Management overview for opioid poisoning
Opioid drugs include buprenorphine, codeine, dihydrocodeine, diphenoxylate, fentanyl and its analogues—alfentanil and remifentanil, heroin, hydromorphone, loperamide, methadone, morphine, oxycodone, pethidine, tramadol and tapentadol.
This monograph discusses the general management of acute opioid poisoning. For advice for first responders to a patient with suspected opioid poisoning in the community or primary healthcare setting, see here.
Specific management is given for the following opioids:
- buprenorphine, which is a partial opioid agonist
- tramadol, which is also an inhibitor of serotonin and noradrenaline reuptake
- tapentadol, which is also an inhibitor of noradrenaline reuptake.
For advice on management of opioid-related harms associated with therapeutic use, see Opioid-related harms.
Opioids are the most common cause of drug-related death in Australia. They can cause respiratory depression that is disproportionately severe compared with their sedative effect, especially in children and other opioid-naive people. First-line treatment for opioid poisoning is support of airway and breathing. The opioid antagonist, naloxone, is used to reverse the effects of the opioid in patients with hypoventilation.
Seek advice from a clinical toxicologist or poisons information centre (13 11 26) for patients:
- with suspected opioid poisoning who do not respond to naloxone
- who have co-ingested other drugs with an opioid
- who require prolonged naloxone infusion.
Patients who have ingested long-acting or modified-release opioid drugs require a longer period of observation following poisoning because death can occur many hours after ingestion—see Risk factors for toxicity.
Synthetic opioids, including illicit fentanyl analogues (eg carfentanil) and nitazenes, are mostly imported from overseas for recreational use. These opioids are highly potent and lipid soluble, and some have longer durations of action than fentanyl. They pose a high risk of opioid toxicity, especially in opioid-naive people. Higher doses of naloxone may be required for management of poisonings due to these drugs.