Oxycodone Overdose: Signs, Symptoms, and Treatment

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Oxycodone is a narcotic analgesic given to treat moderate to severe pain. Prescription opioids, such as oxycodone, can lead to serious health consequences even when taken as prescribed.¹Oxycodone use can lead to misuse, addiction, and withdrawal.² But the most dangerous risk of taking this type of opioid is the risk of oxycodone overdose. Opioid overdose can be life-threatening.^{3, 4}

How Oxycodone Overdose Occurs

Overdose, also called toxicity, occurs when you take more of a substance than your body can safely process.⁵ Overdose can happen when accidentally taking too much oxycodone.⁶ The risk of overdose increases when a person intentionally misuses this substance, particularly when oxycodone is used for sedation or to become intoxicated.^6,7

Accidental Overdose

Accidental overdose may occur while using oxycodone as prescribed.⁸ Accidental overdose risk increases when a person takes larger doses than prescribed to achieve faster, longer-lasting, or stronger pain relief.⁸ The potential for dependence and addiction are the underlying factors that increase a person’s risk of oxycodone overdose.^{2, 3}

Improper use of extended-release capsules or liquid solutions can further increase your chance of experiencing an accidental oxycodone overdose.⁸ For example, when an extended-release tablet is not taken whole (e.g., when a capsule is opened or a pill is crushed), the entire dose is released immediately rather than over a period of 8-12 hours. In many instances, the extended-release capsule discharges the medication faster than the body can safely process. Mistakes in measuring liquid solutions of oxycodone can also result in accidentally taking higher concentrations of the drug.⁸

An accidental oxycodone overdose can occur during misuse. The risk of overdose increases when using counterfeit oxycodone from illicit sources.⁹

Counterfeit medications may come adulterated, or “cut,” with substances like fentanyl. Fentanyl is a synthetic opioid narcotic.¹⁰ Fentanyl is considered one of the most potent opiate-based drugs, often only prescribed for severe pain (e.g., pain in terminal cancer patients and individuals receiving end-of-life care) if oxycodone and other opioids become ineffective due to a person developing a tolerance.¹⁵ Taking oxycodone cut with fentanyl can result in ingesting a life-threatening amount of opioids.

Polysubstance Overdose

Combining oxycodone with other substances, intentionally or unintentionally, can increase the risk of health complications and overdose, ⁸these substances include:^{3, 8}

Alcohol
Antipsychotics
Benzodiazepines
Certain antibiotics
Hypnotic agents
Muscle relaxants
Sedatives

Talk to your health care provider for a complete list of contraindicated medications when taken with oxycodone. Your health care provider can help you weigh the risks and benefits of oxycodone use.

A qualified provider can also guide you through best practices for safe prescription oxycodone use.

Oxycodone Overdose Signs and Symptoms

Even taking oxycodone as prescribed can result in side effects.⁸ These symptoms may differ from the signs of oxycodone overdose.⁶

Side effects of oxycodone use can include:^{6, 8}

Stomach cramps
Drowsiness
Headache
Dry mouth
Changes in mood
Flushing, or increased blood flow to the face, chest, and neck that may change skin temperature and color

If these symptoms persist or become severe, consult with your health care provider.⁸

Severe side effects of oxycodone include: ^6,8

Anxiety
Changes in appetite
Nausea and vomiting
Difficulty or inability to sleep
Increased physical pain
Joint aches
Backache
Hives or rash with itching
Swelling in different body parts, especially in the face

These side effects can indicate acute or progressive health issues related to use of oxycodone. Report mood, sleep, appetite, and pain symptom changes to your prescribing doctor the first time they happen.

Treat symptoms that could be an allergic reaction, like hives or swelling, as a potential medical emergency. Contact your prescribing doctor right away and seek medical attention if you experience any breathing changes.

Breathing changes are one of the most common severe side effects of opioids like oxycodone. Respiratory changes are associated with both allergic reactions and overdose.

Signs of oxycodone overdose include:^{6, 8}

Labored, slow, or an absence of breathing
Extreme drowsiness
Changes in pupil size
Limp or weakened muscle
Changes in pulse rate and blood pressure
Unresponsiveness

If someone who has used oxycodone shows signs of an oxycodone overdose, seek immediate emergency medical attention. The cardiac and respiratory symptoms of an oxycodone overdose can have life-threatening consequences.⁶ The loss of oxygen to the brain can result in chronic brain injury or oxycodone overdose death.¹¹

Oxycodone Overdose Risks

After a person stops using oxycodone, the risk of overdose increases if they use oxycodone again because abstinence increases a person’s sensitivity to oxycodone’s effects.^5,13

People with certain medical conditions may also have a higher risk of experiencing oxycodone overdose.³ Personal and health factors which could increase your risk of adverse effects or oxycodone overdose include:^{3, 8, 12}

