Opiate overdose

Question 1

Define an opiate overdose

Answer 1

ingestion of larger quantities of opiates than physically tolerated

Question 2

Define an opiate and give some examples.

Answer 2

opioids naturally derived from the opium poppy = morphine and codeine

Question 3

Aetiology of opiate overdose

Answer 3

o Complications of substance abuse
o Unintentional overdose with prescribed opiates
o Intent of self-harm
o Therapeutic error (iatrogenic)

Question 4

Risk factors of opiate overdose

Answer 4

• Recent abstinence in chronic users

* Male

Question 5

Epidemiology of opiate overdose

Answer 5

• Heroin overdose is the major cause of opiate mortality
o Most deaths occurs in male IV heroin users in 20s-30s using heroin for 5-10 years
• 17% of deaths occur in novice users
• Recent abstinence causes loss of tolerance and thus increases the risk of overdose
o Drug overdose is the most common cause of death after prison release
o Risk of death in 2 weeks after release from prison is 12 times greater than general population
o 3 times more likely

Question 6

Presenting symptoms of opiate overdose

Answer 6

•	Miosis
•	Altered mental status
o	Drowsiness  stupor  coma
•	Bradypnoea
•	Pulmonary rales
•	Frothy pink sputum
•	Dysrhythmias

Question 7

Signs of opiate overdose on examination

Answer 7

• Fresh needle marks
• Drug paraphernalia
• Old track marks on arms and legs
• Decreased GI motility
• Seizures

Question 8

First line investigations and treatment for opiate overdose?

Answer 8

• 1st line
o Therapeutic trial of naloxone
o ECG
 QRS prolongation, signs of MI

Question 9

Other investigations for opiate overdose?

Answer 9

o	CXR
	Perihilar, basilar or diffuse alveolar infiltrates
o	Abdominal X-ray/CT
	Packets of drugs seen – ‘bodypackers’
o	Opioid urine screen
	Positive for opioids
o	Gas chromatography
	Positive for specific opioids