The use of opioids is one of many ways to relieve pain. While opioids have been formally approved and used for analgesia for almost 70 years and were assumed to be relatively safe, opioid-involved OD deaths have been on the rise over the past two decades. The CDC has started to put in efforts to track the growing opioids overdose epidemic in 2006. Back then, the CDC identified prescription opioids as the primary concern. Data and opioid overdose statistics from the National Institute on Drug Abuse, on the other hand, show that drug OD deaths have been steadily rising since 1999, seeing just a slight decrease in 2018 but again rising significantly in 2019. In the United States alone, 70,630 individuals were reported to have died from drug overdose in 2019 – 49,860 or 71% of them from opioids. With all that said, it is apparent that OD deaths from opioids remain to be a huge public health concern. And so, it is vital to be informed about opioid overdose symptoms and be able to identify them in a patient.
This article will talk about opioid overdose and its causes, opiates of concern, and how to recognize opioids overdose symptoms. Moreover, the article will dive into the right things to do when someone shows opioids overdose symptoms. Resources and information regarding prevention and opioid overdose treatment will also be provided.
Opioids Overdose: Finding The Threshold Levels
There are common misconceptions about what opioids are. The difference between opiates vs opioids is a frequently asked inquiry, and why can an opioid overdose cause death is another question many people ask. It is true that prescription opioids are relatively safe, but the use of synthetic or illegal ones can be dangerous. In addition, prescription opioids should only be given when other pain medications have been exhausted yet pain persists.
It must be noted, that higher doses have not been proven to reduce pain in the long run. Opioid overdose statistics from the Veterans Health Administration’s national sample from 2004-2009 suggest that people who died of opioid toxicity and OD took 98 MME (morphine milligram equivalents) per day, while others took 48 MME per day. Data from the CDC, on the other hand, has found that doses 50 MME or above have twice the risk as that of doses below 20 MME per day.
What Is Opioid Overdose?
Opioids are prone to misuse and addiction, and with this comes potential risks. Misuse essentially means that one is not taking their medicines as prescribed, while addiction is a brain disease that causes one to compulsively dig through drugs knowing that they may cause harm. Overdose, on the other hand, is what may occur after taking a dosage of medication that is higher than the body can tolerate.
OD for prescription painkillers can easily occur due to opioids’ mechanism of action, which involves blocking pain signals in the brain to help relieve sensations of pain. These medications can build up inside the body. How fast they act depends on many factors, including the type of medication taken, dosage, and frequency of intake. Because opioids affect the regulation of breathing, people who take high doses or those who OD can experience slowing of breathing, or in worse cases, stopping of breathing altogether. This answers the question: why can an opioid overdose cause death?
Causes Of Opioid OD
One of the most common causes of drug overdose deaths are opioids, a type of drug that is sometimes called narcotics. There are several things that may cause OD on opioids, such as taking potent prescription ones for pain relief. These include Fentanyl, Tramadol, Oxycodone, and Hydrocodone. Heroin, an illegal substance, is also an opioid. Just like other drugs, some of the most common causes of opioid OD are misuse, abuse, and addiction.
Following Are the Conditions That May Lead To an Overdose:
- Deliberately misusing the medication with or without prescription or taking the drug for recreational purposes
- Use of heroin and other illicit opiates
- Not following the dosage that was prescribed by a qualified physician / taking an extra dose or taking it too often
- Taking a prescription opioid that was prescribed for someone else
- Taking drugs that are contaminated with more potent substances, such as fentanyl
- Therapeutic drug error or unintentional OD due to errors in dispensing or misunderstanding dosing instructions
- Combining them with alcohol, other illicit drugs, benzodiazepines, or other prescription medication
- Substance abuse complications
- For children – accidentally taking opioids
Aside from the causes mentioned above, another thing that puts someone at risk of overdose is if they are getting MAT or medication-assisted treatment. While this particular opioid overdose treatment is used to treat abuse and addiction, a significant number of drugs used for it are controlled substances that are prone to misuse. Someone who has a history of substance abuse or addiction is also at a higher risk of opioid misuse and OD.
Opioids Drugs Of Concern
As has already been mentioned, there are different types of opioids. Among them are natural opioids, semi-synthetic opioids, and synthetic or prescription opioids. Opiates like morphine and codeine fall under the natural type, originating from the opium poppy. Meanwhile, heroin falls under the semi-synthetic type, and methadone, fentanyl, and tramadol under the synthetic type. According to opioid overdose statistics from the National Institute on Drug Abuse, around 1.7 million people in 2017 suffered from prescription opioid use disorders, while around 652,000 suffered from a heroin use disorder.
Some of the Most Dangerous Opioids Are:
The long-term effects of opioids are likewise well-documented. The most serious risks of these drugs are addiction and OD, which can lead to death. And with ODs on the rise, the opioid epidemic has become a leading cause of injury-related death in the US.
Now, calculating the total daily dosage of opioids is important, as higher dosage means a higher risk of OD and death.
