Decontamination

Gastrointestinal decontamination with activated charcoal may reduce the duration of toxicity for opioid poisonings involving:

• massive ingestions of immediate-release preparations
• opioids with a long half-life (eg methadone, some fentanyl analogues)
• modified-release preparations (eg morphine, oxycodone).

For opioid poisoning, offer activated charcoal to alert and cooperative patients who are able to protect their airway and present within:

• 2 hours after ingesting an immediate-release preparation
• 6 hours after ingesting a modified-release preparation.

If the patient is intubated, activated charcoal can be given any time after ingestion via a nasogastric or orogastric tube—confirm correct placement of the nasogastric or orogastric tube beforehand.