Emergency Diagnosis of Opioid Intoxication

Abstract

Opioids are widely used for analgesic purposes. If taken as prescribed, they are safe and effective. Overdosing, however, can cause coma and life-threatening respiratory depression. In the acute care setting, physicians often base treatment on the presence of classic “opioid syndrome” characteristics—mental status depression, hypoventilation, miosis (pinpoint pupils), and reduced bowel motility. Rather than identify and quantify the specific agent, laboratories should confirm opioid intoxication qualitatively with a urine drug screen. With this information, physicians may expedite treatment with opioid antagonists (naloxone), which help patients to resume spontaneous respiration. Because the drug level does not always correlate with the severity of illness, quantitative drug levels are rarely needed. Hypoglycemia, hypoxia, and hypothermia are also seen with opioid overdose.