RT Book, Section
A1 Jameson, J. Larry
A1 Fauci, Anthony S.
A1 Kasper, Dennis L.
A1 Hauser, Stephen L.
A1 Longo, Dan L.
A1 Loscalzo, Joseph
SR Print(0)
ID 1167062558
T1 Narcotic Overdose
T2 Harrison's Manual of Medicine, 20e
YR 2020
FD 2020
PB McGraw-Hill Education
PP New York, NY
SN 9781260455342
LK accessmedicine.mhmedical.com/content.aspx?aid=1167062558
RD 2023/03/21
AB Lethal  overdose  is  a  relatively  common  complication  of  opioid  use  disorder  (Chap.  203).  Nearly  50,000  overdose  deaths  involving  opioids  occur  annually  in  the  United  States,  and  these  numbers  continue  to  increase  and  have  accelerated  due  to  mixing  high  potency  fentanyl  derivatives  with  heroin.  The  accelerating  death  rates  are  partially  because  reversal  of  fentanyl  overdoses  can  require  several-fold  larger  doses  of  naloxone  than  the  doses  in  the  intranasal  devices  used  for  nonmedical  street  resuscitations.  Diagnosis  is  based  on  recognition  of  characteristic  signs  and  symptoms,  including  shallow  and  slow  respirations,  pupillary  miosis  (mydriasis  does  not  occur  until  significant  brain  anoxia  supervenes),  bradycardia,  hypothermia,  and  stupor  or  coma;  adulterants  can  also  produce  an  “allergic-like”  reaction  characterized  by  decreased  alertness,  frothy  pulmonary  edema,  and  an  elevated  blood  eosinophil  count.  Opioids  generally  do  not  produce  seizures  except  for  unusual  cases  of  polydrug  use  with  the  opioid  meperidine  or  with  high  doses  of  tramadol.  Blood  or  urine  toxicology  studies  can  confirm  a  diagnosis,  but  immediate  management  must  be  based  on  clinical  criteria.