Toxicology
Massive OxyContin ingestion refractory to naloxone therapy*

https://doi.org/10.1067/mem.2002.128143Get rights and content

Abstract

OxyContin (oxycodone hydrochloride controlled release) is a long-acting preparation of oxycodone that is used as an opioid analgesic to treat chronic pain conditions. We report a patient who ingested a massive quantity of OxyContin and had altered mental status, noncardiogenic pulmonary edema, and hypoventilation that proved refractory to naloxone administration. She required mechanical ventilation for 3 days before recovering completely. The severity and length of poisoning was likely related both to the quantity and formulation of the oxycodone ingested. [Ann Emerg Med. 2002;40:425-428.]

Introduction

OxyContin (oxycodone hydrochloride controlled release) has recently received attention as a new drug of abuse.1 However, there is little medical literature describing abuse or poisoning with OxyContin.2, 3 Oxycodone is primarily a μ-opioid agonist that has a similar abuse potential as morphine.4, 5 Compared with oral morphine, oxycodone has 1.5 to 2 times the analgesic potency.6 The tablet OxyContin is formulated with a coating that allows for controlled release, a property that might be therapeutically beneficial.2 However, in overdose conditions such a controlled-release formulation would be expected to cause prolonged toxicity. We report a case of massive OxyContin ingestion in which the patient experienced prolonged respiratory depression refractory to high-dose naloxone therapy.

Section snippets

Case report

After a brief, witnessed, generalized convulsion, paramedics arrived to find a 45-year-old woman lying on the ground with a nearly full bottle containing OxyContin. She was cyanotic with a respiratory rate of 6 breaths/min, had pinpoint pupils, and had frequent premature ventricular contractions (PVCs). Two milligrams of naloxone were administered intravenously, with full reversal of her depressed level of consciousness, hypoventilation, and miosis. She told the paramedics that she had ingested

Discussion

This patient had severe opioid intoxication from a massive ingestion of a controlled-release formulation of oxycodone. The most striking aspects of this case were the prolonged and refractory nature of the patient's respiratory compromise. These features were most likely the result of the massive ingestion and sustained-release formulation rather than being a unique property of oxycodone. In addition, the opioid effect of oxycodone on the gastrointestinal tract to decrease transit time and

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*

Address for reprints: Aaron Schneir, MD, California Poison Control System, San Diego Division, UCSD Medical Center #8925, 200 West Arbor Drive, San Diego, CA 92103-8925; 858-715-6308, fax 858-715-6361; E-mail [email protected]

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