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The term opioid refers to all compounds with opium-like activity. Heroin is made from morphine and is usually sold as a white powder; however, the color may vary to dark brown. “Black tar” heroin may be sticky like roofing tar or hard like coal and is usually dark brown to black in color. Diversion and abuse of opioids is a common practice that is resulting in an increased number of opioid deaths. Opioid-dependent patients may use alternative supplements like kratom to reduce opioid withdrawal symptoms.
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The classic opioid toxidrome is a clinical triad of coma, respiratory depression, and miosis. However, opioid-related CNS depression can range from mild sedation to coma. Normal or dilated pupils may occur after overdose of meperidine or pentazocine, or in the setting of CNS hypoxia. Death is typically due to respiratory depression. Noncardiogenic pulmonary edema (NCPE) is associated with the use of certain opioids, particularly heroin, methadone, and morphine.
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