Recognizing Opioid Overdose Symptoms And Signs
In lethargic patients with no known cause, the National Center for Biotechnology Information recommends always considering opiate OD. And because a substantial number of opiate abusers tend to mix other illicit substances with opiates, they also recommend raising suspicion when the usual or typical opioids overdose symptoms and signs of opioid overdose differ. Listed below are the most common and spotted signs and symptoms of opioid overdose that an individual is suffering from opioid overdose:
- A manifestation of the opioid overdose triad– these signs of opioid overdose, according to the WHO, consists of: loss of consciousness, slowed breathing, and very tiny or pinpointed pupil
- Limp body– this can be accompanied by extreme drowsiness with the marked difficulty of waking
- Patient’s heart beats slower than normal– it is also possible not to be able to detect the heartbeat at all
- Gurgling sound– the person suffering from opioid toxicity or OD may produce a sound that can be likened to snoring or choking
- Bluish or purplish complexion– a marked darkening of the lips and fingernails may be observed. Their face may also be extremely pale and/or feel clammy to the touch
- Hard to awaken and/or inability to speak
To manage opioid toxicity, medical practitioners also take note of key information such as the half-life of the medication taken and consider how long opioids stay in the body. It is equally important for the patient and caregivers to recognize opioid overdose symptoms and be able to administer an antidote at the appropriate volume for the prevention of OD death.
What To Do If You Noticed Opioids Overdose Signs?
Opioid overdose symptoms are not always clear-cut and easily recognizable. On the other hand, signs and symptoms of opioid overdose may not be caused by this drug. In any case, the CDC recommends treating the situation as an opioid overdose and proceeding with processes for opioid reversal.
Do the Following When Responding to Possible Opioid Toxicity or Overdose:
- Observe and evaluate the scene and the person affected – check their vital signs. Check to see the affected person and evaluate signs of opioid overdose
- If the person suspected of opioid overdose is in respiratory distress, obtain airway control before anything else. Try to keep them awake and always ensure that they are breathing
- Call 911 and be as detailed and provide as much information about the affected person’s condition so that one may be guided accordingly. The dispatcher will give instructions on how CPR can be immediately performed. Stay calm and follow the instructions promptly
- Call the person by name and observe the timing and consistency of response. If the person is not responding, administer CPR, but only if qualified
- Administer Naloxone. In case an opioids overdose kit is within reach, administer Naloxone, the most commonly recommended of all opioid antagonists for the immediate reversal of the depressive effect on the central nervous system and respiratory system
- Perform other first aid interventions. Make the patient lie on one side to help improve breathing. Continue to observe breathing and reaction to Naloxone
Dealing with an opioid OD case is not easy. In the unfortunate situation where you are faced with one, it’s important to know how to respond and manage the scene as it could save their life. Staying with the person presenting symptoms of opioid overdose until help arrives is also very important.
Opioid Overdose Treatment And How To Avoid OD
Anyone who takes an opioid is at high risk for OD. The patient and people around them should know how to recognize the signs of opioid overdose. They should also understand how to properly respond to an OD as a measure for prevention, as well as the dos and don’ts when responding to one. It also helps if the individuals who care ensure access to treatment for opioid users, like ready access to naloxone. When one gets prescribed opiates or other addictive painkillers, follow these opioid OD prevention tips to stay safe and sound:
- Never take drugs recreationally and without prescription
- Never take any illegal pain-relieving substances
- Take these drugs only as prescribed. Do not take double doses without your physician’s recommendation
- Check opioid addiction treatment programs nearby to know where to call in case of any drug abuse patterns noticed
- Never mix them with alcohol, other illicit drugs, or with certain medications such as antidepressants, sleeping pills, psychiatric drugs, sedatives, certain antibiotics and antifungals, and antiretroviral drugs used for HIV
- Prevent accidental swallowing, most especially by children, by locking it away or storing it where children are unable to reach them
When opioid OD is suspected, seek professional opioid overdose treatment. The patient will likely be recommended to undergo a rehab program. A growing number of medical facilities and drug recovery houses are combining medication-assisted treatment (MAT) and behavioral therapy for opioid overdose treatment. Typically, in a hospital setting, the patient will be treated to eliminate toxic drug levels from the system while managing symptoms of withdrawal. Simultaneously, in the case of patients with drug dependence, the dose is also tapered off to assist with a more sustainable withdrawal from opioid drugs.
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- CDC. (2018, October 5). Responding to a suspected opioid overdose. From Centers for Disease Control and Prevention: https://www.cdc.gov/niosh/topics/opioids/response.html
- CDC. (2019, January 11). CDC's Response to the Opioid Overdose Epidemic. From Centers for Disease Control and Prevention: https://www.cdc.gov/opioids/strategy.html
- CDC. (n.d.). Calculating Total Daily Dose Of Opioids For Safer Dosage. From Centers for Disease Control and Prevention: https://www.cdc.gov/drugoverdose/pdf/calculating_total_daily_dose-a.pdf
- MedlinePlus. (n.d.). Opioid Misuse and Addiction Treatment. From MedlinePlus: https://medlineplus.gov/opioidmisuseandaddictiontreatment.html
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- NIDA. (2021, June 1). Prescription Opioids DrugFacts. From NIDA: https://www.drugabuse.gov/publications/drugfacts/prescription-opioids
- Schiller, E., Goyal, A., & Mechanic, O. (2021). Opioid Overdose. In E. Schiller, A. Goyal, & O. Mechanic, Opioid Overdose. Florida: StatPearls Publishing.
- World Health Organization. (2021, August 4). Opioid overdose. From World Health Organization: https://www.who.int/news-room/fact-sheets/detail/opioid-overdose