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Update on Current Treatment of Acute Opioid Overdose

  • Substance Use Disorders (FG Moeller, Section Editor)
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Abstract

Purpose

Opioid use, misuse, and abuse are now a rapidly evolving epidemic in the USA. This review aims to update changes in the dosing of naloxone, describe new strategies in prehospital management, and examine in more detail the diverse pathophysiology of opioids beyond respiratory depression.

Recent findings

There are no comparative studies of old or new antidotes or procedures elucidating the superiority of one therapy. Abuse and misuse of over-the-counter loperamide and non-FDA approved tianeptine, using the herbal product kratom, and gambling with powerful fentanyl analogues are recent trends that will impact clinical care. The response to these new threats has resulted in excellent reviews, epidemiology, and case series which are commonly the only data available in the discipline of medical toxicology.

Summary

The antidote naloxone is still first-line therapy to reverse respiratory depression from opioids. Larger and more frequent doses of naloxone may be necessary in the presence of potent fentanyl derivatives. In the hospital, other toxicities may need to be managed such as acute lung injury, seizures, cardiotoxicity, or serotonin toxicity. Therapy for each of these is dependent on attentive supportive care and a variety of antidotes.

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Authors and Affiliations

  1. Department of Emergency Medicine, Virginia Commonwealth University Health System, Virginia Poison Center, 830 E. Main St. Suite 300, Richmond, VA, 23219, USA

    Kirk L. Cumpston DO, FACEP, FACMT, FACCT, John C. Wiggins III MD, Sean Mlodzinski MD, Jacob Moyer DO & Brandon K. Wills DO, FACEP, FACMT

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  1. Kirk L. Cumpston DO, FACEP, FACMT, FACCT
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  2. John C. Wiggins III MD
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  3. Sean Mlodzinski MD
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  4. Jacob Moyer DO
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  5. Brandon K. Wills DO, FACEP, FACMT
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Correspondence to Kirk L. Cumpston DO, FACEP, FACMT, FACCT.

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Kirk L. Cumpston declares that he has no conflict of interest. John C. Wiggins III declares that he has no conflict of interest. Sean Mlodzinski declares that he has no conflict of interest. Jacob Moyer declares that he has no conflict of interest.

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Cumpston, K.L., Wiggins, J.C., Mlodzinski, S. et al. Update on Current Treatment of Acute Opioid Overdose. Curr Treat Options Psych 5, 301–312 (2018). https://doi.org/10.1007/s40501-018-0149-x

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