Acute risk factors in fatal opioid overdoses as a result of hypoxia and cardiotoxicity. A systematic review and critical appraisal

Abstract

Background: The rates of fatal opioid overdoses (FOO) have increased rapidly over the last 10 years. The actual phenomenon occurs as a result of a toxic opioid effect on the cardiorespiratory system. Aims: The systematic review aimed to identify the acute risk factors in fatal opioid overdose (FOO) as a result of hypoxia and cardiotoxicity. Methods: A systematic review was undertaken. The selection of papers has utilised rigorous criteria of inclusion/exclusion, controlled for heterogeneity. Results: A total of thirteen articles met the inclusion criteria. Ten of the thirteen studies included were retrospective and the other three studies employed different designs namely longitudinal cohort, case control and case cohort. Factors that were modestly described with increased acute risk of FOO due to hypoxia and cardiotoxicity include multiple sedative use (opioids and alcohol), reduced tolerance and presence of an acute painful condition. Conclusion: This systematic review has highlighted the lack of information on acute risk factors of FOO due to hypoxia and cardiotoxicity. Future studies need to explore possible mechanisms underlying cardiotoxicity such as reported changes in arterial stiffness in opioid dependent populations and the unexplored potential effects on endothelial function.