A person who uses opiates long enough will develop tolerance. This means that higher and higher doses are required to achieve a “high”.. The tolerance may be lost after a few days of abstinence.
Clinical findings:
(1) A person has a history of abusing opiates with tolerance.
(2) The person discontinues opiate use for a reason, such as detoxification, imprisonment or hospitalization.
(3) When the person is discharged s/he starts abusing opiates again, using an amount that was safe when the person was opiate tolerant.
(4) Because the person is no longer tolerant the dose causes overdose and possibly death.
Quantitative hair testing can demonstrate an absence of opiates in the hair just prior to presentation. Urine testing for opiates should be positive since it will be an acute exposure.
The diagnosis requires exclusion of other causes of sudden death.
Prevention may include:
(1) educate addicts about tolerance and loss of tolerance
(2) provide naloxone kits to the community
(3) use of extended-release naltrexone in the post-release period
To read more or access our algorithms and calculators, please log in or register.
