Opioid toxicity - Revision history

Danbot: Strip excess bold

2026-03-22T09:30:51Z

Strip excess bold

Danbot: Add MedicationDose SMW annotations for naloxone (4 entries: IV/IM, IN, pediatric, drip) and buprenorphine; dosing verified per ACEP/AHA guidelines

2026-03-20T16:19:06Z

Add MedicationDose SMW annotations for naloxone (4 entries: IV/IM, IN, pediatric, drip) and buprenorphine; dosing verified per ACEP/AHA guidelines

← Older revision		Revision as of 16:19, 20 March 2026
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	*All patients with OUD, regardless of interest in buprenorphine, should receive harm reduction supplies: take-home naloxone, fentanyl test strips (where legal), and connection to community resources		*All patients with OUD, regardless of interest in buprenorphine, should receive harm reduction supplies: take-home naloxone, fentanyl test strips (where legal), and connection to community resources


			<div style="display:none">
			<!-- SMW MedicationDose annotations for opioid toxicity medications -->
			{{MedicationDose\|drug=Naloxone\|dose=2 mg IV (apneic/near-apneic); or 0.4 mg IV (opioid-naïve, mild-mod); or 0.04-0.05 mg IV (opioid-dependent); repeat q2-5min PRN\|route=IV/IM/IO\|context=Opioid reversal (IV/IM/IO)\|indication=Opioid toxicity\|onset=1-2 min (IV), 3-5 min (IN/IM)\|duration=20-90 min\|max_dose=10 mg total (consider alt diagnosis if no response)\|display=Naloxone (Narcan)}}
			{{MedicationDose\|drug=Naloxone\|dose=4 mg intranasal (may repeat q2-3min)\|route=IN\|context=Opioid reversal (intranasal)\|indication=Opioid toxicity\|onset=3-5 min\|duration=20-90 min\|display=Naloxone (Narcan)\|notes=OTC nasal spray available; may need higher/repeated doses for fentanyl}}
			{{MedicationDose\|drug=Naloxone\|dose=0.1 mg/kg IV/IM/IO (max 2 mg); or 0.1 mg/kg IN via nasal atomizer\|route=IV/IM/IO/IN\|context=Opioid reversal (pediatric)\|indication=Opioid toxicity\|population=Pediatric\|max_dose=2 mg per dose\|display=Naloxone (Narcan)}}
			{{MedicationDose\|drug=Naloxone\|dose=Continuous infusion: 2/3 of effective bolus dose per hour\|route=IV drip\|context=Naloxone drip for recurrent/prolonged toxicity\|indication=Opioid toxicity\|display=Naloxone (Narcan)\|notes=For long-acting opioid OD or recurrent sedation; titrate to respiratory effort}}
			{{MedicationDose\|drug=Buprenorphine\|dose=4 mg SL initial; may give additional 4 mg SL after 1-2 hours (total 8-16 mg on day 1)\|route=SL\|context=ED-initiated buprenorphine for OUD\|indication=Opioid toxicity\|notes=No X-waiver required since MAT Act 2023; must be in mild-moderate withdrawal (COWS ≥8)}}
			</div>
	==See Also==		==See Also==
	*[[Opioid withdrawal]]		*[[Opioid withdrawal]]

Ostermayer at 18:39, 8 March 2026

2026-03-08T18:39:11Z

Show changes

Rossdonaldson1: /* Background */

2024-04-24T19:50:03Z

Background

← Older revision		Revision as of 19:50, 24 April 2024
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	==Background==		==Background==
			[[File:2 milligrams of fentanyl on pencil tip. A lethal dose for most people. US Drug Enforcement Administration.jpg\|thumb\|A two milligram dose of fentanyl powder (on pencil tip).]]
	*Natural derivatives: [[Heroin]], [[Morphine]], [[Codeine]], [[Hydrocodone]], [[Oxycodone]] (+ UDS)		*Natural derivatives: [[Heroin]], [[Morphine]], [[Codeine]], [[Hydrocodone]], [[Oxycodone]] (+ UDS)
	*Synthetic: [[Fentanyl]], [[Hydromorphone]], [[Buprenorphine]], [[Methadone]], [[Meperidine]], [[Dextromethorphan]] (- UDS)		*Synthetic: [[Fentanyl]], [[Hydromorphone]], [[Buprenorphine]], [[Methadone]], [[Meperidine]], [[Dextromethorphan]] (- UDS)

Jonrako: /* Background */

2021-07-25T23:32:04Z

Background

← Older revision		Revision as of 23:32, 25 July 2021
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	*Consider contributing to the DAWN database for public ED research benefit (Drug Abuse Warning Network)		*Consider contributing to the DAWN database for public ED research benefit (Drug Abuse Warning Network)
	*Other than common co-ingestions, consider adulterants such as amphetamines, anticholinergics, hypnotics, heavy metals, etc.		*Other than common co-ingestions, consider adulterants such as amphetamines, anticholinergics, hypnotics, heavy metals, etc.
			*In the year after an ED visit for an opioid overdose, greater than 5% die & greater than 19% will experience another opioid overdose. <ref>Davis, C., Carr, D., Glenn, M., & Samuels, E. (2021). Legal Authority for Emergency Medical Services to Increase Access to Buprenorphine Treatment for Opioid Use Disorder. Annals of Emergency Medicine, 78(1), 102–107. </ref>

	==Clinical Features==		==Clinical Features==

Masoodrm: /* Naloxone (Narcan) */

2021-06-16T16:41:48Z

Naloxone (Narcan)

