Opioid overdose occurs when a person takes opioids in larger quantities than are physically tolerated.
Signs include central nervous system and respiratory depression, miosis, and apnea.
The patient's history from bystanders/friends/family can assist diagnosis.
Initial treatment consists of ensuring adequate ventilation and consideration of the opioid antagonist naloxone.
Monitor patients for resedation 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 apnea, which can be fatal if not treated rapidly.
History and exam
Key diagnostic factors
- history of opioid abuse and dependence
- 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 or toxicity: in cardiac arrest
patients with signs of opioid overdose or toxicity: not in cardiac arrest
Ruben Thanacoody, MD, FRCP
Consultant Physician and Clinical Toxicologist
Director, 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 topic.
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.
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