Opioid overdose is the leading cause of death for Americans 25 to 64 years of age, and
opioid use disorder affects >2 million Americans. The epidemiology of
opioid-associated
out-of-hospital cardiac arrest in the United States is changing rapidly, with exponential increases in death resulting from synthetic
opioids and linear increases in
heroin deaths more than offsetting modest reductions in deaths from prescription
opioids. The pathophysiology of polysubstance toxidromes involving
opioids, asphyxial death, and prolonged
hypoxemia leading to global
ischemia (
cardiac arrest) differs from that of
sudden cardiac arrest. People who use
opioids may also develop
bacteremia,
central nervous system vasculitis and
leukoencephalopathy,
torsades de pointes, pulmonary vasculopathy, and
pulmonary edema. Emergency management of
opioid poisoning requires recognition by the lay public or emergency dispatchers, prompt emergency response, and effective ventilation coupled to compressions in the setting of
opioid-associated
out-of-hospital cardiac arrest. Effective ventilation is challenging to teach, whereas
naloxone, an
opioid antagonist, can be administered by emergency medical personnel, trained laypeople, and the general public with dispatcher instruction to prevent
cardiac arrest.
Opioid education and
naloxone distributions programs have been developed to teach people who are likely to encounter a person with
opioid poisoning how to administer
naloxone, deliver high-quality compressions, and perform rescue breathing. Current American Heart Association recommendations call for laypeople and others who cannot reliably establish the presence of a pulse to initiate
cardiopulmonary resuscitation in any individual who is unconscious and not breathing normally; if
opioid overdose is suspected,
naloxone should also be administered.
Secondary prevention, including counseling,
opioid overdose education with take-home
naloxone, and medication for
opioid use disorder, is important to prevent recurrent
opioid overdose.