From the Guidelines
In cases of suspected opioid overdose, immediately call emergency services and administer naloxone if available, as it can temporarily reverse the effects of opioids and restore normal breathing. The initial management should focus on supporting the patient's airway and breathing, which begins with opening the airway followed by delivery of rescue breaths, ideally with the use of a bag mask or barrier device 1. While waiting for help, place the person in the recovery position (on their side) to prevent choking if they vomit, and stay with them. Check their breathing and pulse; if they stop breathing or have no pulse, begin CPR if you're trained. Signs of opioid overdose include:
- Pinpoint pupils
- Unconsciousness
- Slow or stopped breathing
- Blue/purple lips or fingernails
- Limp body After administering naloxone, the person may need additional doses as naloxone wears off after 30-90 minutes while opioids may remain in the system longer 1. Even if the person responds to naloxone, medical attention is still necessary as they could relapse into overdose. Naloxone works by competing with opioids for receptor sites in the brain, temporarily blocking their effects and restoring normal breathing. It is essential to note that early activation of the emergency response system is critical for patients with suspected opioid overdose, and rescuers should not delay calling for help while awaiting the patient's response to naloxone or other interventions 1.
From the FDA Drug Label
The most rapid onset of action is achieved by intravenous administration and it is recommended in emergency situations. Since the duration of action of some opioids may exceed that of naloxone, the patient should be kept under continued surveillance Repeated doses of naloxone should be administered, as necessary.
Signs of opioid overdose are not explicitly stated in the provided drug labels, but the administration guidelines for naloxone hydrochloride injection imply that respiratory depression is a key indicator of opioid overdose.
- The labels recommend intravenous administration of naloxone in emergency situations, with an initial dose of 0.4 mg to 2 mg for adults and 0.01 mg/kg body weight for children.
- Repeated doses of naloxone may be necessary, as the duration of action of some opioids may exceed that of naloxone.
- Patients should be kept under continued surveillance to monitor for signs of opioid overdose and to administer additional doses of naloxone as needed 2.
From the Research
Signs of Opioid Overdose
- Slow or stopped breathing
- Unresponsiveness
- Small pupils
- Slow heartbeat
- Blue-tinged lips and fingers
- Confusion or loss of consciousness
Immediate Steps to Take in Cases of Suspected Opioid Overdose
- Call emergency services immediately 3, 4
- Administer naloxone if available and trained to do so 3, 5, 4, 6
- Provide rescue breathing if the person is not breathing 3, 6
- Stay with the person until emergency services arrive
Naloxone Administration
- Naloxone can be administered via intramuscular injection or nasal spraying 3, 4, 6
- Higher-concentration intranasal naloxone (2 mg/mL) seems to have efficacy similar to that of intramuscular naloxone for reversal of opioid overdose 4
- Nontransport after reversal of overdose with naloxone seems to be associated with a low rate of serious harms, but no study evaluated risks of transport versus nontransport 4