Opioid overdose: Difference between revisions

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{{Infobox disease
| Name          = Opioid overdose
| Image          =
| Caption        =
| DiseasesDB    =
| ICD10          = {{ICD10|F|11||f|10}}.0, {{ICD10|T|40|0|t|36}}-{{ICD10|T|40|2|t|36}}
| ICD9          = {{ICD9|305.5}}, {{ICD9|965.0}}
| ICDO          =
| OMIM          =
| MedlinePlus    =
| eMedicineSubj  = emerg
| eMedicineTopic = 330
| MeshID        =
}}
An '''opioid overdose''' is an [[acute]] condition due to excessive use of [[narcotics]]. It should not be confused with [[opioid dependency]]. Prescription opioid overdose was responsible for more deaths in the United States from 1999-2008 than [[heroin]] or [[cocaine]] overdose combined.<ref name="painreview">{{cite journal|title=Caring for Patients with Chronic Pain: Pearls and Pitfalls |journal=Journal of the American Osteopathic Association |date=August 2013|last1= Debono|first1=DJ |last2=Hoeksema |first2=LJ |last3=Hobbs |first3=RD|pmid=23918913|volume=113 |issue=8 |pages=620–627|doi=10.7556/jaoa.2013.023}}</ref>
==Symptoms==
[[Toxidromes#Opiate toxidrome|Opiate overdose symptoms and signs]] include: decreased [[level of consciousness]] and pinpoint pupils.<ref>{{cite web|last=Chandler|first=Stephanie|title=Symptoms of an opiate overdose|url=http://www.livestrong.com/article/68582-symptoms-opiate-overdose/|publisher=Live Strong|accessdate=17 May 2012}}</ref>  Heart rate and breathing slow down, sometimes to a stop. Blue lips and nails are caused by insufficient oxygen in the blood. Other symptoms include seizures and muscle spasms. A person experiencing an opiate overdose usually will not wake up even if their name is called or if they are shaken vigorously.
==Prevention==
Although opioid overdose accounts for the leading cause of accidental death, it can be prevented and often in primary care settings.<ref name="Bowman S, Eiserman J, Beletsky L, Stancliff S, Bruce RD. 2013 565–71">{{cite journal|author=Bowman S, Eiserman J, Beletsky L, Stancliff S, Bruce RD.|title=Reducing the health consequences of opioid addiction in primary care|journal=Am J Med|year=2013|pmid=23664112|doi= 10.1016/j.amjmed.2012.11.031|volume=126|issue=7|pages=565–71}}In press</ref><ref name="Beletsky L, Rich JD, Walley AY. 2012 1863–1864">{{cite journal|author=Beletsky L, Rich JD, Walley AY. |title=Prevention of Fatal Opioid Overdose|journal=JAMA|year=2012|pmid=23150005|doi=10.1001/jama.2012.14205|volume=308|issue=18|pmc=3551246|pages=1863–1864}}</ref> Providers should routinely screen patients using tools such as the CADE-AID and the Drug Abuse Screening Test (DAST-10) to screen adults and the CRAFT to screen adolescents aged 14–18 years.<ref name="Bowman S, Eiserman J, Beletsky L, Stancliff S, Bruce RD. 2013 565–71"/> Other “drug seeking” behaviors as well as physical indications of drug use should be used as clues to perform formal screenings.<ref name="Bowman S, Eiserman J, Beletsky L, Stancliff S, Bruce RD. 2013 565–71"/> Individuals diagnosed with opioid dependence should be prescribed naloxone to prevent overdose and/or should be directed to one of the many intervention/treatment options available, such as needle exchange programs and treatment centers.<ref name="Bowman S, Eiserman J, Beletsky L, Stancliff S, Bruce RD. 2013 565–71"/><ref name="Beletsky L, Rich JD, Walley AY. 2012 1863–1864"/> Brief [[motivational interviewing]] can also be performed by the clinician during patient visits and has been shown to improve patient motivation to change their behavior.<ref name="Bowman S, Eiserman J, Beletsky L, Stancliff S, Bruce RD. 2013 565–71"/><ref>{{cite journal|author=Zahradnik A, Otto C, Crackau B, et al.|title=Randomized controlled trial of a brief intervention for problematic prescription drug use in non-treatment-seeking patients|year=2009|pmid=19133895|doi=10.1111/j.1360-0443.2008.02421.x|volume=104|issue=1|pages=109–117}}</ref> Despite these opportunities, the dissemination of prevention interventions in the US has been hampered by the lack of coordination and sluggish federal government response.<ref name="Beletsky L, Rich JD, Walley AY. 2012 1863–1864"/>
==Treatment==
[[Naloxone]] is very effective at reversing the cause, rather than just the symptoms, of an opioid overdose.<ref name="pmid17621393">{{cite journal |pmid=17621393 |url=http://www.cjem-online.ca/v2/n3/p156 |year=2000 |last1=Etherington |first1=J |last2=Christenson |first2=J |last3=Innes |first3=G |last4=Grafstein |first4=E |last5=Pennington |first5=S |last6=Spinelli |first6=JJ |last7=Gao |first7=M |last8=Lahiffe |first8=B |last9=Wanger |first9=K |title=Is early discharge safe after naloxone reversal of presumed opioid overdose? |volume=2 |issue=3 |pages=156–62 |journal=CJEM}}</ref> A longer-acting variant is [[naltrexone]]. Naltrexone is primarily meant to treat opioid and alcohol dependence. [[Diprenorphine]] (Revivon) is similar in action to naloxone, only it is significantly stronger and is reserved for acting as an antagonist to the strongest, non-human opioids, such as [[carfentanyl]] (in fact, carfentanyl, and other opioids for usage on large animals such as elephants, often come packaged with Revivon to be used after carfentanyl is no longer needed in the animal).
