Authors: Tom Bannister / Codes: SLO3, RP5, PC1, PhP2, PhC1, PhC4 / Published: 22/06/2024
Scope / Reason for Development
The initial management of acute opioid toxicity related to the use of illicit opioids, and/or misuse (non-medical use), or deliberate self-poisoning (overdose) of prescription and over the counter opioids. It is not applicable for opioid toxicity in patients taking prescribed opioids for palliative care/cancer pain (follow guidance on TOXBASE for management of these patients), or for managing acute opioid toxicity in settings other than Emergency Departments.
Summary of Recommendations
1) In acute opioid toxicity, the aim of naloxone administration should be reversal of respiratory depression and maintenance of airway protective reflexes, not full reversal of unconsciousness.
2) Adverse effects from naloxone are more likely to occur when excessive doses of naloxone are used.
3) Generally, patients should be observed for at least four hours after the last dose of naloxone and for at least six hours after the suspected time of opioid use. The length of the observation period may need to be adjusted from this standard depending on the duration of the effect of the opioid(s) taken.
4) The treatment of patients who have experienced a non-fatal overdose provides a valuable opportunity to provide brief intervention, onward referral to drug liaison services, and to promote engagement with community services.
Key Information
Acute opioid toxicity typically causes the triad of i) drowsiness (CNS depression); ii) respiratory depression (hypoventilation and reduced respiratory rate); and iii) pupillary miosis.
Linked RCEM Learning Content
Toxicology – Induction
Breathe it in: Nebulised Naloxone – Blog
One Response
excellent guidelines about opioid toxicity in ED.