but those instances are not reliable indicators. A comprehensive study involving 421,466 attempts at overdose using medications found that only 21,594 resulted in death (5.1%), often in individuals with existing and underlying health issues or using multiple drugs (including street obtain drugs with other substances). Other studies report success (for our purposes) rates ranging from 1-6%, although one report went to 8%, which puts the comprehensive study I've chosen above at the high-mid to higher end of the spectrum. And let's talk for a moment about some of those OTC since those are readily available and may seem like a good choice (it isn't a good choice for CTB): it may be also interesting to know that some medications, such as Aspirin, have a much lower 1% chance of death, that Tylenol accounts for only around 500 deaths per year in the U.S even though around 60 million people consume it each week, and in 2006 there were 10 reported case fatalities of ibuprofen by self-poisoning (out of the approximate total 15,600 deaths per year). Feel free to do research on how ineffective the method truly is, there is plenty out there! Regardless, even if someone took the highest range of an 8% chance over the 5.1% mentioned here, that's an abysmal percent. There are plenty of studies around medication ODs, but the purpose here is to really just show how very unlikely it is to be able to consume this much of any medication to achieve a mere LD50 threshold.
Well, what about just combining some of these medications? Could combining various substances lead to success? It's possible, but not reliable. Is it worth the risk? Absolutely not. Again, as mentioned at the top of this post, this is excluding combos found in things such as PPH/PPeH/etc, those poly-med cocktails are not considered here. Look into those if that is an interest.
What's the risk in trying OD? The chances of experiencing severe side effects (depending on the medication)—like brain damage, chills, tremors, coma, tachycardia, seizures, pain, delirium, nerve damage, stroke, hallucinations, kidney or liver failure, and cognitive issues—are much higher than the likelihood of a fatal outcome. Even if someone took a LD50 dose and happened to be in that 1-8% of success, the death would not be very peaceful and could take days (or even weeks) in the case of some of them. The short and potentially long-term effects greatly outweigh any possible CTB chance with medication ODs.
I hope this sheds light on why pursuing this path is not a viable or successful option.
This discussion focuses on the LD50 values of various medications, excluding specific polydrug combos and protocols from things like PPH/PPEH or similar books. I included a cross section of some common medications including some benzodiazepines and antidepressants, to some OTC ones, allergy medications, and some specialty ones for things like heart and blood pressure, all to illustrate why ODs often fail. I think the reason will become extremely clear. Despite alarming headlines about the opioid crisis, statistics show that the chance of dying from an overdose on commonly used medications is outstandingly low. This is largely due to individual responses, established safe dosage ranges, and high LD50 values (the higher the LD50, the harder it is to die from a drug, i.e., a possible indicator that they are made 'safe' on purpose).
About LD50: The LD50 (lethal dose for 50% of the test population) indicates the dose that would be fatal for half of those exposed. It is important to note there is never going to be a direct human LD50, LD50s are determined based on laboratory animals such as rats, mice, sometimes rabbits and guinea pigs. This inherently means that there is not going to be definitive data that directly correlates to humans, and there are some flaws in using LD50, however this is how pharmaceutical companies achieve having their medications marked as safe for human consumption thus is used here. Generally, if the immediate toxicity is consistent across the various animal species tested, humans are likely to experience a similar level of immediate toxicity. However, when LD50 values differ among species, estimations and assumptions must be made to determine the estimated, reliable lethal risk for humans. Based on the review of evidence and outcomes it is then evaluated as "safe" for the market. To note, for a human, even at the LD50 level, individual factors—such as age, health, underlying conditions, tolerance, etc, and whether the drugs are legitimate or counterfeit—play significant roles and affect the LD50 potential assumptions. The table below has the LD50, which is the mg per kg, followed by the common dosage and then a hypothetical analysis.
Methodology Used: For purposes of this study, I have chosen to go with rats for consistency purposes as sometimes there are only IP (intraperitoneal, not oral) doses for mice which would create a table which has a lot more disclaimers about the ranges. Typically (but not always), the mice dose is lower but even if these numbers were reduced it does not affect the final outcome which will be discussed later on. It is important to disclaim this since this is a single species review however, the source material is linked so everyone is able to make their own reasonable conclusions on the data. In the calculations, I did use the full weight in kg when converting from lbs, but in the table display a rounded number for easier reading.
