Opioid intoxication
Intoxication - opioids; Opioid abuse - intoxication; Opioid use - intoxicationOpioid-based drugs include morphine, oxycodone, and synthetic (man-made) opioid narcotics, such as fentanyl. They are prescribed to treat pain after surgery or a dental procedure. Sometimes, they are used to treat severe cough or diarrhea. The illegal drug heroin is also an opioid. When abused, opioids cause a person to feel relaxed and intensely happy (euphoria). In short, the drugs are used to get high.
Opioid intoxication is a condition in which you're not only high from using the drug, but you also have body-wide symptoms that can make you ill and impaired.
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Causes
Opioid intoxication may occur when a health care provider prescribes an opioid, but:
- The provider doesn't know the person is already taking another opioid at home.
- The person has a health problem, such as a liver or kidney problem, that may easily result in intoxication.
- The provider prescribes a sleep medicine (sedative) in addition to the opioid.
- The provider doesn't know that another provider already prescribed an opioid.
In people who use opioids to get high, intoxication may be caused by:
- Using too much of the drug
- Using an opioid with certain other drugs, such as sleep medicine or alcohol
- Taking the opioid in ways not normally used, such as smoked or inhaled through the nose (snorted)
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Symptoms
Symptoms depend on how much of the drug is taken.
Symptoms of opioid intoxication can include:
- Altered mental status, such as confusion, delirium, or decreased awareness or responsiveness
- Breathing problems (breathing may slow and eventually stop)
- Extreme sleepiness or loss of alertness
- Nausea and vomiting
- Small pupils
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Exams and Tests
Tests that are ordered depend on the provider's concern for additional medical problems. Tests may include:
- Blood tests
- CT scan of the brain, if the person is having seizures or might have a head injury
- ECG (electrocardiogram) to measure electrical activity in the heart
- Chest x-ray to check for pneumonia
- Toxicology (poison) screening
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Treatment
The provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure. Symptoms will be treated as appropriate. The person may receive:
- Breathing support, including oxygen, or a tube that goes through the mouth into the lungs and attachment to a breathing machine
- IV (fluids given through a vein)
- Medicine called naloxone (Evzio, Narcan) to block the effect of the opioid on the central nervous system
- Other medicines as needed
Since the effect of the naloxone is often short, the health care team will monitor the patient for 4 to 6 hours in the emergency department. People with moderate to severe intoxications will likely be admitted to the hospital for 24 to 48 hours.
A mental health evaluation is needed if the person is suicidal.
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Outlook (Prognosis)
Many factors determine the short- and long-term outcome after opioid intoxication. Some of these are:
- The degree of poisoning, for example, if the person stopped breathing, and for how long
- How often the drugs are used
- Effect of impurities mixed in with illegal substances
- Injuries that occur as a result of the drug use
- Underlying medical conditions
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Possible Complications
Health problems that may occur include any of the following:
- Permanent lung damage
- Seizures, tremors
- Reduced ability to think clearly
- Unsteadiness and difficulty walking
- Infections or even permanent damage of the organs as a result of injection use of the drug
References
Aronson JK. Opioid receptor agonists. In: Aronson JK, ed. Meyler's Side Effects of Drugs. 16th ed. Waltham, MA: Elsevier; 2016:348-380.
National Institute on Drug Abuse website. Opioids. nida.nih.gov/research-topics/opioids. Accessed April 18, 2023.
National Institute on Drug Abuse website. What are the medical complications of chronic heroin use? nida.nih.gov/publications/research-reports/heroin/what-are-medical-complications-chronic-heroin-use. Updated June 2018. Accessed April 18, 2023.
Nikolaides JK, Thompson TM. Opioids. In: Walls RM, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 151.