How to Recognise Opioid Overdose?

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Do you know what the most common reason for patients seeking medical care is? The answer is “Pain.” For the last two decades, people have resorted to opiates to relieve any kind of pain. Opioids had initially been approved as analgesics and people assumed it is safe to consume. However, lately, medical teams have realised that it is addictive and has high chances of overdose because, in the last two decades, cases of opioid overdose have been on the rise. Many reports have raised concern for people’s health in terms of prescribing opiates.  

An opioid overdose occurs if a person has taken an excessive dose of opioids within a very short time span. Opioids include many drugs such as morphine, fentanyl, methadone, heroin, tramadol, oxycodone, codeine, and oxymorphone. In 2015 there were 122,000 deaths on a global level due to opioid use disorders and it was way higher than in 1990 (18,000 deaths). 

To help you understand more about addiction, the following topics are discussed in this blog.

Table of Content

• Signs & Symptoms of Opioid Overdose
• Risk Factors for Opioid Overdose
• Diagnosis of Opioid Overdose
• What to Do if You Think Someone Is Overdosing Opioid?
• Prevention of Opioid Overdose
• What Is the Connection between Naloxone and Opioid Treatment

Signs & Symptoms of Opioid Overdose

Originally opioids were used in the treatment of pain but people often sold it illicitly to use it for euphoric effects. When a person has consumed a dose higher  than their tolerability it results in an overdose and creates CNS and respiratory problems if not treated on time.

The typical overdose signs include — 

• Pinpoint pupils
• Low consciousness 
• Feels clammy to touch
• Pale face
• Respiratory depression
• Unable to speak properly
• Hypothermia
• Heartbeat slows
• Gurgling noises or vomiting
• Body goes limp
• Seizures or muscle spasms

One popular  way of identifying opioid overdose with a combination of only three main signs & symptoms are referred to as the “opioid overdose triad.” The triad includes these three symptoms — 

• Pinpoint pupils
• Respiratory depression
• Unconsciousness 

The  risk of respiratory depression increases when  opioids are combined with alcohol or other sedative medications. Across the world, opioids are a leading cause  for the high proportion of fatal drug overdose.  

[Read more — Heroin Overdose]

Risk Factors for Opioid Overdose

Most opioids get metabolised by the first-pass effect in which metabolisation is done by the liver before the drug is excreted in the urine. This biotransformation of opioids by the liver may either inactivate or activate the drug. 

 A study showed that a person’s metabolisation also plays a vital role in opioid overdose. The strength of the analgesic effect that an opioid has depends on the metabolising capacity of the person. 

Vulnerable population for opioid overdose declared by WHO includes — 

• Male gender
• Older age
• Mental health conditions 
• Individual with opioid dependence 
• A person who uses prescribed opioids in high dose
• Medical conditions such as lung disease, HIV, liver problems, depression
• Lower socioeconomic status
• Combining opioids with other sedating drugs

What increases the risk factors of opioid poisoning occurrence in a person?

• Consumption of any illicit opioid drug  
• Accidentally taking an extra dose of a prescribed opioid drug or consumption without medical supervision. 
• Consumption of opioid with alcohol or any other substances. 
• Consumption of opioid while on any anxiety medications, such as Benzodiazepine (Xanax or valium).
• Taking opioids without a prescription or using  someone else’s prescription 

Opioid poisoning can be fatal and it may require immediate emergency medical attention. So, recognising opioid overdose is crucial for people to save their own or a loved one’s life. The outlook of opioid overdose is based on the severity of the poisoning. Mild cases can be more easily treatable in comparison to severe cases. It may require a longer hospital visit. 

However, it is possible for you or anyone who needs to be pulled out from opioid overdose to continue a healthy life again. People may require therapies or long-term treatment, but treatment is possible for everyone.

[You may also like — Alcohol Overdose]

Diagnosis of Opioid Overdose

Opioids act as a potent agonist to the nu receptor and in result dopamine is released, all pain signals are blocked, and it gives a euphoric sensation. In the human body, there are three opioid receptors which are located in the gut, brain, and spinal cord. While overdosing it excessively affects the part of the brain regulating respiration rate and it results in respiratory blockage and eventually in fatal conditions. 

Opioid poisoning can be understood and diagnosed with three steps; first, opioid overdose may have life-threatening toxic effects in the person’s body or may severely affect many organs. Second, disrupted pharmacokinetic properties may prolong overdose intoxication dramatically. Third, depends on the drug formulation which is taken by the person.

According to The New England Journal of Medicine, This image gives a timeline from — therapeutic dosing to the overdose of selected opioid analgesic agents.

Physical Examination

In terms of physical examination, the doctor evaluates the patient’s pupil size and reactivity of the pupil as well. They may check the degree of respiratory efforts. Patients would also undergo a thorough check-up of fentanyl patches on their body. 

If a patient shows the symptoms of apnea, stupor, or miosis, then the medical diagnosis of an opioid overdose is assured although miosis is not universally present in every opioid overdose’ patient. Medical staff may look into the patient’s signs, and medical history, along with other kinds of physical examination such as drowsiness, euphoria, or fresh needle marks.

Some additional diagnosis can also take place for palpate muscle groups including — swelling, tenderness, and firmness. Breathing rate tests can also be done because breathing gets shallow due to opioid overdose. Some patients may show symptoms of dyspnea, or wheezing since opiates are able to cause bronchoconstriction. 