For educational/informational purposes, consider a hypothetical scenario involving a 125-pound (56.70kg), 150-pound (68.03 kg), and a 175-pound (79.38kg) person and what that LD50 looks like.
Benzodiazepines
| Medication | Oral LD50 (mg/kg) | Dose (mg) | # of pills for 125 lbs (56.70kg) | # of pills for 150 lbs (68.0kg) | # of pills for 175 lbs (79.38kg) |
| Alprazolam (Xanax)* | 300 - 2100* | 1 | 17,010 - 119,698* | 20,412 - 142,882* | 23,814 - 166,696* |
| Clonazepam (Klonipin) | >4000 | 1 | >227,996 | >272,156 | >317,515 |
| Diazepam (Valium) | 1200 | 5 | 13,680 | 16,330 | 19,051 |
| Estazolam (Prosom) | 3200 | 1 | 182,397 | 217,725 | 254,012 |
| Lorazepam (Ativan) | 4500 | 1 | 256,496 | 306,176 | 357,205 |
Hypnotic Sleep Medications
| Medication | Oral LD50 (mg/kg) | Dose (mg) | # of pills for 125 lbs (56.70kg) | # of pills for 150 lbs (68.0kg) | # of pills for 175 lbs (79.38kg) |
| Eszopiclone (Lunesta) | 980 | 2 | 27,930 | 33,340 | 38,896 |
| Zaleplon (Sonata) | >1000 | 10 | >5,700 | >6,804 | 7,938 |
| Zolpidem (Ambien)* | 695 – 1030* | 10 | 3,961 – 5,870* | 4,729 – 7,008* | 5,517 – 8,176* |
Antidepressants
| Medication | Oral LD50 (mg/kg) | Dose (mg) | # of pills for 125 lbs (56.70kg) | # of pills for 150 lbs (68.0kg) | # of pills for 175 lbs (79.38kg) |
| Citalopram (Celexa)* | 900 – 1700* | 20 | 2,565 - 4,845* | 3,062 - 5,783* | 3,572 - 6,748* |
| Duloxetine (Cymbalta) | 491 | 30 | 933 | 1,114 | 1,300 |
| Escitalopram (Lexapro)* | 300 – 2000* | 10 | 1,710 - 11,400* | 2,042 - 13,608* | 2,832 - 15,876* |
| Fluoxetine (Prozac) | 452 | 20 | 1,288 | 1,538 | 1,794 |
| Mirtazapine (Remeron)* | 600 - 720* | 15 | 2,280 - 2,736* | 2,722 - 3,266* | 3,175 - 3,810* |
| Paroxetine (Paxil) | 400 | 20 | 998 | 1,191 | 1,390 |
| Sertraline (Zoloft) | >2000 | 50 | >2,280 | >2,722 | >3,175 |
| Trazodone (Desyrel) | 690 | 50 | 787 | 939 | 1,095 |
| Venlafaxine (Effexor)* | 350 – 700* | 75 | 266 – 532* | 318 – 635* | 370 – 741* |
Antipsychotics
| Medication | Oral LD50 (mg/kg) | Dose (mg) | # of pills for 125 lbs (56.70kg) | # of pills for 150 lbs (68.0kg) | # of pills for 175 lbs (79.38kg) |
| Clozapine (Clozaril) | 251 | 25 | 572 | 684 | 797 |
| Haloperidol (Haldol) | 128 | 5 | 1,460 | 1,742 | 2,033 |
| Prochlorperazine (Compazine) | 1,800 | 5 | 20,520 | 24,494 | 28,576 |
| Quetiapine (Seroquel) | 2000 | 100 | 1,140 | 1,361 | 1,588 |
Anticonvulsants
| Medication | Oral LD50 (mg/kg) | Dose (mg) | # of pills for 125 lbs (56.70kg) | # of pills for 150 lbs (68.0kg) | # of pills for 175 lbs (79.38kg) |
| Gabapentin (Neurontin) | >5000 | 300 | >950 | >1,334 | >1,323 |
| Pregabalin (Lyrica) | >5000 | 150 | 1,900 | >2,268 | >2,646 |
| Topiramate (Topamax) | >1500 | 25 | >3,420 | >4,083 | >4,763 |
Stimulants
| Medication | Oral LD50 (mg/kg) | Dose (mg) | # of pills for 125 lbs (56.70kg) | # of pills for 150 lbs (68.0kg) | # of pills for 175 lbs (79.38kg) |
| Dextroamphetamine (Adderall) | 98.6 | 5 | 1,124 | 1,342 | 1,566 |
