Patient handout

Acute opioid overdose

PRODUCTION

1. Your condition

This handout is for acute opioid overdose. Your care team identified this based on: respiratory depression + miosis + altered mental status — aha 2020 opioid-associated emergency triad.

Other reasons your team may use this plan: witnessed opioid ingestion or injection with obtundation — samhsa 2024; found unresponsive with opioid paraphernalia or known opioid use — aha 2020; ems naloxone administered prehospital with partial or full response — samhsa 2024.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
naloxone	0.04 mg IV	IV	q2-3min titrate to RR >12	Start low (0.04 mg) to restore ventilation without precipitating severe withdrawal; titrate to respiratory rate NOT consciousness — AHA 2020 ACLS opioid algorithm

Plan: Naloxone dosing ladder for opioid-induced respiratory depression — AHA 2020; FDA 2023

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — Recovery — stable after overdose reversal — van Lemmen et al, Anesthesiology 2023

If you have:

Breathing normally (RR >12) without naloxone support for >1 h — AHA 2020
Alert and oriented — AHA 2020
No recurrent drowsiness — van Lemmen et al, Anesthesiology 2023

Do this:

Keep naloxone rescue kit (Narcan 4 mg nasal spray) accessible at all times — FDA 2023 OTC
Teach household members / close contacts naloxone administration — SAMHSA 2024
Attend MOUD appointment within 72 h of discharge — SAMHSA 2024
Do not use opioids alone; call 911 if witnessed overdose — SAMHSA 2024
Understand tolerance loss after abstinence increases overdose risk — SAMHSA 2024
Consider fentanyl test strips to detect fentanyl contamination — SAMHSA 2024

YELLOW — Caution — return precautions after opioid OD — van Lemmen et al, Anesthesiology 2023

If you have:

Feeling drowsy or "nodding off" after discharge — van Lemmen et al, Anesthesiology 2023
Slowed breathing noticed by others — AHA 2020
Confusion or difficulty staying awake — AHA 2020
Nausea/vomiting (aspiration risk) — van Lemmen et al, Anesthesiology 2023

Do this:

Have someone administer naloxone nasal spray immediately — FDA 2023
Call 911 — do not drive yourself — AHA 2020
Lie in recovery position (on side) to protect airway — AHA 2020

RED — Crisis — unresponsive or not breathing — AHA 2020

If you have:

Not breathing or gasping — AHA 2020
Unresponsive to voice or sternal rub — AHA 2020
Blue/gray lips or fingertips (cyanosis) — AHA 2020

Do this:

Bystander: give naloxone 4 mg intranasal spray NOW — FDA 2023
Call 911 immediately — AHA 2020
Start rescue breathing or CPR if no pulse — AHA 2020
Repeat naloxone in 2-3 min if no response — AHA 2020
Stay until EMS arrives — Good Samaritan laws protect in most states — SAMHSA 2024

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Apnea or RR <6 with opioid toxidrome — AHA 2020 ACLS opioid-associated emergency(life-threatening)
No response to naloxone 10 mg total — consider fentanyl analog, non-opioid etiology, or mixed ingestion — AHA 2020; van Lemmen et al, Anesthesiology 2023(life-threatening)
Opioid + benzodiazepine or opioid + alcohol co-ingestion with synergistic respiratory depression — SAMHSA 2024
CK >5000 IU/L from prolonged immobility/compression during opioid-induced unconsciousness — van Lemmen et al, Anesthesiology 2023
Tense compartment with pain disproportionate to exam after prolonged limb compression during opioid-induced unconsciousness — van Lemmen et al, Anesthesiology 2023
Recurrent respiratory depression after initial naloxone response; opioid half-life exceeds naloxone duration (30-90 min) — van Lemmen et al, Anesthesiology 2023

5. Follow-up

Naloxone rescue kit prescription (FDA 2023 OTC); MOUD referral or buprenorphine ED-initiation (SAMHSA 2024); harm reduction counselling; overdose education for patient and family — SAMHSA 2024

6. Sources

Guideline: AHA 2020 Part 3 Adult BLS/ALS — opioid-associated emergency algorithm (Circulation) + AHA 2021 opioid-associated out-of-hospital cardiac arrest scientific statement + van Lemmen et al, Anesthesiology 2023 opioid overdose / naloxone review + SAMHSA 2024 overdose prevention toolkit + FDA 2023 OTC naloxone