Opioid Overdose; Roadside to Resus

Opioid overdose presents as a clinical triad of central nervous system depression, respiratory depression, and miosis. Effective management prioritizes physiological stabilization—specifically airway support and oxygenation—over immediate, full pharmacological reversal. Excessive naloxone administration often triggers acute opioid withdrawal, causing severe pain, agitation, and patient distress. Current best practice advocates for a nuanced, titrated approach using small boluses to achieve adequate respiratory rates rather than complete consciousness. For patients requiring ongoing support, naloxone infusions provide a controlled alternative to repeated boluses. Because naloxone’s duration of action is significantly shorter than many opioids, particularly methadone, prolonged clinical observation is essential to prevent secondary toxicity. Beyond acute reversal, clinicians should integrate substance misuse support, blood-borne virus screening, and safeguarding assessments to address the underlying vulnerabilities of this patient population.