Overdose — the time‑critical recognition 🚩
Triad: depressed consciousness + respiratory depression + miosis (pinpoint pupils). The killer is respiratory depression/hypoxia.
- Airway/breathing support + naloxone (opioid antagonist). Titrate to restore adequate ventilation, not full arousal (over‑reversal → acute withdrawal, agitation).
- Naloxone is short‑acting — re‑sedation is expected with long‑acting opioids (methadone) or large fentanyl loads → observe, repeat, consider infusion. Naloxone supplements, never replaces, resuscitation.
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The disorder — the principle that saves lives
Evidence‑based care = opioid agonist maintenance treatment (OAMT) — methadone (full agonist) or buprenorphine (partial agonist; precipitates withdrawal if started too early) — + psychosocial support + take‑home naloxone + harm reduction. This is a chronic‑disease model.
Withdrawal
Distressing but not life‑threatening (unlike alcohol/benzodiazepines): lacrimation, rhinorrhoea, myalgia, piloerection, diarrhoea, mydriasis, yawning. Manage with an agonist or symptomatic care.
Pitfalls
- Discharging early after naloxone for a long‑acting opioid (re‑sedation death).
- "Successful detox" without maintenance → overdose on relapse.
Pearls
- 🎯 Overdose = respiratory depression → ventilate + naloxone; expect re‑sedation.
- 🩺 OAMT, not detox alone — lost tolerance after detox is lethal.
Next → The stimulant end — activation, toxicity, and induced psychosis (Concept 44).