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Neurologic, Cognitive, and Behavioral Consequences of Opioid Overdose: a Review

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Abstract

Purpose of Review

To review the literature regarding neurologic, cognitive, and behavioral disorders resulting from non-fatal opioid overdose.

Recent Findings

Although there is extensive literature regarding hypoxic-ischemic brain injury resulting from cardiac arrest, studies specifically examining opioid-induced brain injury are limited, derived mainly from patient case reports or animal models. Medical management of this population requires careful consideration of acute and long-term complications, as well as careful treatment planning in coordination with neurology, neuropsychology, psychiatry, and addiction medicine.

Summary

In addition to interventions to prevent fatal opioid overdose, further studies are needed on the neurologic, cognitive, and behavioral sequelae of opioid overdose in order to develop an effective long-term treatment strategy to manage the healthcare needs of this population.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

    Dayer LE, Painter JT, McCain K, King J, Cullen J, Foster HR. A recent history of opioid use in the US: three decades of change. Subst Use Misuse. 2019;54:331–9. https://doi.org/10.1080/10826084.2018.1517175.

  2. 2.

    CDC.gov. Opioid overdose-opioid basics: understanding the epidemic. 2019. Retrieved from https://www.cdc.gov/drugoverdose/epidemic/index.html. Accessed 16 July 2019.

  3. 3.

    Fairbairn N, Coffin PO, Walley A. Naloxone for heroin, prescription opioid, and illicitly made fentanyl overdoses: challenges and innovations responding to a dynamic epidemic. Int J Drug Policy. 2017;46:172–9. https://doi.org/10.1016/j.drugpo.2017.06.005.

  4. 4.

    Morgan J, Jones AL. The role of naloxone in the opioid crisis. Toxicol Commun. 2018;2(1):15–8. https://doi.org/10.1080/24734306.2018.1458464.

  5. 5.

    Cox BM, Christie MJ, Devi L, Toll L, Traynor JR. Challenges for opioid receptor nomenclature: IUPHAR review 9. Br J Pharmacol. 2014;172:317–23. https://doi.org/10.1111/bph.12612.

  6. 6.

    Mustazza C, Pieretti S, Marzoli F. Nociceptin / Orphanin FQ Peptide (NOP) receptor modulators: an update in structure-activity relationships. Curr Med Chem. 2018;25:2353–84. https://doi.org/10.2174/0929867325666180111095458.

  7. 7.

    Zaki PA, Bilsky EJ, Vanderah TW, Lai J, Evans CJ, Porreca F. Opioid receptors types and subtypes: the delta receptor as a model. Annu Rev Pharmacol Toxicol. 1996;36(1):379–401. https://doi.org/10.1146/annurev.pa.36.040196.002115.

  8. 8.

    Vadivelu N, Sukanya M, Hines RL. Peripheral opioid receptor agonists for analgesia: a comprehensive review. J Opioid Manag. 2011;7(1):55–68. https://doi.org/10.5055/jom.2011.0049.

  9. 9.

    Henriksen G, Willoch F. Imaging of opioid receptors in the central nervous system. Brain. 2008;131:1171–96. https://doi.org/10.1093/brain/awm255.

  10. 10.

    Mansour A, Khachaturian H, Lewis ME, Akil H, Watson SJ. Anatomy of CNS opioid receptors. Trends Neurosci. 1988;11(7):308–9. https://doi.org/10.1016/0166-2236(88)90093-8.

  11. 11.

    Stein C. The control of pain in peripheral tissue by opioids. N Engl J Med. 1995;332(25):1685–90. https://doi.org/10.1056/NEJM199506223322506.

  12. 12.

    Stein C. Opioid receptors. Annu Rev Med. 2016;67:433–51. https://doi.org/10.1146/annurev-med-062613-093100.

  13. 13.

    Grechko OY, Spasov AA, Shtareva DM. Opioid κ receptors as a molecular target for the creation of a new generation of analgesic drugs. Pharm Chem J. 2016;50:1–9. https://doi.org/10.1007/s11094-016-1388-z.

  14. 14.

    Pradhan AA, Befort K, Nozaki C, Gavériaux-Ruff C, Kieffer BL. The delta opioid receptor: an evolving target for the treatment of brain disorders. Trends Pharmacol Sci. 2011;32(10):581–90. https://doi.org/10.1016/j.tips.2011.06.008.

  15. 15.

