scholarly journals Opioid Toxicity

2017 ◽  
Vol 7 (1) ◽  
pp. 19-35 ◽  
Author(s):  
David Dolinak
Keyword(s):  
Lung Disease ◽  
Pulmonary Edema ◽  
Respiratory Depression ◽  
Social History ◽  
Toxic Effects ◽  
Opioid Use ◽  
Other Substances ◽  
Drug Paraphernalia ◽  
Scene Investigation ◽  
Needle Track

In recent years, there has been a substantial increase in opioid use and abuse, and in opioid-related fatal overdoses. The increase in opioid use has resulted at least in part from individuals transitioning from prescribed opioids to heroin and fentanyl, which can cause significant respiratory depression that can progress to apnea and death. Heroin and fentanyl may be used individually, together, or in combination with other substances such as ethanol, benzodiazepines, or other drugs that can have additional deleterious effects on respiration. Suspicion that a death is drug-related begins with the decedent's medical and social history, and scene investigation, where drugs and drug paraphernalia may be encountered, and examination of the decedent, which may reveal needle punctures and needle track marks. At autopsy, the most significant internal finding that is reflective of opioid toxicity is pulmonary edema and congestion, and frothy watery fluid is often present in the airways. Various medical ailments such as heart and lung disease and obesity may limit an individual's physiologic reserve, rendering them more susceptible to the toxic effects of opioids and other drugs. Although many opioids will be detected on routine toxicology testing, more specialized testing may be warranted for opioid analogs, or other uncommon, synthetic, or semisynthetic drugs.

scholarly journals Opioid Use and the Risk of Respiratory Depression and Death in the Pediatric Population

2013 ◽  
Vol 18 (4) ◽  
pp. 269-276 ◽  
Author(s):  
Marianne R. Whittaker
Keyword(s):  
Clinical Trials ◽  
Adverse Effects ◽  
Respiratory Depression ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Opioid Use ◽  
Randomized Controlled ◽  
Randomized Controlled Studies ◽  
Increased Risk ◽  
Significant Difference

BACKGROUND Pediatric patients may be at an increased risk of adverse effects from various medications. Recently, there have been a number of serious adverse events, including several pediatric patients experiencing severe respiratory depression and death as a result of the use of codeine for pain control following tonsillectomy and adenoidectomy. OBJECTIVE To assess the safety of opioid agonists in pediatric patients undergoing operative procedures or have experienced trauma and to evaluate the risk of respiratory depression and death among this population. METHODS PubMed and Medline were searched to identify randomized controlled studies from 1994 to 2012 addressing postsurgery/trauma opioid use in pediatric patients. Relative risks and confidence intervals (CIs) were calculated using data available in clinical trials. RESULTS A total of 16 clinical trials were evaluated for this review. Randomized controlled trials included studies comparing opioids versus non-opioids for a variety of painful conditions. The relative risk of respiratory depression associated with opioid use in 1 trial was 1.63 (95% CI: 0.64–6.13). The remaining 15 trials reviewed described no significant difference in respiratory depression or adverse effects associated with treatment. No deaths were attributed to opioid use in any of these studies. CONCLUSION Opioid-associated respiratory depression was very rare and no deaths were reported in the reviewed studies. These findings under the well-defined conditions of controlled studies may not be the best means of determining overall opioid-associated side effects in pediatric patients.

Accidental Methadone Intoxication in a Child

PEDIATRICS ◽  
1971 ◽  
Vol 48 (2) ◽  
pp. 294-296
Author(s):  
Mark J. Sey ◽  
David Rubenstein ◽  
David S. Smith
Keyword(s):  
Pulmonary Edema ◽  
Respiratory Depression ◽  
First Time

A child with severe accidental methadone intoxication is presented. The symptoms are discussed with particular reference to respiratory depression. The phenomenon of transient pulmonary edema secondary to this intoxication is described, we believe, for the first time in a child.

Obstructive Lung Diseases

2016 ◽  
pp. 741-746
Author(s):  
Vivek N. Iyer
Keyword(s):  
Differential Diagnosis ◽  
Interstitial Lung Disease ◽  
General Population ◽  
Lung Disease ◽  
Pulmonary Edema ◽  
Lung Diseases ◽  
Lung Parenchyma ◽  
Obstructive Lung Diseases ◽  
Lung Malignancies

An estimated 1 in 3,000 to 1 in 4,000 persons in the general population have a diagnosis of interstitial lung disease (ILD), and ILDs account for about 15% of all consultations for general pulmonologists. These diseases encompass a group of heterogeneous lung conditions characterized by diffuse involvement of the lung parenchyma and pulmonary interstitium. By convention, infections, pulmonary edema, lung malignancies, and emphysema are excluded, but they should be carefully considered as part of the differential diagnosis.

scholarly journals Polysubstance use in the U.S. opioid crisis

2020 ◽  
Author(s):  
Wilson M. Compton ◽  
Rita J. Valentino ◽  
Robert L. DuPont
Keyword(s):  
Opioid Use ◽  
Treatment Interventions ◽  
Opioid Crisis ◽  
Polysubstance Use ◽  
Maximum Benefit ◽  
Internal States ◽  
Other Substances ◽  
Substance Consumption ◽  
Opioid Users ◽  
The U.S

AbstractInterventions to address the U.S. opioid crisis primarily target opioid use, misuse, and addiction, but because the opioid crisis includes multiple substances, the opioid specificity of interventions may limit their ability to address the broader problem of polysubstance use. Overlap of opioids with other substances ranges from shifts among the substances used across the lifespan to simultaneous co-use of substances that span similar and disparate pharmacological categories. Evidence suggests that nonmedical opioid users quite commonly use other drugs, and this polysubstance use contributes to increasing morbidity and mortality. Reasons for adding other substances to opioids include enhancement of the high (additive or synergistic reward), compensation for undesired effects of one drug by taking another, compensation for negative internal states, or a common predisposition that is related to all substance consumption. But consumption of multiple substances may itself have unique effects. To achieve the maximum benefit, addressing the overlap of opioids with multiple other substances is needed across the spectrum of prevention and treatment interventions, overdose reversal, public health surveillance, and research. By addressing the multiple patterns of consumption and the reasons that people mix opioids with other substances, interventions and research may be enhanced.

