What is the immediate treatment for an opioid overdose?

Immediate Management of Opioid Overdose

The immediate treatment for an opioid overdose is to activate the emergency response system, provide high-quality CPR (compressions plus ventilation) if the person is unresponsive and not breathing normally, and administer naloxone as soon as it is available. 1

Initial Assessment and Response

• Check for responsiveness by tapping and shouting at the victim 1
• If unresponsive, immediately activate emergency response system (call 9-1-1) 1
• Get naloxone and an AED if available 1
• Assess breathing status (for less than 10 seconds) 2

Management Based on Clinical Status

If Unresponsive with No Normal Breathing:

• Open airway and check for pulse 1
• If pulse present but not breathing normally:
  • Provide rescue breathing or bag-mask ventilation until spontaneous breathing returns 1, 2
  • Administer naloxone 1
• If no pulse detected:
  • Begin high-quality CPR immediately (compressions plus ventilation) 1
  • Use AED if available 1
  • Administer naloxone while continuing CPR 1

If Responsive but with Respiratory Depression:

• Position to maintain open airway 2
• Administer naloxone 3
• Monitor closely for improvement in respiratory status 3

Naloxone Administration

• Naloxone can be administered via intranasal, intramuscular, or intravenous routes 3, 4
• Standard initial adult dosing: 2 mg intranasal or 0.4 mg intramuscular 1
• May repeat dose after 2-3 minutes if no response 1, 3
• Continue rescue breathing/ventilation while waiting for naloxone to take effect 1

Post-Administration Care

• Monitor for return of respiratory depression, as naloxone's duration of action (30-60 minutes) is shorter than many opioids 3
• Be prepared for possible withdrawal symptoms in opioid-dependent individuals 3, 4
• All patients who receive naloxone should be transported to a healthcare facility for observation, even if they appear to recover 5
• Patients who refuse transport after naloxone administration have a 66% higher risk of subsequent overdose 5

Special Considerations

• Naloxone has an excellent safety profile and is unlikely to cause harm if administered to a patient without opioid overdose 1, 3
• For suspected polysubstance overdose, standard resuscitation measures should take priority, with naloxone administration as an adjunct 1, 6
• Higher doses or repeated doses may be needed for overdoses involving synthetic opioids or long-acting opioids 3, 7
• Buprenorphine overdose may require higher doses of naloxone due to its strong binding to opioid receptors 7, 4

Prevention of Future Overdoses

• Opioid overdose education and naloxone distribution programs are effective in preventing fatal overdoses 1, 6
• Take-home naloxone should be considered for patients at risk of opioid overdose 8
• Medication for opioid use disorder (methadone, buprenorphine, naltrexone) should be considered for long-term management 8