    Raffa RB, Burdge G, Gambrah J, Kinecki HE, Lin F, Lu B, et al. Cebranopadol: novel dual opioid/NOP receptor agonist analgesic. J Clin Pharm Ther. 2017 Feb;42(1):8–17. https://doi.org/10.1111/jcpt.12461.

  16. 16.

    Vanderah TW. Delta and kappa opioid receptors as suitable drug targets for pain. Clin J Pain. 2010;26(Suppl 10):S10–5. https://doi.org/10.1097/AJP.0b013e3181c49e3a.

  17. 17.

    Wadenberg ML. A review of the properties of spiradoline: a potent and selective kappa-opioid receptor agonist. CNS Drug Rev. 2003;9(2):187–98. https://doi.org/10.1111/j.1527-3458.2003.tb00248.x.

  18. 18.

    Zaveri NT. Nociceptin opioid receptor (NOP) as a therapeutic target: progress in translation from preclinical research to clinical utility. J Med Chem. 2016;59(15):7011–28. https://doi.org/10.1021/acs.jmedchem.5b01499.

  19. 19.

    •• Boyer EW. Management of opioid analgesic overdose. N Engl J Med. 2012;367:146–55. https://doi.org/10.1056/NEJMra1202561This is a practical overview of how to assess and treat patients with suspected acute opioid overdose.

  20. 20.

    Chowdhuri S, Javaheri S. Sleep disordered breathing caused by chronic opioid use diverse manifestations and their management. Sleep Med Clin. 2017;12:573–86. https://doi.org/10.1016/j.jsmc.2017.07.007.

  21. 21.

    McNicol E, Horowicz-Mehler N, Fisk RA, Bennett K, Gialeli-Goudas M, Chew PW, et al. Management of opioid side effects in cancer-related and chronic noncancer pain: a systematic review. J Pain. 2003;4(5):231–56. https://doi.org/10.1016/S1526-5900(03)00556-X.

  22. 22.

    Nelson AD, Camilleri M. Opioid-induced constipation: advances and clinical guidance. Ther Adv Chronic Dis. 2016;7(2):121–34. https://doi.org/10.1177/2040622315627801.

  23. 23.

    Benyamin R, Trescot AM, Datta S, Buenaventura R, Adlaka R, Sehgal N, et al. Opioid complications and side effects. Pain Physician. 2008;11(2 Suppl):S105–20.

  24. 24.

    Feldman JL, Del Negro CA. Looking for inspiration: new perspectives on respiratory rhythm. Nat Rev Neurosci. 2006;7:232–41. https://doi.org/10.1038/nrn1871.

  25. 25.

    Bonham AC. Neurotransmitters in the CNS control of breathing. Respir Physiol. 1995;101(3):219–30. https://doi.org/10.1016/0034-5687(95)00045-F.

  26. 26.

    Dahan A, Schrier RVD, Smith T, Aarts L, Velzen MV, Niesters M. Averting opioid-induced respiratory depression without affecting analgesia. Anesthesiology. 2018;128(5):1027–37. https://doi.org/10.1097/ALN.0000000000002184.

  27. 27.

    Pattinson KTS. Opioids and the control of respiration. Br J Anaesth. 2008;100(6):747–58. https://doi.org/10.1093/bja/aen094.

  28. 28.

    Shook JE, Watkins WD, Camporesi EM. Differential roles of opioid receptors in respiration, respiratory disease, and opiate-induced respiratory depression. Am Rev Respir Dis. 1990;142(4):895–909. https://doi.org/10.1164/ajrccm/142.4.895.

  29. 29.

    Santiago TV, Edelman NH. Opioids and breathing. J Appl Physiol. 1985;59(6):1675–85. https://doi.org/10.1152/jappl.1985.59.6.1675.

  30. 30.

    Dolinak D. Opioid toxicity. Acad Forensic Pathol. 2017;7(1):19–35. https://doi.org/10.23907/2017.003.

  31. 31.

    Lynn RR, Galinkin JL. Naloxone dosage for opioid reversal: current evidence and clinical implications. Ther Adv Drug Saf. 2018;9(1):63–88. https://doi.org/10.1177/2042098617744161.

  32. 32.

    Connors NJ. The evolution of recommended naloxone dosing for opioid overdose by medical specialty. J Med Toxicol. 2016;12(3):276–81. https://doi.org/10.1007/s13181-016-0559-3.

  33. 33.

