- Opioids are a group of natural and synthetic substances used both illicitly and for prescription analgesia.
- Opioids include:
- Opiates—naturally occurring in the opium poppy (e.g., codeine, morphine)
- Semisynthetic derivatives (e.g., hydromorphone, nalbuphine, oxycodone, heroin)
- Synthetic compounds (e.g., fentanyl, meperidine, methadone, tramadol, and various “designer” opioids)
- Complications of opioid use include acute intoxication, dependence/abuse, and withdrawal.
- Opioid use disorder is a DSM-5 diagnosis.
- Please see related chapter, “Neonatal Abstinence Syndrome,” for special considerations of opioid intoxication and withdrawal in the neonate.
- Prescription opioids are the most commonly abused and lethal opioids in the United States.
- Poison control centers received reports of 188,468 prescription opioid exposures among children aged <20 years from 2000 to 2015.
- Children who suffer an opioid overdose are more likely to have a mother who was prescribed opioids and antidepressants.
- Hospitalizations for methadone intoxications and adolescent heroin intoxications are rising.
- Strongest risk factor for heroin addiction is addiction to prescription opioids.
- 45% of heroin users are addicted to prescription opioids.
- Prescription opiate-drug era associated with shorter time from first illicit drug use to injection
- Between 1997 and 2012, in children aged 1 to 19 years, hospitalizations for opioid intoxication rose to 3.71 per 100,000 children, representing a 165% increase; 1.3% of these children died during hospitalization.
- In 2013, 169,000 people aged ≥12 years used heroin for the first time within the previous year.
- Difficult to estimate, based on National Survey on Drug Use and Health (NSDUH) data
- 3.8 million people in the United States aged ≥12 years reported past month misuse of a prescription pain medication in 2015.
- Young children with opioid intoxication typically ingest opioids found in the home.
- Adolescents most commonly become intoxicated through intentional ingestion for recreational use or intent to self-harm.
Round-the-clock dosing of opioids can produce opioid dependence within 5 days.
- Routes for use: oral, intranasal, inhalation, or injection (IV, IM, or SC)
- Well absorbed from gastrointestinal (GI) tract, nasal mucosa, pulmonary capillaries, and injection sites
- Metabolized by liver
- Receptor types
- Mu (a.k.a., OP3, MOP)
- Location: CNS, GI tract, and sensory nerve endings
- Effect: analgesia, euphoria, respiratory depression, physical dependence, GI dysmotility, miosis, pruritus, bradycardia
- Kappa (a.k.a., OP2, KOP)
- Location: CNS
- Effect: analgesia, miosis, diuresis, dysphoria
- Delta (a.k.a., OP1, DOP)
- Location: CNS
- Effect: spinal analgesia, modulation of mu receptors/dopaminergic neurons
- Mu (a.k.a., OP3, MOP)
- Metabolites excreted by kidneys
- Typically, from respiratory depression
- Anaphylaxis (rare)
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Cabana, Michael D., editor. "Opioid Intoxication." 5-Minute Pediatric Consult, 8th ed., Wolters Kluwer, 2019. Pediatrics Central, peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/618284/all/Opioid_Intoxication.
Opioid Intoxication. In: Cabana MDM, ed. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/618284/all/Opioid_Intoxication. Accessed May 30, 2023.
Opioid Intoxication. (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult (8th ed.). Wolters Kluwer. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/618284/all/Opioid_Intoxication
Opioid Intoxication [Internet]. In: Cabana MDM, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2023 May 30]. Available from: https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/618284/all/Opioid_Intoxication.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Opioid Intoxication ID - 618284 ED - Cabana,Michael D, BT - 5-Minute Pediatric Consult UR - https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/618284/all/Opioid_Intoxication PB - Wolters Kluwer ET - 8 DB - Pediatrics Central DP - Unbound Medicine ER -