← Older revision		Revision as of 16:41, 16 June 2021
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	*If apneic or near-apneic - 2mg IV		*If apneic or near-apneic - 2mg IV
	*If opioid-naive with minimal respiratory depression - 0.4mg IV		*If opioid-naive with minimal respiratory depression - 0.4mg IV
	*If opioid-dependent with minimal respiratory depression - 0.05mg IV		*If opioid-dependent with minimal respiratory depression - 0.05mg IV ("push dose Narcan")
	*Infusion		*Infusion
	**Only give if ~~the~~ patient responded to the bolus and ~~required~~ repeat administration		**Only give if patient responded to the bolus and requiring repeat administration
	**Step 1: Determine the "wake-up dose" or bolus required to wake the patient		**Step 1: Determine the "wake-up dose" or bolus required to wake the patient
	**Step 2: Give 2/3 of the "wake-up dose" per hr; mix in 1L D5W		**Step 2: Give 2/3 of the "wake-up dose" per hr; mix in 1L D5W

SuperD: /* Narcan Prescription */

2020-01-22T20:24:07Z

Narcan Prescription

← Older revision		Revision as of 20:24, 22 January 2020
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	**Deliver 1 spray to nostril upon signs of opioid overdose. May repeat X 1. Call 911.		**Deliver 1 spray to nostril upon signs of opioid overdose. May repeat X 1. Call 911.

	'''Indications'''<ref>ACEP Policy Statement. "Naloxone Prescriptions by ~~Emerency~~ Physicians." Approved by ACEP Board of Directors October 29, 2015.</ref>		'''Indications'''<ref>ACEP Policy Statement. "Naloxone Prescriptions by Emergency Physicians." Approved by ACEP Board of Directors October 29, 2015.</ref>
	*Discharged from the ED after opioid intoxication or poisoning		*Discharged from the ED after opioid intoxication or poisoning
	*Receiving high doses of opioids or undergoing chronic pain management		*Receiving high doses of opioids or undergoing chronic pain management
	*~~Recieving~~ rotating opioid medication ~~redgimens~~		*Receiving rotating opioid medication regimens
	*Having a legitimate need for analgesia combined with history of substance abuse		*Having a legitimate need for analgesia combined with a history of substance abuse
	*Using extended/long-acting opioid preparations		*Using extended/long-acting opioid preparations
	*Completing mandatory ~~opiooid~~ detoxification or abstinence programs		*Completing mandatory opioid detoxification or abstinence programs
	*Recent release from incarceration and past abuser of opioids		*Recent release from incarceration and past abuser of opioids

Rossdonaldson1: /* External Links */

2018-12-31T21:27:01Z

External Links

← Older revision		Revision as of 21:27, 31 December 2018
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	==External Links==		==External Links==
	*[http://www.mdcalc.com/opioid-risk-tool-ort-for-narcotic-abuse/ MDCalc - Opioid Risk Tool (ORT) for Narcotic Abuse]		*[http://www.mdcalc.com/opioid-risk-tool-ort-for-narcotic-abuse/ MDCalc - Opioid Risk Tool (ORT) for Narcotic Abuse]
			*[https://gallery.mailchimp.com/e35e5fa1ba46b6de2508eeb46/files/60d37229-1c34-4f56-91af-2bfceb71c0bc/3_Opioid_Safety_and_Naloxone_for_Patients.pdf?utm_source=CA+Providers+%28ED%2C+Hospitalists+%26+ICU%29+ICs%2BAPCs&utm_campaign=3a63f208f9-EMAIL_CAMPAIGN_2018_12_31_08_01&utm_medium=email&utm_term=0_4c468cb1a3-3a63f208f9-157631691 Narcan autoinjection instructions (English)]
			*[https://gallery.mailchimp.com/e35e5fa1ba46b6de2508eeb46/files/0d8baa2d-7785-4304-8b1b-d2702f21954b/4_Opioid_Safety_and_Naloxone_for_Patients_Spanish.pdf?utm_source=CA+Providers+%28ED%2C+Hospitalists+%26+ICU%29+ICs%2BAPCs&utm_campaign=3a63f208f9-EMAIL_CAMPAIGN_2018_12_31_08_01&utm_medium=email&utm_term=0_4c468cb1a3-3a63f208f9-157631691 Narcan autoinjection instructions (Spanish)]

	==References==		==References==

Rossdonaldson1: /* Narcan Prescription */

2018-12-31T21:25:49Z

Narcan Prescription

← Older revision		Revision as of 21:25, 31 December 2018
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	===Narcan Prescription===		===Narcan Prescription===
	*Many states (31) offer protection again criminal liability for prescribing and distributing naloxone to laypeople		*Many states (31) offer protection again criminal liability for prescribing and distributing naloxone to laypeople
			*A new California law requires providers to offer [[Naloxone]] autoinjector prescriptions to certain patients at risk for overdose

	{\| class="wikitable"		{\| class="wikitable"
	\|-		\|-

Rossdonaldson1: /* Background */

2018-12-31T21:25:27Z

Background

← Older revision		Revision as of 21:25, 31 December 2018
Line 7:		Line 7:
	*Consider contributing to the DAWN database for public ED research benefit (Drug Abuse Warning Network)		*Consider contributing to the DAWN database for public ED research benefit (Drug Abuse Warning Network)
	*Other than common co-ingestions, consider adulterants such as amphetamines, anticholinergics, hypnotics, heavy metals, etc.		*Other than common co-ingestions, consider adulterants such as amphetamines, anticholinergics, hypnotics, heavy metals, etc.
	*A new California law requires providers to offer [[Naloxone]] autoinjector prescriptions to certain patients at risk for overdose

	==Clinical Features==		==Clinical Features==