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Opioid overdose

Last reviewed: 30 Sep 2024
Last updated: 09 Aug 2024

Summary

Definition

History and exam

Key diagnostic factors

  • history of opioid use disorder and dependence
  • miosis
  • bradypnea
  • altered mental status
  • dramatic response to naloxone
Full details

Other diagnostic factors

  • fresh needle marks
  • drug paraphernalia nearby
  • decreased gastrointestinal motility
  • old track marks on arms and legs
  • pulmonary rales
  • frothy pink sputum
  • seizures
  • dysrhythmias
Full details

Risk factors

  • opioid use disorder and dependence
  • recent abstinence in chronic users
  • chronic pain
Full details

Diagnostic tests

1st tests to order

  • therapeutic trial of naloxone
  • Electrocardiogram (ECG)
Full details

Tests to consider

  • chest x-ray
  • abdominal x-ray
  • abdominal CT scan
  • opioid urine screen
  • gas chromatography/ mass spectrometry
Full details

Treatment algorithm

ACUTE

patients with signs of opioid overdose or toxicity: in cardiac arrest

patients with signs of opioid overdose or toxicity: not in cardiac arrest

Contributors

Authors

Ruben Thanacoody, MD, FRCP

Consultant Physician and Clinical Toxicologist

Director, National Poisons Information Service (Newcastle)

Newcastle-upon-Tyne

UK

Disclosures

RT declares that he has no competing interests.

Acknowledgements

Dr Ruben Thanacoody would like to gratefully acknowledge Dr Dean Olsen, a previous contributor to this topic.

Disclosures

DO declares that he has no competing interests.

Peer reviewers

William Winter, MD

Staff

Gynecologic Oncologist

Northwest Cancer Specialists

Rose Quarter Cancer Center

Portland

OR

Disclosures

WW declares that he has no competing interests.

Anne-Maree Kelley, MD, MClinEd, FACEM

Director

Joseph Epstein Centre for Emergency Medicine Research

Western Health Sunshine Hospital

St Albans

Australia

Disclosures

AMK has received grant funding for research into intranasal delivery of naloxone in heroin overdose.

Andrew Stolbach, MD

Assistant Professor

Johns Hopkins University

Baltimore

MD

Disclosures

AS declares that he has no competing interests.

  • Opioid overdose images
  • Differentials

    • Gammahydroxybutyrate (GHB)/gammabutyrolactone (GBL) overdose
    • Clonidine/imidazolines overdose
    • Antipsychotic overdose
    More Differentials
  • Guidelines

    • 2023 American Heart Association focused update on the management of patients with cardiac arrest or life-threatening toxicity due to poisoning: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care
    • Clinical practice guideline for prescribing opioids for pain
    More Guidelines
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