Opioid Intoxication

Opioid intoxication can have several signs and symptoms that can affect a person’s physical and mental state. Identifying the potential signs early can aid in seeking timely medical help. Below are some commonly observed symptoms of opioid intoxication:

• Respiratory depression: Shallow or slow breathing or breathing that stops entirely after opioid use 
• Drowsiness: Excessive sleepiness or difficulty staying awake
• Constricted pupils: Unusually small pupils, also known as "pinpoint" or "miotic" pupils
• Confusion: Difficulty with concentration, memory, and decision-making
• Slurred speech: A slower mental performance that can lead to difficulty speaking
• Weakness or limp body: Loss of physical strength, which causes difficulty or inability to move
• Cold and clammy skin: Skin that is cool and sweaty to the touch
• Blue or purple color to the lips and fingernails: Blue or purple skin caused by a lack of oxygen in the body, which can be a sign of a serious overdose
• Slow heart rate: Decreased circulation and oxygen delivery to the body's tissues and organs, causing a slowed heart rate 
• Loss of consciousness or unresponsiveness: A serious condition that urgently requires medical attention

Symptoms may vary in severity depending on various factors, such as the type of opioid consumed, the dosage taken, and the individual's tolerance. Some people may experience mild symptoms, while others might have multiple severe symptoms.

Opioid intoxication can be life-threatening if not promptly treated. If a person is experiencing opioid intoxication, especially if they're struggling to breathe or losing consciousness, call for emergency medical assistance immediately.

There are several common causes and risk factors that may lead to opioid intoxication. Three of the key common causes of opioid intoxication are misuse of prescription opioids, use of illegal opioids, and accidental ingestion.

Prescription misuse

In some cases, opioid intoxication can result when a person takes prescription opioids in higher doses than prescribed or for an unintended purpose. This misuse may be accidental or deliberate. In both cases, misuse increases the risk of experiencing harmful side effects or a potentially fatal overdose.

Recreational use

Some individuals may use illicit opioids to achieve the euphoric sensation or "high" that opioids can provide. This behavior can significantly increase the risk of addiction and the risk of experiencing an overdose.

Tolerance and dependence

Some people who use opioids may develop a tolerance to the effects of the drugs, which can lead to an increased desire for higher doses to achieve the same level of relief or high. A tolerance can quickly progress to physical dependence, which may increase the risk of opioid intoxication.

Accidental ingestion

Particularly in homes with children, accidental ingestion of opioids can occur if opioid medications are not properly stored or secured. Children may not understand the dangers associated with these medications, which may elevate the risk. 

Risk factors 

Although opioid intoxication can affect anyone, certain factors may increase an individual's risk:

• A history of substance use or addiction
• Mental health disorders, such as depression or anxiety
• Chronic pain conditions that require long-term opioid therapy
• Access to opioids, either through a prescription or illicit sources
• A family history of addiction or substance abuse
• Age—Opioid intoxication is more common among young adults and middle-aged individuals

The treatment chosen for opioid intoxication can vary depending on the severity of the symptoms. Often, treatment involves the use of medication and supportive options. Therapy and self-care strategies may also help individuals prevent opioid intoxication or manage the long-term effects after an overdose. The main goal of treatment is often to reverse the effects of opioids on the body and prevent potentially fatal complications.

Medication

The primary medication used to treat opioid intoxication is naloxone, a fast-acting opioid antagonist that can reverse the effects of opioids in the body. Naloxone can be given as an intravenous (IV), intramuscular (IM), and subcutaneous (under the skin) injection, as well as a nasal spray. It works by binding to the same receptors in the brain that opioids target and blocking their effects. 

After attaching to the opioid receptors, naloxone may restore normal breathing and consciousness in people experiencing an opioid overdose. Because of naloxone’s rapid effects, many law enforcement agencies are training officers to use it in emergency situations. However, naloxone's effects are temporary, and repeated doses may sometimes be necessary.

In addition to naloxone, other medications may be used to help manage symptoms associated with opioid intoxication, including:

• Benzodiazepines for anxiety, agitation, or seizures
• Antiemetics for nausea and vomiting

Consult a medical doctor before starting, changing, or stopping a medication for any condition. The information in this article is not a replacement for medical advice or diagnosis. 

Other treatment options

Depending on the severity of the intoxication and the presence of coexisting medical conditions, other treatment options may be considered. Activated charcoal may be given in cases where the patient has ingested a large amount of opioids, as it may prevent further absorption of the drug in the gastrointestinal tract. However, it should be given within two or three hours of the overdose for maximum effectiveness.

