Opioid overdose

Epidemiology


Etiology


Indications


Pain management

Strategies for safe opioid prescribing

  • Optimize non-opioid interventions
    • Use acetaminophen/NSAIDs, supportive care (eg, heat/ice) for mild/moderate pain
    • Avoid routine opioid use for chronic pain
  • Optimize opioid dose and duration
    • Limit therapy to <5 days for acute pain
    • Use lowest dose resulting in adequate pain control
    • Avoid long-acting opioids
  • Optimize monitoring
    • Counsel patients on safe use; arrange close follow-up
    • Educate patients on safe disposal of unused opioids


Clinical features

Opioid toxidrome

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The classic triad consists of:

Warning

The absence of miosis does not rule out opioid overdose as hypoxia, co-ingested drugs (e.g., cocaine, amphetamines), and/or medications (e.g., atropine) may cause mydriasis, thereby counteracting the miotic effect of opioids.

Opioid-induced respiratory depression (OIRD)

Warning

OIRD is the most common cause of death from opioid overdose and is treated with naloxone for opioid overdose.

Other clinical features


Diagnostics


Treatment

Tip

Naloxone has short half-life (60 minutes on average; ranges from 30 to 90 minutes). Therefore, patients may develop recurrent symptoms of opioid toxicity after naloxone is metabolized, and frequent redosing may be necessary. Pasted image 20240316203900.png