Obs after Naloxone in Heroin OD

Dr. Mary Callis


As EM docs we see a lot of opiate overdose cases, usually heroin. As a resident learning from attendings, who have different practice patterns, I have noticed varying lengths of observation after naloxone administration. These observations can range from two hours to overnight admissions. This made me want to know the evidence behind observing heroin overdose patients after they received naloxone. 


Willman, Michael W. et al. Do heroin overdose patients require observation after receiving naloxone?

Clinical Toxicology. 2017;55(2):81-87. [paper] 


Literature review looking at need for ambulance transfer after naloxone and risk of refusal (8 studies), duration of ED observation (5 studies) and effectiveness of naloxone by first responders (15 studies). 


Patients with heroin overdose treated with naloxone are safe for discharge after 1-hour of observation if: