MedBalans

Opioid Overdose

Adults · emergency only · brief protocol

Algorithm

  1. Scene safety; call for help; open airway; ventilate if needed (BVM).
  2. Naloxone ASAP for suspected opioid toxicity with respiratory depression.
  3. Titrate to breathing — avoid precipitating severe withdrawal if chronic use when possible.
  4. Observe for renarcotization (long-acting opioids / fentanyl); prepare repeat doses / infusion.
  5. Consider co-ingestions; ECG if indicated; do not leave unmonitored after reversal.

Red flags

  • • Apnea / cardiac arrest — ACLS + naloxone
  • • Recurrent hypoventilation after naloxone
  • • Suspected body packing — specialist pathway

Medications by step

Antidote

  • Naloxone · IV / IM / IN

    Start low (e.g. 0.04–0.4 mg IV/IM/IN) and titrate; repeat q2–3 min

References

  • • WHO / CDC opioid overdose response principles (2023)

Updated: July 2026