Opioid toxicity is a major and growing challenge across the UK and beyond, with nearly 10 deaths every day from opioid overdose and over a million adults using Class A drugs annually, the impact on emergency services is enormous.

In this episode, we’re diving deep into the recognition and management of acute opioid toxicity in the emergency setting, including the reversal using naloxone.

We’ll run through;

  • The scale of the problem, including the rise of novel synthetic opioids like fentanyl and nitazenes.
  • A breakdown of opioid pharmacology, including receptor types, potencies, and onset of action.
  • How to identify classic and mixed presentations of opioid overdose.
  • Best practice on naloxone dosing, routes of administration, and when to start infusions.
  • The risk of acute withdrawal and how to manage it with care.
  • How to approach mixed overdoses, cardiac arrests involving opioids, and nebulised naloxone.
  • And finally, the importance of holistic care, safeguarding, and onward referral to support recovery.

Whether you’re in ED, prehospital care, or just want to sharpen your tox knowledge, this episode’s packed with take-home learning. Oh, and yes… Gangs of London gets a shout-out too.

Once again we’d love to hear any thoughts or feedback either on the website or via X @TheResusRoom!

Simon, Rob & James

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References

Opioid Overdose. Wermeling. StatPearls. 2024

Trick of the Trade: Nebulized Naloxone. Lin. Academic Life in Emergency Medicine (ALiEM). 2015

Opiate Overdose in the ED. Carley. St Emlyn’s Blog. 2019

Opioid Receptors. Mitra. StatPearls. 2024

Naloxone for Opioid-Related Out-of-Hospital Cardiac Arrest. Mechem. Resuscitation Plus. 2023

Naloxone. Boyer. StatPearls. 2024

Nebulised Naloxone – A Novel Approach. Jones. Emergency Medicine Journal (EMJ). 2013

Breathe It In: Nebulised Naloxone. RCEMLearning. RCEM Learning FOAMed. 2022

Acute Opioid Toxicity: Best Practice Guideline v1. Gill. Royal College of Emergency Medicine. 2024.

Opioid-associated cardiac arrest: A systematic review of intra-arrest naloxone and other opioid-specific advanced life-support therapies. Grunau. Resuscitation Plus. 2025

Nobody Wants to Be Narcan’d: A Pilot Qualitative Analysis of Drug Users’ Perspectives on Naloxone. The western journal of emergency medicine (2021)

Opioid overdose reversals using naloxone in New York City by people who use opioids: Implications for public health and overdose harm reduction approaches from a qualitative study. International journal of drug policy (2020)

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