Opioid intoxication

Introduction
• Illicit of opioid drug
• Misuse medical prescription
• Iatrogenic
 Epidemiologi
The drug abuse warning network(DAWN) reported that the
number of emergency department visits related to non medical
use precribed opioid significantly increased 111% between
2004 and 2008.
The highest number of visits were recorded for oxycodone,
hydrocodone and methadone
Second place is cocain and heroin were involved in 1 million ED
visits in both 2004 and 2008
Type of Opioid
Thirth place is prescription or over the counter
drugs used on-medically were involved in 0,5
million visits in 2004 and 1 million in 2008
Doctor shopping related young people mortality
who died of overdose who misuse presciption
drug such as benzodiazepin and opioid. The
prevalence of mortality increased drastically in
US between 1999 and 2006
 Mechanism of action
Opioid drugs act by binding to certain receptors in the
brain which lead to specific action based on type of
receptor involved.
There are 4 types of opioid receptor
1. µ-receptor  µ receptor activate the mesocorticolimbic
dopaminergic system  highes addictive potential
2. Ƙ-receptor
3. δ-receptor
4. Nociceptin/ Orphanin
The opioid receptor are also binding with endogenous
peptide which play an important role in modulating
the respose to pain, regulation of body temperature,
respiration, mood, endocrine and gastrointestinal
activity and other function.
Sign and symptoms of intoxication
Cardinal sign Other cardinal sign
Level of unconsciousness • Pinpoint pupils
• Drowsines/somnolen • Depressed respiratory
• Stuporous rate
• coma • Cyanosis
• Hypotension
• Bradycardi
• hypothermia
 Sign and symptoms of withdrawal
Objective sign Subjective sign
• Vomitting
• Dysporic mood
• Lacrimation
• Rhinorrhea
• Insomnia
• Pupillary dilatation • Muscle aches and
• Piloerection cramp
• Sweating • Abdominal pain and
• Diarrhea colic
• Yawning
• Fever
• Elevate ulse and bood pressure
 Diagnosis
• Laboratory test can identify
 blood  3-12 hours
 Urine  1-3 days
inexpensive
 Hair  7-90 days
 Saliva  3-24 hours
• Gas chromatography  immunoassays is
more expensive
 Treatment
• Naloxon is the standard treatment for opioid
overdose
Naloxon  IV/SC/IM whit starting dose is
ussualy 0,4 mg
long acting opioids such as methadone may need a
longer period of observation Response to initial doses
of naloxone also plays an important factor in
determining the duration of observation and the need
for an inpatient admission
Naloxone injection may induce opioid withdrawal
which may require treatment post overdose.
Opioid withdrawal is usually not life threatening but
may trigger opioid use and relapse. Ambulatory.
opioid detoxifcation is the standard treatment for
opioid withdrawal
 Reference
• A. Fareed, S. Stout, J. Casarella, S. vayalapalli, J. Cox and K.
Drexler. 2011. Illicit Opioid Intoxication: Diagnosis and
Treatment Research and Treatment 2011:5 17–25. Libertas
Academica Ltd. USA.