Opioid overdose
Opioid overdose is a preventable cause of respiratory depression and death.
An opioid overdose happens when someone takes too much of a drug like morphine, codeine, heroin, fentanyl, tramadol, oxycodone, or methadone. This condition is preventable but can be deadly if it causes respiratory depression—slow, shallow breathing that leads to hypoxia, or lack of oxygen. Other signs include pinpoint pupils and loss of consciousness. How quickly symptoms appear depends on how the drug was taken, the dose, and personal risk factors. In 2017, over 110,000 people died from opioid overdoses, and survivors sometimes faced lasting harm, such as permanent brain damage.
Doctors diagnose an opioid overdose based on symptoms and a physical exam. People are more likely to overdose if they are highly dependent on opioids, inject them, take high doses, have a mental disorder or a predisposition to one, or combine opioids with alcohol, benzodiazepines, or cocaine. Prescription opioids used for chronic pain can lead to dependence. After a period of detoxification, tolerance drops, making a return to use especially risky.
Initial treatment focuses on supporting breathing and giving oxygen to prevent hypoxia. If that doesn’t reverse the opioid’s effects, naloxone is given—either as a nasal spray or an injection into a muscle; both methods work equally well. Broader prevention efforts include making naloxone more available and treating opioid dependence.
Worldwide, drug use causes about 500,000 deaths each year. In 2018, opioid overdoses accounted for roughly 115,000 of those deaths, up from 18,000 in 1990. That same year, about 269 million people had used drugs at least once, including 58 million who used opioids. Around 35.6 million people had a drug use disorder. The World Health Organization estimates that 70% of drug-related deaths involve opioids, with 30% due to overdose. The opioid epidemic was partly fueled by the pharmaceutical industry’s assurances in the 1990s that prescription opioids were safe, leading to overtrust and heavy reliance. Although effective treatments exist to lower overdose risk in dependent individuals, fewer than 10% of those who need them receive them.
**Signs and symptoms** The classic signs of an opioid overdose are known as the “opioid toxidrome triad”: decreased consciousness, pinpoint pupils, and slowed breathing. Other symptoms can include seizures and muscle spasms.
- Deaths 2017
- over 110,000
- Deaths 2018 worldwide
- approximately 115,000
- Deaths 1990
- 18,000
- Global drug use 2018
- approximately 269 million people
- Opioid users 2018
- 58 million
- Drug use disorders 2018
- approximately 35.6 million people
- Who estimate opioid deaths
- 70% of deaths due to drug use are in relation to opioids, with 30% being due to overdose
Lore & Background
Opioid overdoses are diagnosed based on symptoms and examination. Risk factors for opioid overdose include high levels of opioid dependence, use of opioids via injection, high-dose opioid usage, having a mental disorder or having a predisposition for one, and use of opioids in combination with other substances, such as alcohol, benzodiazepines, or cocaine. Dependence on prescription opioids can occur from their use to treat chronic pain in individuals. Additionally, if following a period of detoxification, which allows the tolerance level to fall, the risk of overdose upon return to use is high.
Initial treatment of an overdose involves supporting the person's breathing and providing oxygen to reduce the risk of hypoxia. Naloxone is then recommended to those who cannot reverse the opioid's effects through breathing. Giving naloxone via nasal administration or as an injection into a muscle has shown to be equally effective. Other efforts to prevent deaths from overdose include increasing access to naloxone and treatment for opioid dependence.
It is believed that the opioid epidemic has partly been caused due to assurances that prescription opioids were safe, by the pharmaceutical industry in the 1990s. This led to unwarranted trust and a subsequent heavy reliance on opioids. Though there are treatment interventions which can effectively reduce the risk of overdose in people with opioid dependence, less than 10% of affected individuals receive it.
Reader's Guide
Opioid overdose is a significant public health issue because it is a leading cause of preventable death worldwide. The article notes that drug use contributes to 500,000 deaths globally, with opioid overdose resulting in approximately 115,000 of these deaths in 2018, a sharp increase from 18,000 deaths in 1990. The WHO estimates that 70% of deaths due to drug use are in relation to opioids, with 30% being due to overdose. The epidemic's roots are partly attributed to assurances from the pharmaceutical industry in the 1990s that prescription opioids were safe, leading to unwarranted trust and heavy reliance. Despite the availability of effective treatment interventions, less than 10% of affected individuals receive them. The legacy of opioid overdose includes permanent brain damage in survivors and a continued need for increased access to naloxone and treatment for dependence. The article emphasizes that the condition is preventable, yet it remains a major cause of morbidity and mortality, particularly when opioids are combined with other central nervous system depressants such as alcohol or benzodiazepines.
Did You Know?
- Opioid overdose symptoms are referred to as the 'opioid toxidrome triad': decreased level of consciousness, pinpoint pupils, and respiratory depression.
- Alcohol also causes respiratory depression and, when taken with opioids, increases the risk of respiratory depression and death.
- In young children, opioid overdose may not be apparent right away due to differences in absorption, distribution, and metabolism.
- Benzodiazepine use with opioids increases the risk of overdose death by four-fold.
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