Being 65 years or older
History of respiratory illness
Sleep apnea
Cachexia, or wasting syndrome associated with chronic illness
Chronic illness affecting the respiratory, cardiac, or immune systems
Low blood pressure
Stomach or intestine blockage, or other intestinal disorders
Addison’s disease
History of seizures
Heart disease
Kidney disease
Liver disease
Gallbladder disease
Pancreas disease
Thyroid disease
Colon cancer
Esophageal cancer
Reduced opioid tolerance

Obesity—broadly defined as a body mass index (BMI) over 30—is considered an additional risk factor for opioid overdose. However, studies do not show a causal relationship between BMI and overdose, but rather that a high percentage of individuals with a BMI over 30 receive opioid prescriptions for pain, thereby increasing their situational risk of overdose.¹⁶

In many cases, these individuals also do not receive the treatments or services that would allow them to discontinue opioid use, such as physical therapy, reconstructive or reparative surgery, and integrated pain treatments—sometimes due directly to their categorization as “obese.”¹⁶ This can increase the risk of overdose by lengthening the duration of the prescription and leading to a tolerance to the opioid.¹⁶

Oxycodone Withdrawal and Tolerance

Withdrawal symptoms occur when a person reduces the amount of oxycodone taken or when discontinuing oxycodone use.^4,12

The longer you take oxycodone, the greater the risk of developing opioid tolerance.⁴ Tolerance occurs when the effects of oxycodone become weaker. Tolerance causes the need for more oxycodone to achieve the desired result.⁴ People who misuse oxycodone may develop addiction and withdrawal symptoms alongside increased tolerance.

A history of addiction or other mental health conditions can increase your risk of experiencing oxycodone overdose.¹² Having dual diagnosis or a mental health condition at the same time as a substance use disorder can require specialized intervention and treatment.¹³SUD is the clinical name used for addiction.

Oxycodone Overdose Treatment

The preferred approach to oxycodone overdose treatment involves preventative measures. Learning the importance of strictly following the heath care providers’ instructions and safely discontinuing the prescription opioid medication may help protect you from the risk of overdose.²

Talk with your doctor about your need for opioid medication and the benefits alternatives, such as integrated pain management, nonnarcotic pain medication, and alternative methods of pain relief.² Discuss any medical or substance use history that you or your family has experienced. Consider how to keep your medicines secured in your home to reduce the risk of misuse by others.²

If you receive a prescription for oxycodone, use it as directed and maintain regular contact with your health care provider regarding any changes in your physical and mental status.^2,7 Consult with your health care provider before discontinuing the use of oxycodone. A qualified medical professional can help you safely taper off of oxycodone and minimize the impact of withdrawal on your health.¹²

If you, or someone you know, intentionally or accidentally experiences an overdose, call 911 or seek emergency medical attention immediately. Stay with the person and attempt to help them breathe if needed.⁷ Position the person on their side in the recovery position to prevent choking if they experience vomiting. If possible, administer naloxone.⁷

Naloxone for Oxycodone Overdose

Naloxone, available with a prescription and over the counter in some states, can reverse the respiratory effects of opioid overdose.¹⁴ Offered in auto-injectable and nasal spray formulas, naloxone can help a person breathe normally during an overdose event. Emergency medical responders and caregivers or loved ones with adequate training can administer this medication.¹⁴

Continuous monitoring is necessary after receiving naloxone while waiting for medical emergency support to arrive.¹⁴ In some instances, multiple doses of naloxone are required within minutes of a previous dosage.⁸

Naloxone can reduce the risk of severe and lasting consequences of oxycodone overdose, including brain injury or oxycodone overdose death.^8,11

Transitioning to Long-Term Treatment

After seeking emergency medical support for an overdose, you may consider the path to long-term recovery. Recovery from opioid use most often begins with medical detoxification (detox).

After detox, treatment—such as inpatient or outpatient rehab—can help you learn the skills you need to maintain lasting recovery. Some people participate in long-term residential treatment and aftercare once they have completed inpatient or outpatient rehab.

If you or someone you know has struggled with oxycodone addiction, misuse, withdrawal, or overdose, seek help. Call 800-681-1058 (Who Answers?) to speak with a treatment specialist about your options in addiction recovery.

Resources

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Hoey, N.M. (2019). Overdose. Salem Press Encyclopedia of Health. Salem Press.
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S. National Library of Medicine. (2021, August 23). Oxycodone. MedlinePlus.
US Drug Enforcement Agency. (2020, August 06). Alarming spike in fentanyl-related overdose deaths leads officials to issue public warning.
The United States Department of Justice. (2020, December 15). Opioid facts.
Nattional Association of State Head Injury Administrators. Brain Injury and Opioid Overdose: Fast Facts.
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Andrew Stokes, A. Lundberg, D.J., Sheridan, B., Hempstead, K., Morone, N., Lasser, K.E., Trinquart, L., Neogi, T. (2020, April 02) Association of Obesity With Prescription Opioids for Painful Conditions in Patients Seeking Primary Care in the US. JAMA Network.