What is the treatment for opioid (op) poisoning?

Treatment for Opioid Poisoning

The primary treatment for opioid poisoning is supportive care focused on airway management and ventilation, with naloxone administration for patients with respiratory depression who have a pulse, while standard resuscitative measures take priority in cardiac arrest. 1

Initial Management Algorithm

For Respiratory Depression/Arrest (Patient Has Pulse)

1. Activate emergency response system immediately - Do not delay while waiting for response to interventions 1
2. Establish and maintain airway - Open airway and provide rescue breaths/bag-mask ventilation 1
3. Administer naloxone - For patients with a definite pulse but no normal breathing or only gasping 1
   • Intranasal (2 mg/mL): Similar efficacy to intramuscular route 2
   • Intramuscular/intravenous: Effective for rapid reversal 3, 4, 5
4. Continue respiratory support until spontaneous breathing returns 1

For Cardiac Arrest (No Pulse)

1. Focus on high-quality CPR (compressions plus ventilation) 1
2. Standard resuscitative measures take priority over naloxone administration 1
3. Naloxone can be administered along with standard care if it does not delay high-quality CPR 1

Post-Resuscitation Management

• Observe in healthcare setting until risk of recurrent toxicity is low and vital signs normalize 1
• Monitor for recurrent respiratory depression - The duration of naloxone action (30-90 minutes) may be shorter than the opioid effect, particularly with long-acting formulations 1
• Administer repeated doses or continuous infusion of naloxone if recurrent opioid toxicity develops 1

Naloxone Administration Considerations

• Effective antidote that can restore spontaneous respirations and protective airway reflexes 1, 3
• Potential adverse effects include:
  • Precipitation of opioid withdrawal symptoms (nausea, vomiting, sweating, tremulousness, agitation) 3, 6
  • Pulmonary edema (responds to positive pressure ventilation) 3, 4
  • Cardiovascular effects (hypertension, hypotension, dysrhythmias) in patients with pre-existing cardiac disease 4, 5

Common Pitfalls and Caveats

• Do not delay activating emergency response while awaiting response to naloxone 1
• Do not neglect ventilatory support while administering naloxone 1, 3
• Do not assume short observation periods are adequate for all opioid overdoses - longer monitoring is required for long-acting or sustained-release opioids 1
• Do not overlook possibility of polysubstance overdose - benzodiazepine overdose often occurs with opioids 1, 7
• Do not miss the opportunity for secondary prevention - patients who survive should receive education on overdose prevention and naloxone use 1, 7

Special Considerations

• Higher risk of mortality with synthetic opioids (particularly fentanyl analogs) may require higher or repeated naloxone doses 7
• Buprenorphine overdose may require larger doses of naloxone due to its high binding affinity and slow dissociation from opioid receptors 3, 4, 5
• Community-based naloxone distribution is reasonable to improve outcomes for at-risk individuals 1, 7