Opioid intoxication happens when a patient takes too many opioids at once. It could be accidental or on purpose, but it’s always dangerous. If not handled correctly, it could lead to fatal drug overdoses.
Opioids are prescribed to manage cases of severe pain, but they must be used with extreme care to avoid complications that may arise because of them.
So what exactly are opioids? And how does the intoxication happen? What are the signs and symptoms, and how to handle and prevent it?
What Are Opioids?
Opioids are a class of drugs that doctors sometimes prescribe as pain relievers after severe injury, illness, or surgery. These drugs work by disrupting the pain receptors in the brain.
They attach to the opioid receptors in the brain and the body, reducing the effect of pain and producing a sensation of happiness or euphoria.
Not all opioids are legally obtained. A synthetic opioid like heroin is always obtained through illicit means and isn’t used medicinally.
Other synthetic opioids, like fentanyl, have medicinal purposes, but can also be illegally obtained.
Unfortunately, both prescription and street opioids are often abused, which leads to addiction, intoxication, and potential drug overdose deaths.
What Is Opioid Intoxication?
Opioid intoxication is a state where the individual is under the influence of a high dose of opioids. This commonly happens with drug abuse, but it can still occur with prescription medications in the following cases:
- The patient used too much of the drug by accident, which is common when patients forget whether they’ve taken a dose.
- The doctor prescribed an opioid to a patient without knowing that they were already on another opioid.
- The doctor prescribed a muscle relaxant or a sedative in addition to an already existing opioid treatment.
- The patient has a liver or a kidney problem that the doctor doesn’t know about, which can reduce drug elimination from the body.
Opioid Intoxication Symptoms
Whether the patient is intentionally or accidentally abusing an opioid, they will show the following symptoms of substance use:
1. Altered Mental State
Because opioids bind to opioid receptors in the brain, an overdose of the medication will activate too many receptors, which slow down the transmission of signals in the brain and impair cognitive function. Eventually, it’ll depress the central nervous system.
The patient then displays signs of distress like confusion, decreased awareness, and delirium.
2. Nausea and/or Vomiting
Drug overdoses will irritate the stomach lining, which disrupts the normal gastrointestinal motility, which is the natural movement of food in the digestive system.
If this irritation occurs, the patient might feel like they want to throw up.
Excessive vomiting can be especially dangerous because of the loss of fluid and electrolytes from the body.
3. Drowsiness or Sleepiness
The continuous intoxication and CNS depression makes the patient feel that they lack energy. It might then be followed by loss of consciousness.
Opioid-induced fainting and vomiting can be a fatal mix. If the patient passes out and vomits while sleeping, they may inhale the vomit into their lungs, causing suffocation.
4. Breathing Issues
Breathing belongs to the category of “automatic functions,” which are controlled and regulated by the autonomic nervous system.
Opioids have a marked effect on the brain stem, which is responsible for controlling said automatic function. As such, the patient might have a disruption and slowing down in these natural processes, like heart rate and breathing, which can lead to death.
5. Small Pupils
The small or constricted pupils (or miosis) are a classic sign of opioid intoxication that helps the police and doctors identify the condition.
Miosis occurs because the opioids affect the muscles that control the pupils, causing their contraction.
Is Opioid Intoxication the Same as Addiction?
It’s important not to mix between opioid intoxication and opioid addiction (opioid use disorder). The latter happens when the patient can’t stop using opioids for a long period of time because they’re addicted to the euphoric feeling they produce.
Opioid use disorder happens when opioid intoxication is left unchecked for enough time to create dependence. Patients addicted to opioids experience some of the following signs:
These signs include:
- Sudden weight loss or gain
- Slurred speech
- Poor coordination
- Change in sleep patterns
These signs include:
- Obsessing over opioids
- Isolation from friends and family
- Lying or stealing to get opioids
- Neglecting work, school, or social obligations
These signs include:
- Opioid cravings
- Anxiety and depression
- Paranoia and/or hallucinations
- Mood swings
How to Treat Opioid Intoxication?
The treatment of opioid intoxication will depend on the severity of the condition. Typically, a patient will experience mild, moderate, or severe symptoms.
Treating Mild Opioid Intoxication
A patient with mild symptoms like small pupils, confusion, and drowsiness mostly won’t need professional intervention or hospitalization.
However, monitoring such patients is a must to prevent them from harming themselves or anyone else around them.
Remove Any Hazards
Make the environment around the patient safe by removing any potential hazards or sharp objects. Do your best to be discreet while removing dangerous objects, as the patient may take it too personally and get aggravated.
Remember that they’re not in their normal state, and they won’t have logical reactions nor understand that you’re trying to help.
Keep The Patient Awake
Engaging in a simple conversation with the patient is recommended. This will force their cognitive functions to snap into action, which can help inhibit the opioid effects on their nervous system.
Don’t make any loud noises or move excessively to avoid agitating or scaring the patient.