The U.S. [[Centers for Disease Control and Prevention]] (CDC) estimates that US programs for drug users and their caregivers prescribing take-home doses of [[naloxone]] and training on its utilization are estimated to have reversed 10,000 opioid overdose deaths.<ref>{{cite web|title=OD Prevention Program Locator.|url=http://www.overdosepreventionalliance.org/p/od-prevention-program-locator.html|publisher=Overdose Prevention Alliance|accessdate=15 May 2012}}</ref><ref>{{cite journal |pmid=22337174 |url=http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6106a1.htm |year=2012 |author1=Centers for Disease Control and Prevention |title=Community-Based Opioid Overdose Prevention Programs Providing Naloxone — United States, 2010 |volume=61 |issue=6 |pages=101–5 |journal=Morbidity and Mortality Weekly Report}}</ref> Healthcare institution-based naloxone prescription programs have also helped reduce rates of opioid overdose in the US state of North Carolina, and have been replicated in the US military.<ref>{{cite journal |doi=10.1111/j.1526-4637.2011.01128.x |title=Project Lazarus: Community-Based Overdose Prevention in Rural North Carolina |year=2011 |last1=Albert |first1=Su |last2=Brason Ii |first2=Fred W. |last3=Sanford |first3=Catherine K. |last4=Dasgupta |first4=Nabarun |last5=Graham |first5=Jim |last6=Lovette |first6=Beth |journal=Pain Medicine |volume=12 |pages=S77–85 |pmid=21668761}}</ref><ref>{{cite journal |last1=Beletsky |first1=Leo |last2=Burris |first2=Scott C. |last3=Kral |first3=Alex H. |title=Closing Death's Door: Action Steps to Facilitate Emergency Opioid Drug Overdose Reversal in the United States |date=July 21, 2009 |doi=10.2139/ssrn.1437163 |ssrn=1437163 |journal=SSRN Electronic Journal}}</ref> Nevertheless, scale-up of healthcare-based opioid overdose interventions is limited by providers’ insufficient knowledge and negative attitudes towards prescribing take-home naloxone to prevent opioid overdose.<ref>{{cite journal |doi=10.1007/s11524-006-9120-z |title=Physicians' Knowledge of and Willingness to Prescribe Naloxone to Reverse Accidental Opiate Overdose: Challenges and Opportunities |year=2006 |last1=Beletsky |first1=Leo |last2=Ruthazer |first2=Robin |last3=MacAlino |first3=Grace E. |last4=Rich |first4=Josiah D. |last5=Tan |first5=Litjen |last6=Burris |first6=Scott |journal=Journal of Urban Health |volume=84 |pages=126–36 |pmid=17146712 |issue=1 |pmc=2078257}}</ref> Programs training police and fire personnel in opioid overdose response using naloxone have also shown promise in the US.<ref>{{cite web|last=Beletsky L, Moroz E.|title=The Quincy Police Department: Pioneering Naloxone Among First Responders |url=http://www.overdosepreventionalliance.org/2012/05/quincy-police-department-pioneering.html|publisher=Overdose Prevention Alliance|accessdate=15 May 2012}}</ref><ref>{{cite journal|author=Lavoie D.|title=Naloxone: Drug-Overdose Antidote Is Put In Addicts' Hands|journal=Huffington Post|date=April 2012|url=http://www.huffingtonpost.com/2012/04/26/naloxone-drug-overdose-antidote_n_1456531.html}}</ref>
==Co-ingestion==
Opioid overdoses associated with a conjunction of [[benzodiazepines]] or [[alcohol]] use leads to a contraindicated condition wherein higher instances of general negative overdose traits native to the overdose profile of opioid use alone but to a much greater extent.<ref>{{cite web |url=http://www.bestbets.org/bets/bet.php?id=1007 |title=BestBets: Concomitant use of benzodiazepines in opiate overdose and the association with a poorer outcome. |format= |work= |accessdate=}}</ref><ref>{{cite web |url=http://www.bestbets.org/bets/bet.php?id=1006 |title=BestBets: Concomitant use of alcohol in opiate overdose and the association with a poorer outcome. |format= |work= |accessdate=}}</ref> Other CNS depressants, or "downers", muscle relaxers, pain relievers, anti-convulsants, [[anxiolytics]] (anti-anxiety drugs), treatment drugs of a psychoactive or epileptic variety or any other such drug with its active function meant to calm or mitigate neuronal signaling ([[barbiturate]]s, etc.) can additionally cause a worsened condition with less likelihood of recovery cumulative to each added drug of a diverse or disparate hampering effect to the central or peripheral nervous system of the user. This includes drugs less immediately classed to a slowing of the metabolism such as with GABAergics like [[Gamma-Hydroxybutyric acid|GHB]] or glutamatergic antagonists like [[Phencyclidine|PCP]] or [[Ketamine]].
==References==