    Neale J, Strang J. Naloxone--does over-antagonism matter? Evidence of iatrogenic harm after emergency treatment of heroin/opioid overdose. Addiction. 2015;110(10):1644–52. https://doi.org/10.1111/add.13027.

  34. 34.

    Ryan SA, Dunner RB. Pharmacokinetic properties of intranasal and injectable formulations of naloxone for community use: a systematic review. Pain Manag. 2018;8(3):231–45. https://doi.org/10.2217/pmt-2017-0060.

  35. 35.

    Elmer J, Lynch MJ, Kristan J, Morgan P, Gerstel SJ, Callaway CW, et al. Recreational drug overdose-related cardiac arrests: break on through to the other side. Resuscitation. 2015;89:177–81. https://doi.org/10.1016/j.resuscitation.2015.01.028.

  36. 36.

    Parthvi R, Agrawal A, Khanijo S, Tsegaye A, Talwar A. Acute opiate overdose: an update on management strategies in emergency department and critical care unit. Am J Ther. 2019;26:e380–7. https://doi.org/10.1097/MJT.0000000000000681.

  37. 37.

    Elmer J, Flickinger KL, Anderson MW, Koller AC, Sundermann ML, Dezfulian C, et al. Effect of neuromonitor-guided titrated care on brain tissue hypoxia after opioid overdose cardiac arrest. Resuscitation. 2018;129:121–6. https://doi.org/10.1016/j.resuscitation.2018.04.013.

  38. 38.

    He X, Sandhu HK, Yang Y, Hua F, Belser N, Kim DH, et al. Neuroprotection against hypoxia/ischemia: δ-opioid receptor-mediated cellular/molecular events. Cell Mol Life Sci. 2013;70:2291–303. https://doi.org/10.1007/s00018-012-1167-2.

  39. 39.

    Geocadin RG, Koenig MA, Jia X, Stevens RD, Peberdy MA. Management of brain injury after resuscitation from cardiac arrest. Neurol Clin. 2008;26:487–506. https://doi.org/10.1016/j.ncl.2008.03.015.

  40. 40.

    Greer DM. Mechanisms of injury in hypoxic-ischemic encephalopathy: implications to therapy. Semin Neurol. 2006;26(4):373–9. https://doi.org/10.1055/s-2006-948317.

  41. 41.

    Schurr A, Rigor BM. The mechanism of cerebral hypoxic-ischemic damage. Hippocampus. 1992;2(3):221–8. https://doi.org/10.1002/hipo.450020303.

  42. 42.

    Cervos-Navarro J, Diemer NH. Selective vulnerability in brain hypoxia. Crit Rev Neurobiol. 1991;6(3):149–82.

  43. 43.

    Hopkins RO, Bigler ED. Neuroimaging of anoxic injury: implications for neurorehabilitation. NeuroRehabilitation. 2012;31(3):319–29. https://doi.org/10.3233/NRE-2012-0799.

  44. 44.

    Hossmann K-A. The hypoxic brain: insights from ischemia. In: Roach RC, Wagner PD, Hackett PH, editors. Hypoxia Into the Next Millenium: Advances in Experimental Medicine and Biology, vol. 474. Boston: Springer; 1999. https://doi.org/10.1007/978-1-4615-4711-2_14.

  45. 45.

    •• Huang BY, Castillo M. Hypoxic-ischemic brain injury: imaging findings from birth to adulthood. Radiographics. 2008;28:417–39. https://doi.org/10.1148/rg.282075066Comprehensive review article detailing neuro-imaging findings with HI-BI.

  46. 46.

    Barrett KM, Freeman WD, Weindling SM, Brott TG, Broderick DF, Heckman MG, et al. Brain injury after cardiopulmonary arrest and its assessment with diffusion-weighted magnetic resonance imaging. Mayo Clin Proc. 2007;82(7):828–35. https://doi.org/10.4065/82.7.828.

  47. 47.

    Greer D, Scripko P, Bartscher J, Sims J, Camargo E, Singhal A, et al. Clinical MRI interpretation for outcome predictionin cardiac arrest. Neurocrit Care. 2012;17:240–4. https://doi.org/10.1007/s12028-012-9716-y.

  48. 48.

    Roine RO, Raininko R, Erkinjuntti T, Ylikoski A, Kaste M. Magnetic resonance imaging findings associated with cardiac arrest. Stroke. 1993;24(7):1005–14. https://doi.org/10.1161/01.STR.24.7.1005.

