What is the treatment for opioid (op) poisoning?

Treatment of Opioid Poisoning

The cornerstone of opioid poisoning treatment is naloxone administration along with respiratory support, followed by appropriate monitoring for recurrent toxicity in a healthcare setting. 1

Initial Management Algorithm

For Respiratory Depression/Arrest

1. Airway management and ventilation

   • Open airway and provide rescue breathing or bag-mask ventilation 1
   • Continue ventilatory support until spontaneous breathing returns

2. Naloxone administration

   • For respiratory arrest with pulse present: 0.04-2 mg IV/IO/IM or 2-4 mg intranasal 2
   • Titrate to restore adequate spontaneous respiration, not necessarily full consciousness 3
   • Do not delay activating emergency response systems while awaiting response 1

3. Supportive care

   • Monitor vital signs continuously
   • Establish IV access
   • Consider fluid support if hypotensive

For Cardiac Arrest

1. Prioritize high-quality CPR with ventilation 1
   • Standard resuscitative measures take priority over naloxone
   • Naloxone can be administered along with standard care if it doesn't delay CPR

Post-Resuscitation Management

Monitoring Period

• All patients must be observed in a healthcare setting until risk of recurrent toxicity is low and vital signs have normalized 1
• Monitor for at least 4-6 hours after last naloxone dose 2
• Extend observation to 12-24 hours for long-acting opioid formulations 2

Managing Recurrent Toxicity

• If respiratory depression recurs, administer repeated small doses of naloxone 1
• Consider naloxone infusion for long-acting opioids 1
• Formula for infusion: 2/3 of the effective bolus dose per hour

Special Considerations

Naloxone-Related Complications

• Potential adverse effects:
  • Acute withdrawal syndrome in opioid-dependent patients 1, 2
  • Nausea, vomiting, sweating, agitation, hypertension 3
  • Rare but serious: pulmonary edema, cardiac arrest 3

Managing Withdrawal

• Use appropriate naloxone dosing to minimize withdrawal symptoms 2
• For severe withdrawal symptoms, consider supportive care and potentially buprenorphine for symptom management 4

Polysubstance Overdose

• Be prepared to treat multiple toxidromes 2
• Consider toxicology screening but don't delay treatment awaiting results 2
• For concurrent insulin overdose, monitor glucose levels frequently 2

Discharge Criteria

• Patient must have normal mental status and vital signs
• No recurrence of respiratory depression after naloxone's expected duration of action
• Patients with severe overdose or complications should be transferred to intensive care 2

Prevention Strategies

• It is reasonable for lay rescuers to receive training in responding to opioid overdose, including naloxone administration 1
• Consider prescribing take-home naloxone to at-risk patients 5

Common Pitfalls to Avoid

1. Excessive naloxone dosing - can precipitate severe withdrawal and cardiovascular complications 3
2. Premature discharge - naloxone's duration of action (60-120 minutes) is shorter than many opioids 2
3. Delayed ventilatory support - don't wait for naloxone to work before providing respiratory support 1
4. Failure to recognize long-acting opioid toxicity - requires extended monitoring 1

The evidence strongly supports that prompt administration of naloxone combined with appropriate respiratory support and careful monitoring is the most effective approach to reduce mortality and morbidity in opioid poisoning.