===Famous People Death From Overdose===
===Famous People Death From Overdose===
Philip Seymour Hoffman (2014), Anna Nicole Smith (2007), Anna Nicole Smith (1999), River Phoenix (1993), Marilyn Monroe (1962), Heath Ledger (2008), Janis Joplin (1970), Corey Haim (2010), Whitney Houston (2012), John Belushi (1982), Chris Farley (1997), Elvis Presley (1977), Judy Garland (1969), Hillel Slovak (1988), Jimi Hendrix (1969), Paula Yates (2000), Billie Holiday (1959), Jim Morrison (1971), Lenny Bruce (1966), Peter Farndon (1983), Kurt Cobain (1994), Dee Dee Ramone (2002), Sid Vicious (1979), Corey Monteith (2013), Chris Kelly (2013), Michael Carl Baze (2011), Derek Boogaard (2011), Erica Blasberg (2010), Andy Irons (2010), Edward Fatu “Umaga” (2009), Billy Mays (2009), Christopher Bowman (2008), Scott Charles (“Bam Bam”) Bigelow (2007), Chris Mainwaring (2007), Ike Turner (2008),  
Philip Seymour Hoffman (2014), Anna Nicole Smith (2007), Anna Nicole Smith (1999), River Phoenix (1993), Marilyn Monroe (1962), Heath Ledger (2008), Janis Joplin (1970), Corey Haim (2010), Whitney Houston (2012), John Belushi (1982), Chris Farley (1997), Elvis Presley (1977), Judy Garland (1969), Hillel Slovak (1988), Jimi Hendrix (1969), Paula Yates (2000), Billie Holiday (1959), Jim Morrison (1971), Lenny Bruce (1966), Peter Farndon (1983), Kurt Cobain (1994), Dee Dee Ramone (2002), Sid Vicious (1979), Corey Monteith (2013), Chris Kelly (2013), Michael Carl Baze (2011), Derek Boogaard (2011), Erica Blasberg (2010), Andy Irons (2010), Edward Fatu “Umaga” (2009), Billy Mays (2009), Christopher Bowman (2008), Scott Charles (“Bam Bam”) Bigelow (2007), Chris Mainwaring (2007), Ike Turner (2008),  
Anthony Durante (2003), Howie Epstein (2003), Elisa Bridges (2002), John Entwistle (2002), Darrell Porter (2002), Peter Jackson (1997), David Waymer (1993), Paul Hayward (1992), Chet Baker (1988), David Croudip (1988), Len Bias (1986), Don Rogers (1986), David Kennedy (1984)
Anthony Durante (2003), Howie Epstein (2003), Elisa Bridges (2002), John Entwistle (2002), Darrell Porter (2002), Peter Jackson (1997), David Waymer (1993), Paul Hayward (1992), Chet Baker (1988), David Croudip (1988), Len Bias (1986), Don Rogers (1986), David Kennedy (1984)

