Know the risk factors for an opioid overdose

More than 130 people die from opioid overdose every day in the United States (“Opioid crisis,” 2023). Deaths from drug overdoses are more frequent than motor vehicle-related deaths in some U.S. states, and around the world the most common cause of death for opioid users is overdose.

An opioid overdose occurs if more of an opioid is ingested than a person’s body can handle at that moment. In this case, the opioid slows down the breathing so that the person does not get enough oxygen. Breathing can also stop completely, and the heart can stop. If intervention measures are not taken, the overdose victim may become unconscious, fall into a coma, have long-term brain/nerve or physical damage, or even die. Most opioid overdose deaths are not instantaneous; they usually occur over 1–3 hours after use, so even if the person is not breathing or is unresponsive, an intervention can still help.

Tolerance shift

Individuals with decreased tolerance due to recent release from incarceration, drug treatment/detoxification, hospitalization, abstinence, or intermittent nondaily use of opioids are at risk.

Mixing drugs

Combining opioids with other legal or illegal substances may enhance their effects and thus increase the overdose risk. Combining opioids with alcohol, benzodiazepines, barbiturates, or other psychotropic medications, such as antidepressants, is very dangerous.

Previous history of overdose

Individuals who have had a prior overdose event at any point in their lifetime are more likely to experience another overdose.

Physical health

If a person’s body is already burdened with an acute or chronic illness (e.g. asthma, other substance use disorder, HIV, etc.), the person is more vulnerable to overdose.

Variation in opioid strength/content

Illegally purchased substances vary greatly in their strength (e.g., one bag of heroin or fentanyl might not be as strong as another bag even when obtained from the same seller).

Switching from snorting/smoking to injection

How a person ingests a substance plays an important role in overdose risk. Injecting is usually riskier than other forms of administration, but an overdose can also occur when a person just swallows a single pill.

Using alone

If no one is there, no one can help. Overdose reversal can be effective 1–3 hours after use of the opioid, but the risk of fatality is high if the user is alone.

Persons with concurrent medical illnesses that increase breathing difficulty

Any medical problem that independently impairs respiration or increases the risk of respiratory depression (particularly heart and pulmonary problems, or sleep apnea) will increase the risk that opioid consumption may result in an overdose.

Persons with chronic pain

Persons with chronic pain who are exposed to high-dose opioids for extended periods of time have an increased opportunity for an overdose event to occur. This population is also highly likely to be coprescribed other medications that could interact with or increase the risk of respiratory depression and/or have concurrent medical illnesses that could further increase their risk.

Older individuals

The rate of overdose among older persons continues to increase. This is likely due to the presence of concurrent medical illnesses and concurrent prescriptions that reduce their threshold for respiratory depression. Not adhering to medication dosing schedules (e.g., doubling up medications or taking them too close together in time) could also increase the risk of an overdose.

Children

The incidence of opioid overdose among children under 2 years of age who are accidentally exposed to opioids has steadily increased over the past decade. It is important for opioids to be kept in childproof containers and stored in secure places to minimize the risk of accidental exposure.

Men

Data suggest that men are significantly more vulnerable than women to overdose deaths involving opioid and stimulant drugs, with one study finding that men had a 2–3 times greater rate of overdose death from opioids (Butelman et al., 2023). Although the basis for this discrepancy is not well understood, researchers posit that biological, behavioral, and social factors likely combine to increase the men’s risk for opioid overdose.