The Effects of Opioids on the Lung

Abstract

The term opioid refers to a broad class of medications that are used most frequently for their analgesic effects. Along with this effect, they also produce euphoria, and it is for this reason that they have been used illicitly, as well as medicinally, for thousands of years. While the most well-known complications of opioid use and misuse include respiratory and central nervous system depression, there are many other toxicities that have been associated with these drugs. Many complications can occur with multiple different opioids, such as non-cardiogenic pulmonary edema, while many of the complications are unique to the opioid used as well as the route of administration. This review focuses on the pulmonary complications associated with opioid use and abuse, but opioids can affect nearly every organ system. Their effects on the pulmonary system can be direct, such as causing granulomatous change, but they can also work indirectly. For example, opioids cause respiratory depression by decreasing sensitivity of peripheral chemoreceptors to carbon dioxide and decreasing activity in the central respiratory centers. Opioids have also been reported to affect the immune system, and place users at increased risk for many different infectious complications. Patients can have a wide array of signs and symptoms, sometimes making it difficult to recognize opioids as a cause for a patient's clinical picture. Due to the sedative effects of opioids, patients are also often not able to provide a reliable history. Knowledge of the possible toxicities of opioids can help prepare a physician to recognize the many complications associated with opioid use.

Fatality of 33‐Year‐Old Man Involving Kratom Toxicity

“…Excluding mitragynine, the medical examiner concluded that all other substances in the blood were at levels that would be unlikely to contribute to the cause of death. The pulmonary congestion and edema identified through autopsy, though not specific, supported this conclusion; these findings are typically observed in deaths resulting from opioid use . With no prior attempts or outward signs of suicide noted, the medical examiner classified the decedent's manner of death as an “accident.” When compared with other fatal cases involving mitragynine toxicity, the elevated concentrations of mitragynine in the current case report are some of the highest levels reported to date .…”

Heroin Epidemic and Acute Kidney Injury: An Under-Recognized but Important Consequence of Opioid Overdose

“…The pulmonary infiltrates are not due to infection (pneumonia), can be bilateral or unilateral and resolve within 48 h [19]. Multiple recent reports have documented unilateral pulmonary infiltrate associated with a high leukocyte count following heroin overdose [19][20][21][22]. Both resolve spontaneously within 48 h and are not associated with infection [19][20][21][22].…”

“…Multiple recent reports have documented unilateral pulmonary infiltrate associated with a high leukocyte count following heroin overdose [19][20][21][22]. Both resolve spontaneously within 48 h and are not associated with infection [19][20][21][22]. In the 25-year-old male, after normal physical examination on day 2, the internist obtained a chest X-ray to document the disappearance of infiltrates.…”

Acute Radiologic Manifestations of America’s Opioid Epidemic

“…Another entity that can occur in association with opioid abuse is noncardiogenic pulmonary edema (NCPE) (56,57). In one cohort of patients who presented with symptoms of opioid overdose, NCPE was found in 10% of these patients, with a male predominance.…”

“…In one cohort of patients who presented with symptoms of opioid overdose, NCPE was found in 10% of these patients, with a male predominance. The pulmonary edema is most often caused by the opioid itself and is seen in association with the use of different µ-receptor agonists, including heroin and buprenorphine (56,57). It is worth mentioning that in some cases, NCPE has also been attributed to naloxone use rather than the opioid itself (58).…”