Revision as of 17:19, 7 February 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Vidit Bhargava, M.B.B.S [2]

Opioid overdose
Classification and external resources
ICD-10 F11.0, T40.0-T40.2
ICD-9 305.5, 965.0
eMedicine emerg/330 

An opioid overdose is an acute condition due to excessive use of narcotics. It should not be confused with opioid dependency. Prescription opioid overdose was responsible for more deaths in the United States from 1999-2008 than heroin or cocaine overdose combined.[1]

Symptoms

Opiate overdose symptoms and signs include: decreased level of consciousness and pinpoint pupils.[2] Heart rate and breathing slow down, sometimes to a stop. Blue lips and nails are caused by insufficient oxygen in the blood. Other symptoms include seizures and muscle spasms. A person experiencing an opiate overdose usually will not wake up even if their name is called or if they are shaken vigorously.

Prevention

Although opioid overdose accounts for the leading cause of accidental death, it can be prevented and often in primary care settings.[3][4] Providers should routinely screen patients using tools such as the CADE-AID and the Drug Abuse Screening Test (DAST-10) to screen adults and the CRAFT to screen adolescents aged 14–18 years.[3] Other “drug seeking” behaviors as well as physical indications of drug use should be used as clues to perform formal screenings.[3] Individuals diagnosed with opioid dependence should be prescribed naloxone to prevent overdose and/or should be directed to one of the many intervention/treatment options available, such as needle exchange programs and treatment centers.[3][4] Brief motivational interviewing can also be performed by the clinician during patient visits and has been shown to improve patient motivation to change their behavior.[3][5] Despite these opportunities, the dissemination of prevention interventions in the US has been hampered by the lack of coordination and sluggish federal government response.[4]

Treatment

Naloxone is very effective at reversing the cause, rather than just the symptoms, of an opioid overdose.[6] A longer-acting variant is naltrexone. Naltrexone is primarily meant to treat opioid and alcohol dependence. Diprenorphine (Revivon) is similar in action to naloxone, only it is significantly stronger and is reserved for acting as an antagonist to the strongest, non-human opioids, such as carfentanyl (in fact, carfentanyl, and other opioids for usage on large animals such as elephants, often come packaged with Revivon to be used after carfentanyl is no longer needed in the animal).

The U.S. Centers for Disease Control and Prevention (CDC) estimates that US programs for drug users and their caregivers prescribing take-home doses of naloxone and training on its utilization are estimated to have reversed 10,000 opioid overdose deaths.[7][8] Healthcare institution-based naloxone prescription programs have also helped reduce rates of opioid overdose in the US state of North Carolina, and have been replicated in the US military.[9][10] Nevertheless, scale-up of healthcare-based opioid overdose interventions is limited by providers’ insufficient knowledge and negative attitudes towards prescribing take-home naloxone to prevent opioid overdose.[11] Programs training police and fire personnel in opioid overdose response using naloxone have also shown promise in the US.[12][13]

Co-ingestion

Opioid overdoses associated with a conjunction of benzodiazepines or alcohol use leads to a contraindicated condition wherein higher instances of general negative overdose traits native to the overdose profile of opioid use alone but to a much greater extent.[14][15] Other CNS depressants, or "downers", muscle relaxers, pain relievers, anti-convulsants, anxiolytics (anti-anxiety drugs), treatment drugs of a psychoactive or epileptic variety or any other such drug with its active function meant to calm or mitigate neuronal signaling (barbiturates, etc.) can additionally cause a worsened condition with less likelihood of recovery cumulative to each added drug of a diverse or disparate hampering effect to the central or peripheral nervous system of the user. This includes drugs less immediately classed to a slowing of the metabolism such as with GABAergics like GHB or glutamatergic antagonists like PCP or Ketamine.

References

Famous People Death From Overdose

Philip Seymour Hoffman (2014), Anna Nicole Smith (2007), Anna Nicole Smith (1999), River Phoenix (1993), Marilyn Monroe (1962), Heath Ledger (2008), Janis Joplin (1970), Corey Haim (2010), Whitney Houston (2012), John Belushi (1982), Chris Farley (1997), Elvis Presley (1977), Judy Garland (1969), Hillel Slovak (1988), Jimi Hendrix (1969), Paula Yates (2000), Billie Holiday (1959), Jim Morrison (1971), Lenny Bruce (1966), Peter Farndon (1983), Kurt Cobain (1994), Dee Dee Ramone (2002), Sid Vicious (1979), Corey Monteith (2013), Chris Kelly (2013), Michael Carl Baze (2011), Derek Boogaard (2011), Erica Blasberg (2010), Andy Irons (2010), Edward Fatu “Umaga” (2009), Billy Mays (2009), Christopher Bowman (2008), Scott Charles (“Bam Bam”) Bigelow (2007), Chris Mainwaring (2007), Ike Turner (2008), Anthony Durante (2003), Howie Epstein (2003), Elisa Bridges (2002), John Entwistle (2002), Darrell Porter (2002), Peter Jackson (1997), David Waymer (1993), Paul Hayward (1992), Chet Baker (1988), David Croudip (1988), Len Bias (1986), Don Rogers (1986), David Kennedy (1984)