| Lisdexamfetamine (Vyvanse) | >1000 | 30 | >1,900 | >2,268 | >2,646 |
| Methylphenidate (Ritalin) | 367 | 10 | 2,092 | 2,497 | 2,913 |
Muscle Relaxants
| Medication | Oral LD50 (mg/kg) | Dose (mg) | # of pills for 125 lbs (56.70kg) | # of pills for 150 lbs (68.0kg) | # of pills for 175 lbs (79.38kg) |
| Baclofen (Lioresal) | 145 | 10 | 826 | 987 | 1,151 |
| Chlorzoxazone (Flexeril) | 763 | 10 | 4,349 | 5,192 | 6,057 |
Cardiac and Blood Pressure Medications
| Medication | Oral LD50 (mg/kg) | Dose (mg) | # of pills for 125 lbs (56.70kg) | # of pills for 150 lbs (68.0kg) | # of pills for 175 lbs (79.38kg) |
| Atorvastatin (Lipitor) | 5000 | 40 | 7,125 | 8,505 | 9,922 |
| Digoxin (Lanoxin) | 28.27 | 0.25 | 6,446 | 7,694 | 8,978 |
| Lisinopril (Prinivil) | >8500 | 20 | >24,225 | >28,917 | >33,736 |
Opioids
| Medication | Oral LD50 (mg/kg) | Dose (mg) | # of pills for 125 lbs (56.70kg) | # of pills for 150 lbs (68.0kg) | # of pills for 175 lbs (79.38kg) |
| Hydrocodone | 375 | 5 | 4,275 | 5,104 | 5,953 |
| Morphine (MS Contin) | 460 | 30 | 874 | 1,044 | 1,218 |
| Oxycodone | >300 | 10 | >1,710 | >2,042 | >2,382 |
| Tramadol (Ultram) | 228 | 50 | 260 | 311 | 363 |
Miscellaneous Prescriptions
| Medication | Oral LD50 (mg/kg) | Dose (mg) | # of pills for 125 lbs (56.70kg) | # of pills for 150 lbs (68.0kg) | # of pills for 175 lbs (79.38kg) |
| Amoxicillin (Amoxil) | >15000 | 250 | >3,420 | >4,083 | >4,763 |
| Furosemide (Lasix) | 2600 | 20 | 7,410 | 8,845 | 10,319 |
| Metoclopramide (Reglan) | 750 | 10 | 4,275 | 5,103 | 5,953 |
| Ropinirole (Requip) | 862 | 2 | 24,567 | 29,325 | 34,313 |
| Tamsulosin (Flomax) | 650 | 0.4 | 92,623 | 110,564 | 128,990 |
| Levomepromazine (Nozinan)* | 300 - 2000* | 25 | 684 - 4,560* | 816 - 5,442* | 953 - 6,350* |
Over-the-Counter (OTC) Medications
| Medication | Oral LD50 (mg/kg) | Dose (mg) | # of pills for 125 lbs (56.70kg) | # of pills for 150 lbs (68.0kg) | # of pills for 175 lbs (79.38kg) |
| Acetaminophen (Tylenol, Paracetamol) ** | 1944 | 500 | 222 | 265 | 309 |
| Bisacodyl (Ducalox) | 4320 | 5 | 49,238 | 58,786 | 68,584 |
| Cetirizine (Zyrtek) | 365 | 10 | 2,080 | 2,550 | 2,897 |
| Diphenhydramine (Benadryl) | 500 | 25 | 1,140 | 1,360 | 1,588 |
| Dextromethorphan (Robitussin DM) | 500 | 15 | 1,900 | 2,268 | 2,646 |
| Ibuprofen (Advil)** | 636 | 200 | 182 | 217 | 253 |
| Fexofenadine (Allegra) | >5146 | 180 | >1,630 | >1,945 | >2,270 |
| Guaifenesin (Mucinex) | 1510 | 200 | 431 | 514 | 600 |
| Pseudoephedrine (Sudafed) | 2200 | 30 | 4,180 | 4,990 | 5,821 |
(A greater than symbol (>) indicates that the toxicity endpoint being tested was not achievable at the highest dose used in the tests; items marked * have several competing ranges so included both for context, and items marked ** are examples of medications which take several days before death if the LD50 or greater is even achieved although others do I am flagging Tylenol and Advil due to the OCT availability factor).
