Opioid Intoxication

Basics

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.
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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