Management of opioid poisoning

2016 ◽  
Author(s):  
Alison L. Jones
Keyword(s):  
Respiratory Depression ◽  
Opioid Antagonist ◽  
Arterial Oxygen ◽  
Opioid Use ◽  
Analgesic Tolerance ◽  
Medication Misuse ◽  
Acute Withdrawal ◽  
Close Observation ◽  
The Central Nervous System ◽  
Long Acting

Opioids are ‘morphine like’ substances that have actions at specific opioid receptors (especially µ receptors) in the central nervous system (CNS). Tolerance of respiratory depression develops at a slower rate than analgesic tolerance, placing patients with a long history of opioid use at particular risk for respiratory depression. If chronic users abruptly stop taking opioids, they develop an acute withdrawal syndrome. Most opioid toxicity is the result of inadvertent overdosage during recreational use or in self-harm, but it can also be due to medication misuse and drug errors. It is characterized by three main clinical features (all may not be consistently present); depressed respiratory rate (the sine qua non of opioid poisoning) and respiratory volume, and reduced arterial oxygen desaturation, CNS depression, and small or pin-point pupils. Opioid-poisoned patients require early clinical assessment, appropriate administration of intravenous naloxone (competitive opioid antagonist) and meticulous respiratory supportive care, with close observation. Because of the longer half-life of opioids than naloxone, repeated doses may be needed for long-acting opioids or large doses of shorter acting opioids. If opioid antagonists are given to regular opioid users in excess, they can precipitate acute withdrawal symptoms. The need for ITU admission usually occurs as a result of a complication of the opioid toxicity.

Solvent Abuse from a Health Education Perspective

1982 ◽  
Vol 1 (3) ◽  
pp. 331-336 ◽  
Author(s):  
Jasper Woodcock
Keyword(s):  
Health Education ◽  
Illicit Drugs ◽  
Toxic Effects ◽  
Preventive Strategies ◽  
Different Types ◽  
Other Substances ◽  
The Usa ◽  
Solvent Abuse ◽  
Types Of Information ◽  
Overall Mortality

1 The development of health education and preventive strategies for solvent abuse requires the adaptation of findings and data from other fields and other countries. Experience with illicit drugs suggests that simply denying access to a particularly abused substance may only serve to shift abusers towards other substances. It is, therefore, necessary to acquire evidence on which to judge the relative harmfulness of different substances. Data from the USA on the overall mortality from solvent abuse and on the relative involvement of different solvents is summarized. 2 Findings from health education researches lead to the conclusion that (a) health education is not an effective way of preventing experimentation with solvents, but (b) health education can be effective in modifying abusers' choices of substance and styles of use. 3 Combining these different types of information led to the production of a leaflet suggesting health education strategies that might reduce the likelihood of physical harm befalling solvent abusers. 4 Finally, a plea is made for reports of toxic effects from abused substances to include the kind of data that would assist the development of preventive strategies.

scholarly journals Pharmacologic and Clinical Considerations of Nalmefene, a Long Duration Opioid Antagonist, in Opioid Overdose

2021 ◽  
Vol 2 (4) ◽  
pp. 365-378
Author(s):  
Amber N. Edinoff ◽  
Catherine A. Nix ◽  
Tanner D. Reed ◽  
Elizabeth M. Bozner ◽  
Mark R. Alvarez ◽  
...  
Keyword(s):  
Respiratory Depression ◽  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Antagonist ◽  
Opioid Overdose ◽  
Opioid Use ◽  
Physical Damage ◽  
Onset Of Action ◽  
Duration Of Action ◽  
Opioid Intoxication

Opioid use disorder is a well-established and growing problem in the United States. It is responsible for both psychosocial and physical damage to the affected individuals with a significant mortality rate. Given both the medical and non-medical consequences of this epidemic, it is important to understand the current treatments and approaches to opioid use disorder and acute opioid overdose. Naloxone is a competitive mu-opioid receptor antagonist that is used for the reversal of opioid intoxication. When given intravenously, naloxone has an onset of action of approximately 2 min with a duration of action of 60–90 min. Related to its empirical dosing and short duration of action, frequent monitoring of the patient is required so that the effects of opioid toxicity, namely respiratory depression, do not return to wreak havoc. Nalmefene is a pure opioid antagonist structurally similar to naltrexone that can serve as an alternative antidote for reversing respiratory depression associated with acute opioid overdose. Nalmefene is also known as 6-methylene naltrexone. Its main features of interest are its prolonged duration of action that surpasses most opioids and its ability to serve as an antidote for acute opioid overdose. This can be pivotal in reducing healthcare costs, increasing patient satisfaction, and redistributing the time that healthcare staff spend monitoring opioid overdose patients given naloxone.

Sign in / Sign up

Export Citation Format

Share Document