At last, the medical team would take acetaminophen concentration measurements in the patients’ body. 

Psychiatric Examination

Anxiety, Dysphoria, Paranoia, Hallucinations, Depression, Agitation, Nightmares. 

Laboratory Examinations

Popularly, opioid testing looks for the presence of opioids in urine, blood, or saliva. During opiate toxicity following laboratory tests may get performed:

• Creatine Kinase Level
• Complete Blood Cell Count
• Arterial Blood Gas Determinations
• Comprehensive Metabolic Panel 

What To Do if You Think Someone Is Overdosing Opioid?

Remember that treating an opioid overdose at home is not a replacement for a medical assistance. Even if you think the patient is doing fine after a while, there could be some internal problems, so don’t take risks. 

You can follow these steps if you witness an opioid overdose — 

1. Call 102 (Emergency Ambulance Number in India)

If you suspect or witness any opioid overdose with your loved ones or others, and find them unresponsive then immediately call for an ambulance. So that they can receive medical assistance as soon as possible. Don’t leave that person alone till the ambulance doesn’t  arrive. 

2. Put Them in the Recovery Position

After calling an ambulance put them in the recovery position — lay them on their side, cross their top leg over the body and put their bottom arm under their head, so that they don’t vomit out. Check if they are breathing or not. 

3. Comfort and Support 

If the person is conscious but not able to breathe properly then help them sit comfortably until paramedical assistance arrives at the location. If you find the person confused then support them and try to comfort them. Do not allow them to take any more drugs if they’re trying to. 

You may get scared with an overdose but remember that overdose can be treated and it is not fatal  if treated on time. Life can be normal again after an overdose treatment so don’t avoid medical assistance during opioid overdose even if it is not chronic because, in the long run, it can be chronic and fatal. 

Prevention of Opioid Overdose

Can someone prevent an opioid overdose? Yes, it can be prevented with few precautions. Here are a few points which you can follow to prevent opioid overdose — 

• Don’t increase the dependency on prescribed opioids for pain relief
• Take medicines carefully and exactly at what dose it is prescribed without taking even one extra dose
• Never mix medicines with illicit substances such as alcohol or sleeping pills
• Store medicines away from the person who can misuse it 
• Do not take the medicine frequently, only take it as prescribed by the health advisor
• Dispose off the unused medicines and medicines which don’t have a clear expiry date

Educate your family and friends as well, about the negative effects of opioids, so that they do not take extra doses of it.

What Is the Connection between Naloxone and Opioid Treatment

Naloxone has a great connection with opioid treatment as anyone can save a life with naloxone. Naloxone is a life-saving drug, and if someone sprayed it into the nose of a person who is suffering from an opioid overdose — they could be safe by a quick reverse of an opioid overdose. 

Every patient who is suffering from an opioid overdose — needs naloxone. Anyone can buy it from a pharmacist, it is a prescription drug but in emergency cases it can be bought without a prescription in some places. This step in every country is making a big difference in opioid overdose treatment. However, it is not a permanent treatment of opioid overdose; it can only provide temporary relief to a patient. If a person has an overdose and gets naloxone injection they will be able to wake up within three minutes and it becomes possible for them to reach the hospital for medical assistance. But they need to have proper medical treatment after reaching the hospital.

Naloxone acts as an antagonist of opiate receptors and blocks any agonistic activity. It can be administered in patients in various ways such as intramuscular, intravenous, or subcutaneous. FDA has approved the intranasal formula of naloxone as well to make it more comfortable to use. 

A person can administer a naloxone dose every 3 minutes to make a patient completely awake. However, once the patient is awake, discontinue providing naloxone and help them get medical assistance as soon as possible. In case of an overdose of methadone, nalbuphine, or diphenoxylate; higher doses of naloxone may be required to bring the patient to consciousness. 

A few important points to remember about naloxone — 

• People can find naloxone at any near-by pharmacies without a prescription.
• It only helps in reversing an opioid overdose.
• It is a safe drug and doesn’t have any major side-effects in patients.
• A person needs to have medical treatment once they’re awake after several naloxone doses.
• Naloxone works for 30 to 90 minutes so there are possibilities that patient may show shallow breathing after naloxone effects wear off
• High addictive opiates may require repetitive doses of naloxone to restore a patient’s breathing
• Store it in room temperature 
• People could have it in their first-aid if they used opioids 

Getting on the journey of opioid overdose recovery may seem scary, but it is always possible. Take opioid medicines carefully with the particular prescribed amount as it is used to treat certain kinds of pain. Also, speak to your health advisor about naloxone if you or your loved ones were addicted to opioids earlier and now you’re prescribed opioid again. You can have naloxone handy if you think any of your close ones use opioids or may misuse it. Encourage your loved ones to go for treatment and choose the path to recovery and to a better life. 

Sources 

https://www.who.int/substance_abuse/information-sheet/en/

https://www.nejm.org/doi/pdf/10.1056/NEJMra1202561

https://www.healthline.com/health/opioid-intoxication#treatment

https://www.fda.gov/consumers/consumer-updates/having-naloxone-hand-can-save-life-during-opioid-overdose

https://www.msdmanuals.com/professional/special-subjects/recreational-drugs-and-intoxicants/opioid-toxicity-and-withdrawal