Which of the following is a common finding in symptomatic opioid overdose?

• A. Decreased LOC and/or respiratory depression (e.g., respiratory rate of <12 or EtCO2 ≥40 mmHg)
• B. Chest pain and hypertension
• C. Nausea and bradycardia
• D. Hyperactivity and agitation

Answer: (A)

Opioid overdose most reliably presents with respiratory depression accompanied by altered level of consciousness. Opioids blunt the brainstem drive to breathe, leading to slower and shallower respirations and reduced mental status, which clinicians recognize as decreased LOC with signs of hypoventilation. This often shows as a respiratory rate below 12 breaths per minute and elevated CO2 on capnography (EtCO2 40 mmHg or higher). Other options describe symptoms that aren’t the hallmark of opioid toxicity—chest pain with hypertension suggests cardiac issues, nausea with bradycardia is less characteristic, and hyperactivity or agitation fits stimulant effects rather than opioid overdose.