Opioid Intoxication

Descriptive text is not available for this imageBASICS

DESCRIPTION

  • Opioids are a group of natural and synthetic substances that provide effects like morphine—used for both prescription analgesia and illicit use.
  • 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 Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) diagnosis.
  • Please see related chapter, “Neonatal Opioid Withdrawal Syndrome,” for special considerations of opioid intoxication and withdrawal in the neonate.

EPIDEMIOLOGY

  • Prescription opioids are the most commonly abused and lethal opioids in the United States. 9.3 million people aged ≥12 years misused prescription pain relievers in 2020 compared with 902,000 people who used heroin.
  • Between July 2019 and December 2021, in children aged 10 to 19 years, 91.3% of overdose deaths involved opioids and 83.9% involved illicitly manufactured fentanyls.
  • Strongest risk factor for heroin addiction is addiction to prescription opioids.
  • Perceived availability of narcotics has declined since 2010, including large declines from 2019 to 2021, particularly among 12th graders—possibly related to the COVID-19 pandemic.
  • Poison control centers received reports of 188,468 prescription opioid exposures among children aged <20 years from 2000 to 2015.

Incidence

  • Pediatric intensive care unit (PICU) admission rates related to opioids increased from 24.9 to 35.9 per 10,000 PICU admissions between 2004 and 2015.
  • 8,986 children and adolescents died between 1999 and 2016 from prescription and illicit opioid poisonings. During this time, the mortality rate increased to 268.2%.

Prevalence

  • Difficult to estimate based on data from the National Survey on Drug Use and Health (NSDUH), Monitoring the Future (MTF), and the Youth Risk Behavior Survey (YRBS)
  • 7.2% of U.S. high school students reported current prescription opioid misuse (2019 YRBS).
  • 0.3% of adolescents aged 12 to 17 years (or 80,000 people) had an opioid use disorder in the past year (2020 NSDUH).
  • Although the percentage of adolescents reporting drug use on the MTF survey decreased significantly in 2021 (attributed to the COVID-19 pandemic), opioids showed no significant change in annual prevalence in 2021.

PATHOPHYSIOLOGY

  • Exposure:
    • 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.
ALERT

Pain is often undertreated in pediatrics, possibly due to fear of opioid dependence. Black and Hispanic children are even less likely to receive opioids and optimal pain reduction.

  • Routes for use: oral, intranasal, inhalation, or injection (IV, IM, or SQ)
  • Well absorbed from gastrointestinal 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
  • Metabolites excreted by kidneys
  • Death:
    • Typically, from respiratory depression
    • Anaphylaxis (rare)

There's more to see -- the rest of this topic is available only to subscribers.