A patient being treated for severe pain with opioids may develop opioid toxicity if too much drug is given or if it accumulates due to decreased excretion.
Risk factors for opioid toxicity:
(1) rapid escalation in dose when trying to control severe pain
(2) renal impairment (for an opioid excreted by the kidney)
(3) pain unresponsive to opioid, causing ever increasing doses and/or more frequent dosing
(4) following a pain relieving intervention (nerve block, radiation therapy, etc; I assume this is because of loss in arousal caused by the decrease in pain)
(5) miscalculation of dose
(6) malfunction (accidental or intentional) associated with a drug infusion pump delivering the opioid
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