Opium poisoning and overdose present significant challenges to public health, with profound implications for individual well-being and societal welfare. Derived from the opium poppy plant,opium has been used for millennia for its analgesic and euphoric effects. However, its potent pharmacological properties can lead to a range of adverse reactions, from mild gastrointestinal disturbances to life-threatening respiratory depression and coma. The rise of the opioid epidemichas brought renewed attention to the dangers of opium misuse and abuse, highlighting the urgentneed for a comprehensive understanding of opium toxicity. This review aims to provide a detailed examination of opium poisoning and overdose, encompassing epidemiology, clinical manifestations, pathophysiology, diagnosis, and management strategies. Epidemiological data reveal a rising tide of opium-related morbidity andmortality, driven by factors such as the proliferation of prescription opioids, illicit drug trafficking, and evolving patterns of drug use. Clinical manifestations of opium toxicity vary widely, depending on factors such as dose, route of administration, and individual susceptibility.Common signs and symptoms include respiratory depression, altered mental status, pinpoint pupils, and cardiovascular instability. The pathophysiology of opium poisoning is complex, involving the interface of opium alkaloids with opioid receptors within the central nervous system. The alkaloids in opium -Morphine, codeine, and thebaine, the principal alkaloids in opium, exert their effects through modulation of neurotransmitter release and neuronal excitability. Diagnosis of opium poisoning relies on acombination of clinical assessment, laboratory testing, and toxicological analysis. Prompt recognition and intervention are crucial in mitigating the consequences of opium overdose, withtreatment modalities ranging from supportive care to opioid antagonists such as naloxone. Despite advances in clinical management, challenges remain in addressing the multifaceted nature of opium toxicity. Barriers to care, including stigma, limited access to healthcare services,and gaps in provider education, hinder efforts to prevent and treat opium-related overdose. Moreover, the emergence of novel opioid formulations and synthetic opioids presents newchallenges in the realm of toxicology. In conclusion, opium poisoning and overdose represent pressing public health concerns, necessitating a coordinated and multidisciplinary approach to prevention, intervention, and harmreduction. By elucidating the complexities of opium toxicity, this review aims to inform clinical practice, guide policy development, and ultimately, reduce the burden of opium-related morbidity and mortality in communities worldwide