A 41-year-old female is unconscious with severe respiratory depression after ingesting a handful of an unknown pain killer. Which overdose should you suspect?

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Opioids depress respiration by acting on mu receptors in the brainstem, which lowers the drive to breathe and reduces tidal volume. In an overdose, this can produce unconsciousness junto with severe respiratory depression. Codeine is an opioid analgesic, so its overdose best explains the combination of unconsciousness and severe breathing suppression. The other pain relievers don’t typically cause this pattern: acetaminophen overdoses mainly injure the liver; aspirin overdoses cause metabolic disturbances and respiratory changes but not prominent acute respiratory depression, and ibuprofen overdoses mainly cause GI, kidney, and cardiovascular effects. If opioid overdose is suspected, reversal with naloxone can rapidly restore respiration.