The patient's history from bystanders/friends/family can assist diagnosis.
Signs include central nervous system and respiratory depression, miosis, and apnoea.
Initial treatment consists of ensuring adequate ventilation followed by administration of the opioid antagonist naloxone.
Monitor patients for re-sedation and repeat antidote dose if necessary.
An opioid is any synthetic or natural agent that stimulates opioid receptors and produces opium-like effects. Opiates are opioids naturally derived from the opium poppy, Papaver somniferum, and include morphine and codeine. Opioids are used in the treatment of pain but are often sold illicitly and abused for their euphoric effects. An overdose occurs when larger quantities than physically tolerated are taken, resulting in central nervous system and respiratory depression, miosis, and apnoea, which can be fatal if not treated rapidly.
History and exam
Key diagnostic factors
- presence of risk factors
- altered mental status
- dramatic response to naloxone
Other diagnostic factors
- fresh needle marks
- drug paraphernalia nearby
- decreased gastrointestinal motility
- old track marks on arms and legs
- pulmonary rales
- frothy pink sputum
- opioid abuse and dependence
- recent abstinence in chronic users
- chronic pain
1st investigations to order
- therapeutic trial of naloxone
- Electrocardiogram (ECG)
Investigations to consider
- chest x-ray
- abdominal x-ray
- abdominal CT scan
- opioid urine screen
- gas chromatography/mass spectrometry
patients with signs of opioid overdose: antidote available
patients with signs of opioid overdose: antidote not available
patients with retained drug packages: signs of opioid toxicity
patients with retained drug packages: no signs of opioid toxicity
Ruben Thanacoody, MD, FRCP
Consultant Physician and Clinical Toxicologist
National Poisons Information Service (Newcastle)
RT declares that he has no competing interests.
Dr Ruben Thanacoody would like to gratefully acknowledge Dr Dean Olsen, a previous contributor to this monograph. DO declares that he has no competing interests.
William Winter, MD
Northwest Cancer Specialists
Rose Quarter Cancer Center
WW declares that he has no competing interests.
Anne-Maree Kelley, MD, MClinEd, FACEM
Joseph Epstein Centre for Emergency Medicine Research
Western Health Sunshine Hospital
AMK has received grant funding for research into intranasal delivery of naloxone in heroin overdose.
Andrew Stolbach, MD
Johns Hopkins University
AS declares that he has no competing interests.
- Gammahydroxybutyrate (GHB)/gammabutyrolactone (GBL) overdose
- Clonidine/imidazolines overdose
- Antipsychotic overdose
- BTS guideline for oxygen use in adults in healthcare and emergency settings
- Community management of opioid overdose
- Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer