Emergency Management of Opioid Misuse, Overdose and Withdrawal

A major pitfall is assuming no opioid overdose in the patient with normal or enlarged pupil size. The classic sign of pinpoint pupils is not always present when mixed substances, sometimes without the patient’s awareness of drug mixing or contamination, is at at play.

 Opioid intoxication

The goal here is to give just enough naloxone so that the patient protects their airway. The therapeutic target is thus a patient who is comfortable and sleepy, but easily awakens and protects their airway. The goal isn't to bring the patient back to a normal state of consciousness. For patients on chronic opioids, trying to “normalize” their mental status may provoke pain and severe agitation.

 Opioid Overdose

Of all drugs taken in overdose, opioids have been consistently shown to be the most likely to cause death.

Fewer than 10% of opioid overdose patients are prescribed potentially lifesaving medications after emergency treatment

The strikingly low numbers of naloxone and buprenorphine prescriptions highlight many missed opportunities for equipping patients with rescue medicines to use in case they or others overdose in the future, and starting appropriate patients on addiction treatment in both the emergency department and follow-up care, says Kao-Ping Chua, M.D., Ph.D., lead author of the study and assistant professor of pediatrics at Michigan Medicine.

Kratom Overdoses Are on the Rise. Why They’re Hard to Spot

Its complexity means that overdose symptoms can be more difficult to diagnose — especially when compared with traditional opioids. Kratom affects the μ-receptor [mu-receptor], like other opiates, but also affects serotonin and norepinephrine reuptake inhibition.

A New Paramedic Policy May Guide Overdose Patients Into Treatment

As the number of opioid overdose deaths continues to surge across the United States, some experts stress the urgency of providing the addiction treatment medication buprenorphine to drug users as soon as possible, on the scene of an overdose. Not only does buprenorphine help people with an opioid use disorder resist cravings and stay away from drugs, but it also protects patients from the increasingly likely possibility that they will end up using an illicit drug laced with fentanyl and die.

Dose of Reality: Opioid Overdose

Anyone who use opioids can experience an overdose at any time. When a person survives an opioid overdose, it’s because someone knew what was happening and how to take action. Call 911 immediately if you think someone is experiencing an opioid overdose.

How to Respond to an Opioid Overdose

If taken differently than prescribed, opioids can cause death by slowing, and eventually stopping, a person's breathing. However, quick response to an opioid overdose, including administering naloxone and calling for medical assistance, can prevent brain injury and death.

Misuse of Novel Synthetic Opioids: A Deadly New Trend

The United States is experiencing an epidemic of opioid overdose deaths. A major factor in this crisis is the increasing availability of potent opioid drugs, including fentanyl and novel synthetic opioids (NSOs).

Opioids & Sedatives Toxicity

Dose: standard is (.4mg) , but we start with( .1mg) and see the response if it didn’t work we increase gradually till we reach .4mg.

Responding to an Opioid Overdose

Although being traditionally administered by emergency personnel, naloxone can also be administered by minimally trained individuals in the community.

Retrospective analysis of patterns of opioid overdose and interventions delivered at a tertiary hospital emergency department: impact of COVID-19

Survivors of non-fatal overdose are at high risk of subsequent overdose. As such, interventions delivered in the ED post-overdose offer a unique opportunity to tackle the opioid epidemic.

Reverse an Opioid Overdose

Anyone taking a prescription opioid is at risk for an overdose, whether unintentional or not. If you have opioids in your home (like fentanyl, hydrocodone, morphine, or codeine), there are things you can do to keep loved ones safe:

The Challenge Posed by New Synthetic Opioids: Pharmacology and Toxicology

Recently, NSOs have been involved in a significant spike of acute intoxications (classic opioid toxidrome) and overdose deaths in North America, challenging healthcare professionals, law enforcement agencies fighting against their diffusion, and policymakers trying to restrain their use

The ToxIC NOSE (Novel Opioid and Stimulant Exposure)

Although maternal MAT therapy is low risk to breast feeding children, opioid toxicity in young children occurs easily via other methods. Notably, exploratory ingestions of improperly secured medications and intentional administration of opioids by caregivers does occur.

Tramadol revisited

If the patient has an opioid toxidrome, treatment with naloxone is indicated. For agitation, tremulousness, and/or seizures, benzodiazepines are the first line therapy. Although there are conflicting reports on naloxone to treat seizures or naloxone causing seizures after tramadol ingestion, it is important to remember that mechanistically, naloxone does not have any antiepileptic properties.

Treat and Release After Naloxone Following Opiate Overdose

The bulk of this data supports the “treat and release” strategy adopted by many EMS systems, with the caveat that such a strategy be employed in select patients who have returned to baseline with stable vital signs and are capable of understanding the risks associated with discharge in the field.