Observation and patient disposition after opioid poisoning

See specific observation and patient disposition advice for Buprenorphine poisoning, Tramadol poisoning and Tapentadol poisoning.

Observe all patients with an opioid ingestion, for at least:

• 12 hours for poisoning due to an immediate-release preparation
• 24 hours for poisoning due to a long-acting or modified-release preparation.

Observe all symptomatic patients for the minimum observation period above and until they are asymptomatic. For patients who have received naloxone, only discharge them if they have no evidence of respiratory depression, they have a normal level of consciousness, and it is at least:

• 2 hours after a single bolus dose of intravenous or intranasal naloxoneDowling 2008
• 4 hours after a single bolus dose of intramuscular naloxoneDowling 2008
• 4 hours after a naloxone infusion has been ceased.

Only discharge patients following opioid poisoning in daylight hours. Sedative drugs can continue to cause significant cognitive impairment for several days following exposure. Advise patients not to drive or operate machinery for at least 3 days after dischargeDassanayake et al, 2012Dassanayake et al, 2012.

Many acute opioid poisonings are deliberate. Assess patients for deliberate self-harm and, if appropriate, refer them for psychiatric evaluation. Also consider referral for management of opioid dependence (see Overview of management of disorders of opioid use). To reduce risk of death from poisonings, discuss the use of take-home naloxone with all patients with hazardous, harmful or dependent use of opioids (and those close to them because they are likely to be the people administering the drug). Take-home naloxone is available as a nasal spray or preprepared injection. It can be obtained free of charge and over-the-counter through the Take Home Naloxone program in all Australian states and territories.