From the Guidelines
Opioid toxicity symptoms include central nervous system depression, respiratory depression, and can progress to cardiac arrest.
Key Symptoms
- Central nervous system depression, characterized by sleepiness and unresponsiveness 1
- Respiratory depression, marked by slowed and stopped breathing 1
- Severe life-threatening instability, including severe CNS or respiratory depression, hypotension, or cardiac arrhythmia 1
- In severe cases, opioid toxicity can cause respiratory arrest and cardiac arrest 1
Additional Considerations
- Opioid overdose can also lead to hypertension, tachycardia, piloerection, vomiting, agitation, and drug cravings in patients with opioid dependency, particularly after naloxone administration 1
- Pulmonary edema has been reported with naloxone administration, but it may also be caused primarily by opioid toxicity 1
From the Research
Symptoms of Opioid Toxicity
The symptoms of opioid toxicity can vary in severity and may include:
- Respiratory depression, which can progress to apnea and death 2
- Pulmonary edema and congestion, with frothy watery fluid often present in the airways 2
- Airway occlusion, including positional asphyxia 3
- Exaggerated respiratory depression and depression of consciousness 3
- Non-cardiogenic pulmonary edema 4
- Granulomatous change in the lungs 4
- Immune system effects, increasing the risk of infectious complications 4
- Cognitive failure, hallucinations, myoclonus, nausea and vomiting, and local toxicity 5
- Abdominal cramping and unintentional defecation in cases of naloxone-precipitated opioid withdrawal 6
Severity of Opioid Toxicity
The severity of opioid toxicity can be classified into different grades, with increasing levels of toxicity associated with more severe symptoms, such as:
- Grade 1 severity: mild symptoms, requiring minimal clinical intervention 3
- Grade 2 severity: moderate symptoms, requiring more significant clinical intervention 3
- Grade 3 severity: severe symptoms, requiring intensive clinical intervention 3
- Complicated heroin overdose cases: requiring specialized care and management 3
Onset of Opioid Toxicity
The onset of opioid toxicity can occur rapidly, with a median time of 17 minutes from heroin injection to clinical intervention 3. Early intervention is critical in managing overdose cases and preventing fatal outcomes 3.