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Opioid Intoxication

Opioid Intoxication is a topic covered in the 5-Minute Pediatric Consult.

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  • 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.


  • 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.
    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
  • Metabolites excreted by kidneys
  • Death:
    • 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 MD, ed. 5-Minute Pediatric Consult. 8th ed. Wolters Kluwer; 2019. https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/618284/all/Opioid_Intoxication. Accessed April 18, 2019.
Opioid Intoxication. (2019). In Cabana, M. D. (Ed.), 5-Minute Pediatric Consult. Available from https://peds.unboundmedicine.com/pedscentral/view/5-Minute-Pediatric-Consult/618284/all/Opioid_Intoxication
Opioid Intoxication [Internet]. In: Cabana MD, editors. 5-Minute Pediatric Consult. Wolters Kluwer; 2019. [cited 2019 April 18]. 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 -