Citation

Zivanovic R, Wood E, Nolan S. Can. J. Addict. 2016; 7(4): 19-24.

Copyright

(Copyright © 2016, Canadian Society of Addiction Medicine)

DOI

unavailable

PMID

unavailable

Abstract

Drug-related overdoses and deaths are a major public health concern in Canada. Reasons for this include high rates of opioid and benzodiazepine prescribing in addition to a surge of high potency opioids, such as fentanyl, in Canada's illicit drug markets. The vast majority of opioid-related overdose deaths are accidental in nature and require emergency resuscitation with naloxone, a pure mu opioid receptor antagonist. Though established as an effective antidote for opioid overdose, there is some literature to suggest naloxone may also be an effective intervention for a variety of non-opioid toxicities. Here we report a case of a patient who presented to the emergency department of an urban hospital located in downtown Vancouver, Canada due to an overdose after intentionally ingesting multiple unknown illicitly purchased pills. Despite empiric treatment with a naloxone infusion, which was associated with clinical improvement, the patient's urine mass spectrometry collected over 40 hours after initial presentation was negative for all opioids and their metabolites. This case reinforces the importance of prompt urine drug screen collection and emphasizes the complexity in detecting a potential highpotency opioid overdose. Furthermore, it highlights the potential difficulty in differentiating the clinical presentation of a benzodiazepine from opioid induced overdose and considers what role, if any, naloxone might play in the management of a non-opioid toxicity.

Language: en

Keywords

adult; human; naloxone; female; case report; Overdose; Drug use; suicide attempt; drug overdose; clinical article; mass spectrometry; quetiapine; middle aged; temazepam; drug urine level; emergency treatment; drug efficacy; drug tolerability; urinalysis; drug screening; topiramate; escitalopram; narcotic agent; Article; consciousness disorder; drug dose increase; oxazepam; Naloxone; Benzodiazapine toxicity; Opioid toxicity