Opioid Toxicity Medical Directive

Question 1

Opioid Toxicity Medical Directive

Answer 1

A Primary Care Paramedic may provide the treament prescribed in this Medical Directive if authorized.

Question 2

Indications

Answer 2

Altered LOC;
AND
Respiratory depression;
AND
Inability to adequately ventilate; OR persistent need to assist ventilations;
AND
Suspected opioid overdose.

Question 3

Conditions - Naloxone

Answer 3

Age: ≥24 hours
LOA: Altered
NR: N/A
RR: <10 breaths/min
SBP: N/A
Other: N/A

Question 4

Contraindications - Naloxone

Answer 4

Allergy or sensitivity to naloxone

Question 5

Treatment

Answer 5

Consider naloxone

Question 6

Consider naloxone

Answer 6

Route: IV
Dose: Up to 0.4 mg*
Max. single dose: 0.4 mg
Dosing interval: 5 min
Max. # of doses: 3
* For the IV route, titrate naloxone only to restore the patient’s respiratory status.

Route: IM
Dose: Up to 0.4 mg*
Max. single dose: 0.4 mg
Dosing interval: 5 min
Max. # of doses: 3

Route: IN
Dose: 2-4 mg
Max. single dose: 2-4 mg
Dosing interval: 5 min
Max. # of doses: 3

Route: SC
Dose: 0.8 mg
Max. single dose: 0.8 mg
Dosing interval: 5 min
Max. # of doses: 3

Question 7

Clinical Considerations

Answer 7

IV administration of naloxone applies only to PCPs authorized for PCP Autonomous IV.
Upfront aggressive management of the airway is paramount and the initial priority.
If no response to initial treatment; consider patching for further doses.
If the patient does not respond to airway management and the administration of naloxone, glucometry should be considered.
Combative behaviour should be anticipated following naloxone administration and paramedics should protect themselves accordingly, thus the importance of gradual titrating (if given IV) to desired clinical effect: respiratory rate ≥10, adequate airway and ventilation, not full alertness.