  49. 49.

    Andresen M, Gazmuri JT, Marin A, Regueira T, Rovegno M. Therapeutic hypothermia for acute brain injuries. Scand J Trauma Resusc Emerg Med. 2015;23(42). https://doi.org/10.1186/s13049-015-0121-3.

  50. 50.

    Nagal S, Papadakis M, Hoyte L, Buchan AM. Therapeutic hypothermia in experimental models of focal and global cerebral ischemia and intercerebral hemorrhage. Expert Rev Neurother. 2008;8(8):1255–68. https://doi.org/10.1586/14737175.8.8.1255.

  51. 51.

    •• Nora GJ, Harun R, Fine DF, Hutchinson D, Grobart AC, Stezoski JP, et al. Ventricular fibrillation cardiac arrest produces a chronic striatal hyperdopaminergic state that is worsened by methylphenidate treatment. J Neurochem. 2017;142:305–22. https://doi.org/10.1111/jnc.14058This study found that rats had a functionally elevated dopaminergic state following cardiac arrest.

  52. 52.

    Bernat JL. Chronic disorders of consciousness. Lancet. 2006;367:1181–92. https://doi.org/10.1016/S0140-6736(06)68508-5.

  53. 53.

    Bernat JL. The natural history of chronic disorders of consciousness. Neurology. 2010;75:206–7. https://doi.org/10.1212/WNL.0b013e3181e8e960.

  54. 54.

    Bernat JL. Prognostic limitations of syndromic diagnosis in disorders of consciousness. AJOB Neurosci. 2016;7(1):46–8. https://doi.org/10.1080/21507740.2016.1146367.

  55. 55.

    Giacino JT, Kalmar K. Diagnostic and prognostic guidelines for the vegetative and minimally conscious states. Neuropsychol Rehabil. 2005;15(3–4):166–74. https://doi.org/10.1080/09602010443000498.

  56. 56.

    Venkatesan A, Frucht S. Movement disorders after resuscitation from cardiac arrest. Neurol Clin. 2006;24:123–32. https://doi.org/10.1016/j.ncl.2005.11.001.

  57. 57.

    Levy A, Chen R. Myoclonus: pathophysiology and treatment options. Curr Treat Options Neurol. 2016;18(21). https://doi.org/10.1007/s11940-016-0404-7.

  58. 58.

    Freund B, Kaplan PW. Myoclonus after cardiac arrest: where do we go from here? Epilepsy Curr. 2017;17(5):265–72. https://doi.org/10.5698/1535-7597.17.5.265.

  59. 59.

    Khot S, Tirschwell D. Long-term neurological complications after hypoxic-ischemic encephalopathy. Semin Neurol. 2006;26(4):422–31. https://doi.org/10.1055/s-2006-948323.

  60. 60.

    Krumholz A, Stern BJ, Weiss HD. Outcome from coma after cardiopulmonary resuscitation: relation to seizures and myoclonus. Neurology. 1988;38(3):401–5. https://doi.org/10.1212/wnl.38.3.401.

  61. 61.

    Gupta HV, Caviness JN. Post-hypoxic myoclonus: current concepts, neurophysiology, and treatment. Tremor Other Hyperkinet Mov. 2016;6:409. https://doi.org/10.7916/D89C6XM4.

  62. 62.

    Rapun IA, Novy J, Solari D, Oddo M, Rossetti A. Early lance-Adams syndrome after cardiac arrest: prevalance, time to return to awareness, and outcome in a large cohort. Resuscitation. 2017;115:169–72. https://doi.org/10.1016/j.resuscitation.2017.03.020.

  63. 63.

    Katyal N, Narula N, George P, Nattanamai P, Newey CR, Beary JM. Delayed post-hypoxic leukoencephalopathy: a case series and review of the literature. Cureus. 2018;10(4):e2481. https://doi.org/10.7759/cureus.2481.

  64. 64.

    Thacker AK, Asthana AB, Sarkari NB. Delayed post-anoxic encephalopathy. Postgrad Med J. 1995;71(836):373–4. https://doi.org/10.1136/pgmj.71.836.373.

  65. 65.

    Custodio CM, Basford JR. Delayed postanoxic encephalopathy: a case report and literature review. Arch Phys Med Rehabil. 2004;85(3):502–5. https://doi.org/10.1016/S0003-9993(03)00471-4.

  66. 66.

