Opioid Intoxication

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

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Basics

Description

  • 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.

Epidemiology

  • 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

Incidence

  • 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.

Prevalence

  • 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.

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
    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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