title: Do co-intoxicants increase adverse event rates in the first 24 hours in patients resuscitated from acute opioid overdose?
abstract: BACKGROUND
  Patients frequently arrive in emergency departments (EDs) after being resuscitated from opioid overdose. Autopsy studies suggest that multidrug intoxication is a major risk factor for adverse outcomes after acute heroin overdose in patients. If this is true, there may be high-risk drug combinations that identify patients who require more intensive monitoring and prolonged observation. Our objective was to determine the impact of co-intoxication with alcohol, cocaine, or CNS depressant drugs on short-term adverse event rates in patients resuscitated from acute opioid overdose.
  
  
  METHODS
  Data were extracted from the database of a prospective opioid overdose cohort study conducted between May 1997 and 1999. Patients were prospectively enrolled if they received naloxone for presumed opioid overdose. Investigators gathered clinical, demographic, and other predictor variables, including co-intoxicants used. Patients were followed to identify prespecified adverse outcome events occurring within 24 h, and multiple logistic regression was used to determine the association of concomitant drug use on short-term adverse event rates.
  
  
  RESULTS
  Of 1155 patients studied, 58 (5%) had pure opioid overdose and 922 (80%) reported co-intoxicants, including alcohol, cocaine, and CNS depressants. Overall, out of 1056 patients with known outcome status there were 123 major adverse events (11.6%) and 194 minor adverse events (18.4%). After adjustment for age, gender, HIV status, cardiovascular disease, pulmonary disease and diabetes, we found that coadministration of alcohol, cocaine, or CNS depressants, alone or in combination, was not associated with increased risk of death or adverse events during the 24 h follow-up period.
  
  
  CONCLUSIONS
  In patients resuscitated from acute opioid overdose, short-term outcomes are similar for patients with pure opioid overdose and multidrug intoxications. A history of cointoxication cannot be used to identify high-risk patients who require more intensive ED monitoring or prolonged observation.
authors.affiliation: Department of Emergency Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, Canada. smm@fastmail.ca
authors.forename: Seyed Mostafa
authors.initials: SM
authors.lastname: Mirakbari
authors.forename: Grant D
authors.initials: GD
authors.lastname: Innes
authors.forename: Jim
authors.initials: J
authors.lastname: Christenson
authors.forename: Jessica
authors.initials: J
authors.lastname: Tilley
authors.forename: Hubert
authors.initials: H
authors.lastname: Wong
mesh_terms: D000208:Acute Disease; D000328:Adult; D002492:Central Nervous System Depressants / Q000506:poisoning; D003042:Cocaine / Q000506:poisoning; D016208:Databases, Factual; D062787:Drug Overdose; D004357:Drug Synergism; D000431:Ethanol / Q000506:poisoning; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009293:Opioid-Related Disorders / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D011446:Prospective Studies; D012151:Resuscitation; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D002492:Central Nervous System Depressants; D000431:Ethanol; D003042:Cocaine