    Plum F, Posner JB, Hain RF. Delayed neurological deterioration after anoxia. Arch Intern Med. 1962;110:18–25. https://doi.org/10.1001/archinte.1962.03620190020003.

  67. 67.

    Won SJ, Kim DY, Gwag BJ. Cellular and molecular pathways of ischemic neuronal death. J Biochem Mol Biol. 2002;35(1):67–86. https://doi.org/10.5483/BMBRep.2002.35.1.067.

  68. 68.

    Choi IS. Delayed neurologic sequelae in carbon monoxide intoxication. Arch Neurol. 1983;40(7):433–5. https://doi.org/10.1001/archneur.1983.04050070063016.

  69. 69.

    Arias F, Arnsten JH, Cunningham CO, Coulehan K, Batchelder A, Brisbane M, et al. Neurocognitive, psychiatric, and substance use characteristics in opioid dependent adults. Addict Behav. 2016;60:137–43. https://doi.org/10.1016/j.addbeh.2016.03.018.

  70. 70.

    Baldacchino A, Balfour DJK, Passetti F, Humphris G, Matthews K. Neuropsychological consequences of chronic opioid use: a quantitative review and meta-analysis. Neurosci Biobehav Rev. 2012;36(9):2056–68. https://doi.org/10.1016/j.neubiorev.2012.06.006.

  71. 71.

    •• Wollman SC, Hauson AO, Hall MG, Connors EJ, Allen KE, Stern MJ, et al. Neuropsychological functioning in opioid use disorder: a research synthesis and meta-analysis. Am J Drug Alcohol Abuse. 2019;45:11–25. https://doi.org/10.1080/00952990.2018.1517262This is a meta-analysis of 61 studies comparing neuropsychological functioning in opioid use disorder in patients to controls. Group differences were present across multiple domains and were influenced by attention ability and duration of abstinence.

  72. 72.

    Scott TM, Rivera Mindt M, Cunningham CO, Arias F, Coulehan K, Mangalonzo A, et al. Neuropsychological function is improved among opioid dependent adults who adhere to opiate agonist treatment with buprenorphine-naloxone: a preliminary study. Subst Abuse Treat Prev Policy. 2017;12:48. https://doi.org/10.1186/s13011-017-0133-2.

  73. 73.

    Barash JA, Ganetsky M, Boyle KL, Raman V, Toce MS, Kaplan S, et al. Acute amnestic syndrome associated with fentanyl overdose [letter]. N Engl J Med. 2018;378:1157–8. https://doi.org/10.1056/NEJMc1716355.

  74. 74.

    • Barash JA, Somerville N, Jr DMA. Cluster of an unusual amnestic syndrome—Massachusetts, 2012–2016. MMWR Morb Mortal Wkly Rep. 2017;66:76–9. https://doi.org/10.15585/mmwr.mm6603a2This report describes a cluster of patients with amnesia possibly associated with opioid use and highlights the need for additional surveillance and investigation as a potential public health syndrome.

  75. 75.

    Benoilid A, Collongues N, de Seze J, Blanc F. Heroin inhalation-induced unilateral complete hippocampal stroke. Neurocase. 2013;19:313–5. https://doi.org/10.1080/13554794.2012.667125.

  76. 76.

    Duru UB, Pawar G, Barash JA, Miller LE, Thiruselvam IK, Haut MW. An unusual amnestic syndrome associated with combined fentanyl and cocaine use. Ann Intern Med. 2018;168:747–8. https://doi.org/10.7326/L17-0575.

  77. 77.

    Haut MW, Hogg JP, Marshalek PJ, Suter BC, Miller LE. Amnesia associated with bilateral hippocampal and bilateral basal ganglia lesions in anoxia with stimulant use. Front Neurol. 2017;8:27. https://doi.org/10.3389/fneur.2017.00027.

  78. 78.

    Ramirez-Zamora A, Ramani H, Pastena G. Bilateral pallidal and medial temporal lobe ischaemic lesions after opioid overdose. J Neurol Neurosurg Psychiatry. 2015;86:1383–4. https://doi.org/10.1136/jnnp-2014-308730.

  79. 79.

    Barash JA, Lev MH. Opioid-associated acute hippocampal injury with cardiac arrest. Radiology. 2018;289:315. https://doi.org/10.1148/radiol.2018181379.

  80. 80.

    O’Brien P, Todd J. Hypoxic brain injury following heroin overdose. Brain impair. 2009;10:169–79. https://doi.org/10.1375/brim.10.2.169.

