What discharge advice should be given to a patient who has been treated for opioid (op) poisoning?

Discharge Advice for Opioid Poisoning Patients

Patients treated for opioid poisoning should receive comprehensive discharge education including overdose recognition training, take-home naloxone kits, and referral to addiction treatment services to reduce mortality risk from future overdoses. 1

Essential Discharge Components

1. Take-Home Naloxone (THN) Provision

• Provide take-home naloxone kits to all patients who have experienced opioid overdose 1, 2
• Include family members and close contacts in naloxone training, as family involvement increases likelihood of connection to follow-up services by 5.16 times 3
• Teach proper naloxone administration technique with hands-on practice 1
  • Intranasal or intramuscular routes are appropriate for layperson use 4
  • Instruct on dose titration to restore respiratory function while minimizing withdrawal symptoms 5

2. Overdose Recognition Education

• Train patients and their support network to recognize signs of overdose 1:
  • Unresponsiveness
  • Slow or absent breathing
  • Pinpoint pupils
  • Blue/gray skin color (especially lips and fingernails)
• Emphasize that naloxone's duration of action (45-70 minutes) may be shorter than many opioids' effects, requiring repeated doses 1

3. Emergency Response Training

• Teach the response algorithm 6, 1:
  1. Check for responsiveness
  2. Call emergency services immediately
  3. Administer naloxone if available
  4. Position person on their side (recovery position)
  5. Begin CPR if not breathing normally
  6. Administer additional naloxone doses if no response after 2-3 minutes

4. Risk Reduction Counseling

• Warn about increased overdose risk after periods of abstinence (reduced tolerance)
• Advise against mixing opioids with other sedatives (alcohol, benzodiazepines)
• Explain dangers of using alone and encourage having naloxone-trained observers present
• Discuss risks of long-acting opioid formulations requiring extended monitoring 6

5. Follow-up Care Arrangements

• Schedule addiction treatment assessment appointment before discharge 1
• Connect patient with peer recovery support specialists when available 3
• Arrange follow-up appointment with primary care provider within 1-2 weeks

Special Considerations

For Patients with Prescription Opioids

• Evidence shows these patients are less likely to be offered naloxone (AOR 0.41) despite being at risk 2
• Review pain management alternatives and safe medication storage
• Consider opioid dose reduction or rotation to safer alternatives

For Patients Who Left Against Medical Advice

• These patients are significantly less likely to receive naloxone (AOR 0.16) 2
• Make extra effort to provide THN before departure if possible
• Document attempts to provide discharge education

For Elderly Patients

• Older individuals (>50 years) are less likely to receive appropriate naloxone intervention (OR 4.8) 7
• Provide age-appropriate education materials with larger print
• Ensure caregivers are included in overdose response training

Documentation Requirements

• Document that take-home naloxone was offered and whether accepted/declined
• Record specific education provided to patient and family/friends
• Note follow-up arrangements made for addiction treatment
• Include contact information for local overdose prevention resources

Common Pitfalls to Avoid

• Failing to recognize prescription opioid users as at-risk for overdose 2, 7
• Discharging patients without naloxone training for both patient and family 1
• Not addressing the increased risk of recurrent respiratory depression after initial recovery 6
• Overlooking older adults or those without obvious signs of substance use disorder 7

By implementing these comprehensive discharge practices, healthcare providers can significantly reduce the risk of fatal opioid overdose among this vulnerable patient population.