Monday, January 21, 2019

Opioid Overdose

R.E.B.E.L.EM - January 21, 2019 - By Mark Ramzy
"Author’s Conclusions:
The St. Paul’s Early Discharge Rule appears to be useful for identifying suspected opioid overdose patients treated with naloxone who are safe for discharge one hour after administration. This prediction rule works when naloxone is administered intra-nasally in a population where synthetic opioids are more common than the original study. Further studies are needed to determine the rule’s performance in the context of drug combinations and different routes of opioid administration.
Our Conclusion:
The St. Paul Early Discharge Rule has very limited utility and was found to be no better than clinical gestalt at detecting adverse effects in overdose patients who received intranasal naloxone. We do not recommend the use of this rule as it may be harmful to the patient and implies a focus on throughput and disposition. Opiate overdose patients should be observed for 4-6 hours to allow for safe disposition. The additional time should be used to counsel patients on safe use, referral for treatment, distribution of naloxone to them or their friends, opiate education, risk modification, safe-injection site locations and other patient-centered factors."