Abstract
* Consider acute opioid intoxication if respiratory depression, miosis, and depressed mental status are present. * When using naloxone to reverse mental status depression in the stable patient, use a low dose, for example, 0.04 mg IV, with escalating doses titrated according to the clinical response. * If the patient responds to naloxone by awakening and recovering full alertness, observe for 90 minutes to assess for potential opioid-rebound. * Use the ED visit for opioid overdose as an opportunity for both harm-reduction strategies and screening, treatment initiation, and referral.