  81. 81.

    Dassanayake TL, Michie PT, Jones A, Carter G, Mallard T, Whyte I. Cognitive impairment in patients clinically recovered from central nervous system depressant drug overdose. J Clin Psychopharmacol. 2012;32:503–10. https://doi.org/10.1097/JCP.0b013e31825d6ddb.

  82. 82.

    Anderson CA, Arciniegas DB. Cognitive sequelae of hypoxic-ischemic brain injury: a review. NeuroRehabilitation. 2010;26:47–63. https://doi.org/10.3233/NRE-2010-0535.

  83. 83.

    Garcia-Molina A, Roig-Rovira T, Enseñat-Cantallops A, Sanchez-Carrion R, Pico-Azanza N, Bernabeu M, et al. Neuropsychological profile of persons with anoxic brain injury: differences regarding physiopathological mechanism. Brain Inj. 2006;20:1139–45. https://doi.org/10.1080/02699050600983248.

  84. 84.

    Brady JE, Giglio R, Keyes KM, DiMaggio C, Li G. Risk markers for fatal and non-fatal prescription drug overdose: a meta-analysis. Injury Epidemiol. 2017;4(1):24. https://doi.org/10.1186/s40621-017-0118-7.

  85. 85.

    Bartoli F, Carra G, Brambilla G, Carretta D, Crocamo C, Neurfeind J, et al. Association between depression and nonfatal oversodes among drug users: a systematic review and meta-analysis. Drug Alcohol Depend. 2014;134:12–21. https://doi.org/10.1016/j.drugalcdep.2013.10.007.

  86. 86.

    • Snyder S, Morse M, Siobhan A, Bride BE. A comparison of 2013 and 2017 baseline characteristics among treatment-seeking patients who used opioids with co-occurring disorders. J Subst Abus Treat. 2019;99:134–9. https://doi.org/10.1016/j.jsat.2019.01.023This is a summary and discussion of the robust association between depressive disorders and non-fatal drug overdose.

  87. 87.

    Hunt GE, Malhi GS, Cleary M, Man H, Lai HM, Sitharthan T. Comorbidity of bipolar and substance use disorders in national surveys of general populations, 1990–2015: systematic review and metaanalysis. J Affect Disord. 2016;206:321–30. https://doi.org/10.1016/j.jad.2016.06.051.

  88. 88.

    Yoon YH, Chen CM, Yi HY. Unintentional drug and alcohol poisoning in association with substance use disorder and mood and anxiety disorders: results from the 2010 Nationwide Inpatient Sample. Injury Prevent. 2014;20(1):21–8. https://doi.org/10.1136/injuryprev-2012-040732.

  89. 89.

    Grigsby TJ, Howard P. Prescription opioid misuse and comorbid substance use: past 30-day prevalence, correlates and co-occurring behavioral indicators in the 2016 National Survey on Drug Use and Health. Am J Addict. 2019;28(2):111–8. https://doi.org/10.1111/ajad.12866.

  90. 90.

    Passik SD, Lowery A. Psychological variables potentially implicated in opioid-related mortality as observed in clinical practice. Pain Med. 2011;12:S36–42. https://doi.org/10.1111/j.1526-4637.2011.01130.x.

  91. 91.

    Garland EL, Hanley AW, Thomas EA, Knoll P, Ferraro J. Low dispositional mindfulness predicts self-medication of negative emotion with prescription opioids. J Addict Med. 2015;9(1):61–7. https://doi.org/10.1097/ADM.0000000000000090.

  92. 92.

    Sanmartin MX, Ali MM, Novac P, Chen J. Sources and main motivation for prescription opioid misuse among reproductive-aged parenting women in the United States. Subst Use Misuse. 2019;54(8):1332–6. https://doi.org/10.1080/10826084.2019.1580294.

  93. 93.

    Garland EL, Bryan CJ, Nakamura Y, Froeliger B, Howard MO. Deficits in autonomic indices of emotional regulation and reward processing associated with prescription opioid use and misuse. Psychopharmacology. 2017;234(4):621–9. https://doi.org/10.1007/s00213-016-4494-4.

  94. 94.

    Kroll SL, Nikolic E, Bieri F, Soyka M, Baumgartner MR, Quednow BB. Cognitive and socio-cognitive functioning of chronic non-medical prescription opioid users. Psychopharmacology. 2018;235(12):3451–64. https://doi.org/10.1007/s00213-018-5060-z.

