Intoxication

The management of opioid overdose is best accomplished in a medical facility with the availability of sophisticated expertise and technology. These can be brought to bear on the potential "worst-case scenario," for example, opioid overdose in a pregnant female with septicemia, pulmonary edema, and coma. In addition to intensive physiological support needed in opioid overdose, the use of an opioid antagonist can be life saving. Naloxone is the drug of choice, because it does not further depress respiratory drive (Berger & Dunn, 1986). A regimen of 0.4-0.8 mg, administered intravenously several times over the course of 20-30 minutes, is usually effective. If after 10 mg of naloxone there is no improvement in the patient's condition, one must question the diagnosis of opioid overdose. Other drugs may be involved, or other central nervous system processes may exist. One also must remember that the action of naloxone almost always will be shorter than the action of the opioid, necessitating close attention to the reemergence of the opioid's physiological effects (Wilford, 1981). The use of opiate antagonists in tolerant individuals will precipitate opiate withdrawal.

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