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.