Opioid overdose

Opioid overdose is characterised by sedation, loss of consciousness, miosis (small pupils), shallow breathing, respiratory depression and cyanosis. Pulmonary oedema may also occur. Opioid overdose can occur with use of opioids by any route and in any formulation (including slow-release preparations). Risk of death is particularly increased in people who use an opioid together with another drug with sedative effects (eg pregabalin or gabapentin, alcohol, benzodiazepines), and in those who use novel opioids such as fentanyl analogues.

For advice on the management of opioid overdose (also referred to as opioid poisoning), see the following topics in the Toxicology and Toxinology Guidelines:

For advice on overdose with novel psychoactive substances including novel opioids, see Introduction to novel psychoactive substance poisoning.

To reduce risk of death from overdose, discuss take-home naloxone with all patients with hazardous, harmful or dependent use of opioids (and those close to them because they are likely to be the people administering the drug). Naloxone is a mu-receptor antagonist for immediate use in opioid overdose. Take-home naloxone is available as a nasal spray or preprepared injection. It can be obtained free of charge and over-the-counter through the Take Home Naloxone program in all Australian states and territories. Higher doses of naloxone may be required if the overdose involves a drug with a high affinity for the mu receptor, such as novel fentanyl analogues or buprenorphine. For more information on naloxone for overdose and take-home naloxone, see the Pain and Analgesia guidelines.

Note: Take-home naloxone is lifesaving and should be made available to all patients with hazardous, harmful or dependent use of opioids.