  1. ↑ Debono, DJ; Hoeksema, LJ; Hobbs, RD (August 2013). "Caring for Patients with Chronic Pain: Pearls and Pitfalls". Journal of the American Osteopathic Association. 113 (8): 620–627. doi:10.7556/jaoa.2013.023. PMID 23918913.
  2. ↑ Chandler, Stephanie. "Symptoms of an opiate overdose". Live Strong. Retrieved 17 May 2012.
  3. ↑ 3.0 3.1 3.2 3.3 3.4 Bowman S, Eiserman J, Beletsky L, Stancliff S, Bruce RD. (2013). "Reducing the health consequences of opioid addiction in primary care". Am J Med. 126 (7): 565–71. doi:10.1016/j.amjmed.2012.11.031. PMID 23664112.In press
  4. ↑ 4.0 4.1 4.2 Beletsky L, Rich JD, Walley AY. (2012). "Prevention of Fatal Opioid Overdose". JAMA. 308 (18): 1863–1864. doi:10.1001/jama.2012.14205. PMC 3551246. PMID 23150005.
  5. ↑ Zahradnik A, Otto C, Crackau B; et al. (2009). "Randomized controlled trial of a brief intervention for problematic prescription drug use in non-treatment-seeking patients". 104 (1): 109–117. doi:10.1111/j.1360-0443.2008.02421.x. PMID 19133895.
  6. ↑ Etherington, J; Christenson, J; Innes, G; Grafstein, E; Pennington, S; Spinelli, JJ; Gao, M; Lahiffe, B; Wanger, K (2000). "Is early discharge safe after naloxone reversal of presumed opioid overdose?". CJEM. 2 (3): 156–62. PMID 17621393.
  7. ↑ "OD Prevention Program Locator". Overdose Prevention Alliance. Retrieved 15 May 2012.
  8. ↑ Centers for Disease Control and Prevention (2012). "Community-Based Opioid Overdose Prevention Programs Providing Naloxone — United States, 2010". Morbidity and Mortality Weekly Report. 61 (6): 101–5. PMID 22337174.
  9. ↑ Albert, Su; Brason Ii, Fred W.; Sanford, Catherine K.; Dasgupta, Nabarun; Graham, Jim; Lovette, Beth (2011). "Project Lazarus: Community-Based Overdose Prevention in Rural North Carolina". Pain Medicine. 12: S77–85. doi:10.1111/j.1526-4637.2011.01128.x. PMID 21668761.
  10. ↑ Beletsky, Leo; Burris, Scott C.; Kral, Alex H. (July 21, 2009). "Closing Death's Door: Action Steps to Facilitate Emergency Opioid Drug Overdose Reversal in the United States". SSRN Electronic Journal. doi:10.2139/ssrn.1437163. SSRN 1437163.
  11. ↑ Beletsky, Leo; Ruthazer, Robin; MacAlino, Grace E.; Rich, Josiah D.; Tan, Litjen; Burris, Scott (2006). "Physicians' Knowledge of and Willingness to Prescribe Naloxone to Reverse Accidental Opiate Overdose: Challenges and Opportunities". Journal of Urban Health. 84 (1): 126–36. doi:10.1007/s11524-006-9120-z. PMC 2078257. PMID 17146712.
  12. ↑ Beletsky L, Moroz E. "The Quincy Police Department: Pioneering Naloxone Among First Responders". Overdose Prevention Alliance. Retrieved 15 May 2012.
  13. ↑ Lavoie D. (April 2012). "Naloxone: Drug-Overdose Antidote Is Put In Addicts' Hands". Huffington Post.
  14. ↑ "BestBets: Concomitant use of benzodiazepines in opiate overdose and the association with a poorer outcome".
  15. ↑ "BestBets: Concomitant use of alcohol in opiate overdose and the association with a poorer outcome".
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