Opioid Overdose: Amounts, Signs, Treatment And Prevention Steps

Last Updated: May 5, 2020

Reviewed by Michael Espelin APRN

The World Health Organization estimates at least 34 million people who used these drugs in 2016, with about 27 million affected by the use disorder. The report also highlighted that while heroin was the most common form of opiates used, there was also a growing number of recorded dependencies on prescription pills. Since that time, the Opioid Crisis is not beaten yet.
How many people die from opioids? The WHO estimates that overdose deaths directly attributable to opioids reached 118,000 in 2015 alone on the peak of the epidemic. It is truly vital to be informed about opioid overdose symptoms and be able to identify them in a patient. Discover the opioid overdose issue, known signs of opioid overdose and opioid antidotes available.

Opioids Overdose: Finding The Threshold Levels

There are common misconceptions about what opioids are. The difference between opioids vs. opiates is another frequently asked question. These substances, either illegal or, available by prescription only. They should only be given when other pain medications have been exhausted yet pain persists.

What Is Opioid Overdose?

Overdose is the condition that may appear after taking a dosage of medication that is higher than a body can respond. Overdose for prescription painkiller can easily occur due to opioids mechanism of action, which involves blocking pain signals in the brain to help relieve sensations of pain. These meds 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.

Elderly man counts his pills

Causes Of Opioid Overdose

People who take these medications are at risk of opioid overdose, which is characterized as significant slowing down of heartbeat and respiratory activity with a high possibility of stopping completely. Following are the conditions that may lead to an overdose:

  • Deliberately misusing the medication with or without prescription
  • Use of heroin and other illicit opiates
  • Not following the dosage that was prescribed by a qualified physician
  • Taking drugs that are contaminated with more potent substances, such as fentanyl
  • Accidental overdose due to errors in dispensing or, misunderstanding dosing instructions
  • Combining them with alcohol, other illicit drugs, benzodiazepines or other prescription medication

What Is The Overdose Amount For Some Commonly Prescribed Brands?

Following lists the overdose amounts of the most commonly prescribed pain relievers that can lead to symptoms of opioid overdose or death:

  • Codeine: more than 360 mg per day
  • Hydrocodone: 90 mg per day or more
  • Oxycodone: more than 40 mg on single dose or, more than 80 mg per day for the naive individuals
  • Heroin: 75 to 375 mg for a 170-lb opiate-naive individual
  • Fentanyl: 3 mg for an adult male of average build
  • Methadone: 25 mg for a naive adult, and 200 mg for a regular user
  • Tramadol: 2 to 8 grams, although signs of opioid overdose may manifest at 500 mg dose

Recognizing Signs Of Opioid Overdose

Use of these drugs is associated with adverse effects that include opioid constipation, sexual dysfunction, vomiting, dry skin, and urinary retention. The long term effects of opioids are likewise well-documented. The most serious risks of these drugs are addiction and overdose, which can lead to death.

opioid overdose cause pinpointed pupils
Listed below are the most common and spotted signs and symptoms 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, slow down of breathing, and very tiny or pinpointed pupils.
  • Limp body. This can be accompanied by extreme drowsiness with the marked difficulty of waking up the person affected.
  • 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 overdose may produce a sound that can be likened to snoring or choking. Although the eyes are open, the person appears unable to speak.
  • Bluish or purplish complexion. A marked darkening of the lips and fingernails may be observed.

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 do stay in urine. It is equally important for the patient and caregivers to recognize opioids overdose symptoms and be able to administer an antidote at the appropriate volume to prevent overdose death.

Opioid Overdose Treatment

Opioid overdose symptoms are not always clear-cut and easily recognizable. On the other hand, signs and symptoms of overdose may not be caused by this drug. In any case, the CDC recommends treating the situation as an opioid overdose and proceed with processes for opioid reversal. Do the following when responding to a possible opioid overdose:

  • Observe and evaluate the scene and the person affected. Check to see the affected person and evaluate signs of consciousness.
  • 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.
  • Call 911 immediately. The dispatcher will give instructions on how CPR can be immediately performed. Stay calm and follow the instructions promptly.
  • Administer Naloxone. In case an opioid 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.

However, the effects are temporary. In some cases, additional dose of Naloxone may be necessary if the person affected fails to show any form of improvement within the first 3 minutes from the time of administering the first dose.

Administering CPR to overdosed on opioids

  • Perform other first aid interventions. Make the patient lie on one side to help improve breathing. Continue to observe breathing and reaction to Naloxone. If the 911 dispatcher is on the phone, be as detailed and informative as one can be about the affected person’s condition so that one may be guided accordingly.
  • Be ready to provide information to first responders when they arrive. Describe the observations in detail and provide only information that one knows for certain.

DO NOT do the following when opioid overdose is suspected:

  • Do not touch anything onsite. Some drugs and drug paraphernalia may affect or harm others, so it is best not to risk being exposed.
  • Do not delay calling 911 for immediate help.
  • Do not attempt CPR if one is not trained.
  • Do not administer Naloxone without proper training or instruction.
  • Do not leave the affected person until help arrives.
  • Do not disturb the scene as much as possible so that the exact cause of overdose can be pinpointed and, possibly, the amount taken and mode of administration.

These are vital information for the patient’s drug detoxification.

Opioid Overdose Prevention

Government’s Role In Preventing The Overdose Rates

In the U.S., President Donald Trump declared an opioid public health emergency following a report provided by the National Institute on Drug Abuse in 2017 which indicated that opioid overdose deaths in the US totaled 70,237 between 1999 and 2017. Of which, 47,600 were due to opioid overdoses, where close to a third of this figure point to opioid overdose rates of prescription ones.
The opioid crisis is blamed on the rather loose basis for prescription pain relievers in the 1990s by medical practitioners. The US Department of Health and Human Services estimates that there are 731.2 prescriptions per 1,000 population in the US.
The opioid national emergency has prompted regulatory agencies to find the alternative to opioids. The Centers for Disease Control and Prevention revised their new guidelines for Prescribing, which generally lowers the dosing standards.

doctor consults about safe use of opioids

Patient’s Role in Preventing An Overdose

When one got prescribed with these or other addictive painkillers, follow these opioid overdose prevention tips to stay safe and sound:

  • Never take them 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.
  • Dispose any unconsumed drugs immediately.

Simultaneously, in the case of patients with drug dependence, the dose is also tapered off to assist with a more sustainable opioid withdrawal.

Page Sources

  1. World Health Organization, Information sheet on opioid overdose, https://www.who.int/substance_abuse/information-sheet/en/
  2. The Centers for Disease Control and Prevention, Opioids in the Workplace: Responding to a suspected opioid overdose, https://www.cdc.gov/niosh/topics/opioids/response.html
  3. National Institute on Drug Abuse, Overdose Death Rates, https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates

Published on: September 17th, 2019

Updated on: May 5th, 2020

About Author

Peter J. Grinspoon, MD

Dr. Peter Grinspoon is an experienced physician with long-term clinical practice experience. As a former analgesic addict, Dr. Grinspoon knows precisely how important it is to provide patients with effective treatment and support. Medical writing for him is the way to communicate with people and inform them about their health.

Medically Reviewed by

Michael Espelin APRN

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.


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