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Opioid Toxicity Workup

  • Author: Everett Stephens, MD; Chief Editor: Asim Tarabar, MD  more...
Updated: Jul 14, 2016

Laboratory Studies

Drug screens are widely available but rarely alter clinical management in uncomplicated overdoses. Drug screens are most sensitive when performed on urine. Positive results are observed up to 36-48 hours postexposure, but wide variations are possible depending upon test sensitivity, dose, route, and the patient's metabolism.

In patients with moderate-to-severe toxicity, performing the following baseline studies is appropriate:

  • Complete blood cell count
  • Comprehensive metabolic panel
  • Creatine kinase level
  • Arterial blood gas determinations

Imaging Studies

Obtain chest radiographs if acute lung injury is suspected. Abdominal films may be helpful when evaluating a suspected body stuffer or body packer. Although the body stuffer (ie, a person who quickly swallows drug packages in an effort to hide evidence from police) is more prone to toxicity from hasty preparation, body packers (ie, individuals who carefully seal large amounts of drugs in packages and then swallow them for transport) have much larger amounts of drug liberated should their packages leak. Films suggestive of ingestion are helpful in making a diagnosis, but films negative for drug packages do not rule out potentially life-threatening ingestions.[18]



An ECG should be obtained on all patients with intentional overdose (possible cardiotoxic co-ingestants) or those with significant toxicity.

Contributor Information and Disclosures

Everett Stephens, MD Assistant Clinical Professor, Department of Emergency Medicine, University of Louisville School of Medicine

Everett Stephens, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Michael J Burns, MD Instructor, Department of Emergency Medicine, Harvard University Medical School, Beth Israel Deaconess Medical Center

Michael J Burns, MD is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Asim Tarabar, MD Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital

Disclosure: Nothing to disclose.

Additional Contributors

Mark Louden, MD Assistant Professor of Clinical Medicine, Division of Emergency Medicine, Department of Medicine, University of Miami, Leonard M Miller School of Medicine

Mark Louden, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

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