One of the cornerstones of treating opioid intoxication is supportive care, which can include:

• Monitoring vital signs, such as heart rate, blood pressure, and respiratory rate
• Ensuring that the airway is clear and that the individual is receiving oxygen
• Providing intravenous fluids if the individual is dehydrated or experiencing low blood pressure
• Administering medications to treat symptoms such as nausea, vomiting, or agitation

In some cases, a person may require mechanical ventilation if they’re unable to breathe on their own due to opioid-induced respiratory depression.

Self-care

After initial treatment for opioid intoxication, an individual can take steps to manage their overall health and well-being. Self-care strategies may prevent future episodes of intoxication and support long-term recovery. Key self-care strategies include:

• Focusing on a well-balanced diet, regular exercise, and adequate sleep
• Staying connected with a supportive network of friends, family, and healthcare professionals

Several resources are available for people who have experienced opioid intoxication and are seeking support or guidance for opioid-related problems. For individuals struggling with opioid intoxication, therapy can offer an effective means of help. Online therapy platforms like BetterHelp offer professional therapists who may be experienced in helping people with opioid-related challenges.

In addition to therapy, there are various mental health organizations and support groups that may provide assistance to those affected by opioid intoxication. Some organizations cater to a broad audience, while others are more focused on specific groups of people. For instance, the Substance Abuse and Mental Health Services Administration (SAMHSA) offers a treatment finder that can be an invaluable resource for individuals seeking guidance on options for various mental health problems. Additionally, the National Institute on Drug Abuse (NIDA) provides comprehensive information on opioid intoxication, its effects, and potential treatment options.

For instance, the Substance Abuse and Mental Health Services Administration (SAMHSA), which is part of the US Department of Health and Human Services, provides resources on opioid overdose, opioid use disorder, and opioid prescribing guidelines. Through these guides, you can find information on preventing opioid overdose deaths, navigating emergency department care, and undergoing opioid use disorder treatment. SAMHSA also offers a treatment finder that can be an invaluable resource for individuals seeking guidance on evidence-based mental health care options for substance use disorders.⁴ 

The National Institute on Drug Abuse (NIDA) is the branch of the National Institutes of Health focused primary on public health concerns related to substance use. NIDA provides comprehensive information on opioid intoxication, its effects, and potential treatment options. The National Institutes of Health also provides a searchable list of current clinical trials related to various interventions for opioid addiction. 

Besides these national organizations, local support groups may also offer valuable resources and a sense of community for individuals and families living with the effects of opioids. These groups may operate independently or under the umbrella of larger organizations. 

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).

Recent studies on opioid intoxication are discovering new ways to approach treatment. A study published in 2019 examined the use of monoclonal antibodies for treating synthetic opioid intoxication. The study found that an antibody called 6A4 could decrease the effects of fentanyl and another potent opioid, carfentanil. In addition, 6A4 lasts longer in the body than naloxone and could potentially be used to prevent instances where the effects of the drug return after naloxone has worn off. 

Another study explored how opioid use might change DNA methylation, a process that controls gene activity in the brain. Scientists studied brain tissue samples from 153 individuals who had passed away, some of whom had died from opioid overdose. The researchers analyzed brain tissue samples, including one in the Netrin-1 gene, which influences opioid receptor function. They ultimately found some differences in aging within the brain based on the presence of opioids, which may indicate a link between opioids and epigenetic changes. 

Below are several key statistics on opioid intoxication:

• The number of deaths from opioid-related overdoses dramatically escalated from 21,089 in 2010 to 47,600 in 2017. Opioid overdose deaths remained consistent through 2019, then surged to 68,630 in 2020, and increased to 80,411 in 2021.
• In 2021, drug overdoses claimed the lives of 107,622 individuals in the US, averaging about 295 fatalities daily. Drug overdoses are the leading cause of death among Americans aged between 18 and 45, and opioid overdoses accounted for around 66% of all drug overdose deaths.
• The majority of preventable opioid deaths, around 71%, mainly affect individuals between 25 and 54 years old. Simultaneously, there’s a rise in deaths among those who are 55 and older, while those under 15 years old are affected the least.
• The percentage of adult emergency department (ED) visits resulting in an opioid prescription at discharge decreased from 12.2% in 2017 to 2018 to 8.1% from 2019 to 2020. This decrease may be due to increased harm reduction programs that offer safe ways to use substances and reverse overdoses.