Monitor Their Vital Signs
While talking to the patient, keep an eye out for the movement of their limbs, their breathing, and any other signs of distress.
If the patient’s physical condition worsens, you must seek medical assistance immediately.
Treating Moderate Opioid Intoxication
It’s not easy to identify whether the patient is in a mild or moderate opioid intoxication as the symptoms of both conditions can overlap.
The patient might exhibit the same symptoms as mild intoxication, but the severity of those symptoms will be considerably higher. As such, you should begin by assessing the condition.
Communicate With the Patient
You need to figure out whether the intoxicated person is alert. To do that, start by asking them simple questions that don’t require a lot of focus to answer, like what’s your name, how old are you, what day is it…etc.
Notice how the patient responds to your questions. The patient may respond with difficulty but give correct answers, which is a good sign. If the patient is alert enough, ask them what they feel, which could give you an insight into their condition.
If the patient’s response is a mix of slurs and unidentified speech, that’s your cue to call 911.
Look for Any Visible Damage
Most sensory functions are disrupted when the patient is intoxicated with opioids. The patient may be hurt, injured, or bleeding.
That said, they may not be aware of it because of the analgesic effect of opioids. If you find any injuries, you should immediately call for medical help.
Keep the Patient Calm
The condition of the patient might be shocking, especially if they’re someone you care about. If that’s the case, you should refrain from showing signs of distress, as this could quickly deteriorate the patient’s mental and physical condition.
Instead, calmly handle the patient and call 911. If you can have someone else who’s not immediately close to the patient call 911, that’ll give you even more control of the situation.
Treating Severe Opioid Intoxication
Severe intoxication is when the risk is at its highest. You’ll immediately notice how the patient is in great distress. They may have difficulty breathing, standing up, and keeping their balance even while sitting down.
Besides calling for help, you should be prepared to administer naloxone.
Naloxone is a drug used to reverse the effects of opioid overdose or at least slow them down. It’s a safe medication that doesn’t require someone experienced to handle it. It can be used by first responders, law enforcement, and family members. It’s available as a nasal spray or in injectable form.
A person who has an opioid prescription should keep naloxone on their person at all times. It’s also recommended for family members to practice administering the drug to prepare for emergency situations like an overdose.
If the Patient Is Awake
Even with severe physical symptoms, having the patient awake and alert before you is a good sign. If that’s the case, call 911 and have them come over.
While you wait, administer nasal naloxone in both nostrils of the patient. This should calm down the symptoms within a minute or two until help arrives.
If the Patient Is Unresponsive
If the patient is unresponsive, you should quickly assess the situation. First, look for any objects around the patient that may harm the patient if they react impulsively.
Look for signs of vomiting and clear the patient’s throat if they have indeed vomited. Put the patient on their side to reduce the risk of inhaling any vomit.
You can still use naloxone nasal spray even if the patient is unconscious, but an injection is better suited for the situation.
If you have access to a naloxone auto-injector, it’ll be of great help to the patient. And if you can give injections and have access to naloxone vials, you may aspirate and inject as well.
The injection site is typically the thigh or upper arm.
Note: If the patient is unconscious and you’re not sure if it’s a suspected opioid overdose or not, go ahead and administer naloxone. It’s safe to use even if the patient isn’t overdosing on opioids.
If the Patient Remains Unresponsive
If the patient doesn’t respond after 2-3 minutes of administering naloxone, you may need another dose.
Wait for 2-3 additional minutes. If there’s still no response and the patient’s breathing is severely impaired, you should start CPR while you wait for help.
In any case, you should immediately call 911 after you administer naloxone because its effect is limited to 30–40 minutes after administration. Then, the patient might get back to overdosing.
How to Prevent Opioid Intoxication?
As you may have concluded, opioid intoxication can be fatal, and it’s not to be taken lightly. To prevent that from happening, the following steps can help:
Education and Awareness
Spreading awareness among people makes them less likely to overdose on opioids, especially if they understand how dangerous these drugs can be.
More knowledgeable first responders handle the situation better than those who come in contact with an opioid-intoxicated person for the first time. So raising awareness among regular people about the correct protocol to follow during an opioid overdose can save lives.
Adequate Doctor-Patient Communication
Most doctors write prescription opioids in the best interests of their patients, and many patients are well aware of the dangers of such medications and might never abuse them.
However, the problem comes from miscommunication. For example, if the patient is already on an opioid and gets prescribed another opioid, this will lead to accidental intoxication. That’s why history-taking is a crucial step in any medical setting.
Having Naloxone in the First Aid Kit
By having naloxone readily available, you’ll have the ability to stabilize a sudden opioid intoxication at home while you wait for help.
Handling opioid abuse can be challenging, especially if you don’t know what to do or expect. That said, a lot of danger can be averted by using a naloxone nasal spray or injecting it into the patient’s thigh or arm.
Understanding the symptoms and risk factors of opioid intoxication is of paramount importance. With this knowledge, you can recognize the mental and behavioral symptoms before they progress to become fatal.