My calculations might not be perfect, and this is purely informational—definitely not a suggestion or encouragement—if anything, this is discouragement due to what these results show; not because I don't wish it was a feasible method, but because the data proves why it is not reliable. Some are listed with a "greater than", as the exact LD50 varies. There are also indeed differences with some medications which cannot be reliably gathered from this data set: such as lethality in humans happening at a higher or lower rate than test subjects since metabolic, absorption, or processing differs at different levels. Nonetheless, LD50 remains the approach but clearly yields more ambiguity and risk factors for failure to come into play. Some figures were rounded slightly for math purposes. Please also note that to the extent different LD50 studies by manufacturer had variation, only one source is included here, everyone can independently verify each credential. But I tried to not pick too many without good, consistent LD50 data.
Considering that many would likely vomit before reaching that point, it is extremely unlikely for anyone to come anywhere near LD50; and even then, it's still just a 50% chance and taking into account some biological factors which may decrease or increase based on human vs laboratory animal studies. Potential tolerance is also a factor for human. However, this sample chart should make it clear why ODs fail.
But aren't there cases of people dying from MUCH smaller doses of these drugs? Yes, of course. There are all sorts of one-off cases known as the lowest-reported dose in humans (lowest dose causing lethality aka LDLO). But they are just that, the lowest known dose ever published, not the baseline nor the reliable quantity. There are generally other circumstances like allergies, underlying health issues, the subject being a child, etc in those lowest reported death scenarios which does not give a more objective review to consider. There are always exceptions and extraordinary situations. Those results are not repeatable in a reliable way. Which is why the toxicity to death threshold is used from the LD50, not the lowest reported dose. Also, plenty of people far exceed those lowest reports and live (especially if there a tolerance).
What sort of data is there about ODs? Don't people still die of medication ODs? Yes, there have been cases of people dying from lower amounts, but those instances are not reliable indicators. A comprehensive study involving 421,466 attempts at overdose using medications found that only 21,594 resulted in death (5.1%), often in individuals with existing and underlying health issues or using multiple drugs (including street obtain drugs with other substances). Other studies report success (for our purposes) rates ranging from 1-6%, although one report went to 8%, which puts the comprehensive study I've chosen above at the high-mid to higher end of the spectrum. And let's talk for a moment about some of those OTC since those are readily available and may seem like a good choice (it isn't a good choice for CTB): it may be also interesting to know that some medications, such as Aspirin, have a much lower 1% chance of death, that Tylenol accounts for only around 500 deaths per year in the U.S even though around 60 million people consume it each week, and in 2006 there were 10 reported case fatalities of ibuprofen by self-poisoning (out of the approximate total 15,600 deaths per year). Feel free to do research on how ineffective the method truly is, there is plenty out there! Regardless, even if someone took the highest range of an 8% chance over the 5.1% mentioned here, that's an abysmal percent. There are plenty of studies around medication ODs, but the purpose here is to really just show how very unlikely it is to be able to consume this much of any medication to achieve a mere LD50 threshold.
Well, what about just combining some of these medications? Could combining various substances lead to success? It's possible, but not reliable. Is it worth the risk? Absolutely not. Again, as mentioned at the top of this post, this is excluding combos found in things such as PPH/PPeH/etc, those poly-med cocktails are not considered here. Look into those if that is an interest.
What's the risk in trying OD? The chances of experiencing severe side effects (depending on the medication)—like brain damage, chills, tremors, coma, tachycardia, seizures, pain, delirium, nerve damage, stroke, hallucinations, kidney or liver failure, and cognitive issues—are much higher than the likelihood of a fatal outcome. Even if someone took a LD50 dose and happened to be in that 1-8% of success, the death would not be very peaceful and could take days (or even weeks) in the case of some of them. The short and potentially long-term effects greatly outweigh any possible CTB chance with medication ODs.
I hope this sheds light on why pursuing this path is not a viable or successful option.
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then i guess salty death water is my only option now lol (SN)
how I shall forever refer to this 
