Most Opioid Overdose Patients Can Be Discharged After Brief ER Visit Interview with:

Frank Scheuermeyer MD MHSc Clinical Associate Professor Department of Emergency Medicine St Paul’s Hospital and the University of British Columbia

Dr. Scheuermeyer

Frank Scheuermeyer MD MHSc
Clinical Associate Professor
Department of Emergency Medicine
St Paul’s Hospital and the University of British Columbia What is the background for this study?

Response: Mortality from the opioid epidemic is dramatically increasing and a main culprit appears to be illicit fentanyl. Current research states that patients with presumed fentanyl overdoses are at high risk of deterioration and death, and require prolonged emergency department stays or hospital admission to ensure a safe outcome.

Our inner-city hospital adopted a protocol initially developed for patients with heroin overdose, modified it to account for the greater potency of fentanyl, and studied 1009 consecutive patients who arrived with an overdose. What are the main findings?

Response: Our findings demonstrate that, for patients with presumed fentanyl overdose who are resuscitated with naloxone, the antidote, a short emergency department observation may be sufficient—only a single patients was admitted to hospital. Of the 752 low-risk patients—those with normal alertness and oxygen levels at triage—only three required re-dosing with naloxone. What should readers take away from your report?

Response: This indicates that overdose patients are very unlikely to deteriorate or require hospital admission, and that they can likely be safely discharged home after 2-3 hours observation. It is important to note that most overdoses were as a result of injection, and that our ambulance system has a great deal of experience treating patients with presumed fentanyl overdose. What recommendations do you have for future research as a result of this work? 

Response:      Firstly, do all patients with an overdose need to be transported to an emergency room? Or could a well-equipped community clinic observe and treat them?

Secondly, although the initial overdose may not have caused serious harm, we need to find ways to prevent a second overdose from re-using. 

There are no disclosures or conflicts of interest to report. 


Safety of a Brief Emergency Department Observation Protocol for Patients With Presumed Fentanyl Overdose

Scheuermeyer, Frank X. et al.
Annals of Emergency Medicine , Volume 0 , Issue 0 ,

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Last Updated on April 8, 2018 by Marie Benz MD FAAD