Dins Mironovs

Title: Misidentified stimulant use resulting in acute opioid overdose: A case report with implications for addiction psychiatry and prevention

Abstract

This presentation describes a clinically significant case in which a substance presented and experienced as an amphetamine-type stimulant was later associated with acute opioid toxicity, highlighting diagnostic uncertainty in contemporary substance use. The case highlights the growing clinical challenges posed by the evolving illicit drug market, in which contamination, substitution, and the presence of potent synthetic opioids have become increasingly prevalent.

The patient, with no known history of opioid use disorder, presented with rapid onset of central nervous system depression, respiratory compromise, and reduced level of consciousness after hospitalization. The patient consistently denied opioid use, and initial objective drug screening did not detect any opioids, further complicating the diagnostic process. Despite these findings, the clinical presentation was inconsistent with isolated stimulant intoxication and was highly suggestive of an opioid toxidrome. Prompt administration of naloxone up to 3,2mg led to rapid clinical improvement, strongly supporting opioid involvement despite negative screening results.

This case highlights the limitations of standard toxicological screening in acute clinical settings, particularly in the context of synthetic opioids that may not be detected by routine immunoassay-based urine tests. It emphasizes the importance of clinical judgment and symptom-based assessment over reliance on patient-reported substance use or initial laboratory findings alone. The presentation illustrates how delayed recognition in such cases may significantly increase the risk of morbidity or mortality.

Beyond acute management, the case raises important considerations for addiction psychiatry and prevention-oriented clinical practice. Individuals who do not identify as opioid users may underestimate their overdose risk and may therefore be less likely to engage in harm reduction strategies or carry naloxone. The discussion will address the need for targeted patient education, broader naloxone accessibility, and preventive interventions adapted to contemporary patterns of substance use.

The presentation integrates current evidence on drug market unpredictability, diagnostic uncertainty, and overdose prevention. It highlights the importance of interdisciplinary collaboration between emergency medicine, psychiatry, and public health services to improve early recognition, patient safety, and preventive care in substance-related emergencies.