  95. 95.

    Barnett MH, Miller LA, Reddel SW, Davies L. Reversible delayed leukoencephalopathy following intravenous heroin overdose. J Clin Neurosci. 2001;8(2):165–7. https://doi.org/10.1054/jocn.2000.0769.

  96. 96.

    Furer T, Hauptman AJ, Gurin L. “Depression” after hypoxic-ischemic injury. In: Hauptman A, Salpekar J, editors. Pediatric Neuropsychiatry. Cham: Springer; 2019. https://doi.org/10.1007/978-3-319-94998-7.

  97. 97.

    Huang MF, Yeh YC, Tsang HY, Chen CS. Alexithymia associated with bilateral globus pallidus lesions after carbon monoxide poisoning. Kaohsiung J Med Sci. 2010;26(6):333–6. https://doi.org/10.1016/S1607-551X(10)70048-6.

  98. 98.

    Tazopoulou E, Miljkovitch R, Truelle JL, Schnitzler A, Onillon M, Zucco T, et al. Rehabilitation following cerebral anoxia: assessment of 27 patients. Brain Inj. 2016;30(1):95–103. https://doi.org/10.3109/02699052.2015.1113563.

  99. 99.

    Shah R, Faruqui RA. Delusional jealousy and person directed hostility: 5-year follow-up of a patient after anoxic brain injury. Brain Inj. 2013;27(13–14):1719–22. https://doi.org/10.3109/02699052.2013.831129.

  100. 100.

    Shin JU, Lee J, Park JI. A case of psychosis following delayed encephalopathy of transdermal fentanyl intoxication. Korean J Physiol Pharmacol. 2015;26(1):29–34. https://doi.org/10.0000/kjp.2015.26.1.29.

  101. 101.

    Park YM, Kim YS. Secondary mania in a patient with delayed anoxic encephalopathy after carbon monoxide intoxication caused by a suicide attempt. Gen Hospital Psychiatry. 2014;36(1):125.e3–4. https://doi.org/10.1016/j.genhosppsych.2013.07.003.

  102. 102.

    Quinn KD, Abbott CC. Catatonia after cerebral hypoxia: do the usual treatments apply? Psychosomatics. 2014;55(6):525–35. https://doi.org/10.1016/j.psym.2014.03.010.

  103. 103.

    Sawyer KN, Callaway CW, Wagner AK. Life after death: surviving cardiac arrest—an overview of epidemiology, best acute care practices, and considerations for rehabilitation care. Curr Phys Med Rehabil Rep. 2017;5:30–9. https://doi.org/10.1007/s40141-017-0148-7.

  104. 104.

    • Green CR, Botha JA, Tiruvoipati R. Cognitive function, quality of life and mental health in survivors of our-of-hospital cardiac arrest: a review. Anaesth Intensive Care. 2015;43(5):568–76. https://doi.org/10.1177/0310057X1504300504This is a review of long-term health-related quality of life, including cognitive and psychological outcomes, following cardiac arrest.

  105. 105.

    Frisch S, Thiel F, Schroeter ML, Jentzsch RT. Apathy and cognitive deficits in patients with transient global ischemia after cardiac arrest. Cogn Behav Neurol. 2017;30(4):172–5. https://doi.org/10.1097/WNN.0000000000000139.

  106. 106.

    Blanchard J, Weiss AJ, Barrett ML, Stocks C, Owens PL, Coffey R, et al. Readmissions following inpatient treatment for opioid-related conditions. Subst Use Misuse. 2019;3:473–81. https://doi.org/10.1080/10826084.2018.1517174.

  107. 107.

    Larochelle MR, Bernson D, Land T, Stopka TJ, Wang N, Xuan Z, et al. Medication for opioid use disorder after nonfatal opioid overdose and association with mortality: a cohort study. Ann Intern Med. 2018;169(3):137–45. https://doi.org/10.7326/M17-3107.

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Correspondence to Justin S. Hong.

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Hong, J.S., Moran, M.T., Eaton, L.A. et al. Neurologic, Cognitive, and Behavioral Consequences of Opioid Overdose: a Review. Curr Phys Med Rehabil Rep 7, 305–313 (2019). https://doi.org/10.1007/s40141-019-00247-2

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Keywords

  • Opioid
  • Overdose
  • Brain injury
  • Cognition
  • Behavior
  • Hypoxic ischemic