Non-pharmaceutical fentanyl (NPF) is a major contributor to opioid overdoses and overdose fatality. In certain urban areas such as Vancouver, over 80% of heroin samples contain NPF.  For isolated heroin overdose ED patients, they can be safely discharged after brief observation period (~2 hours). However,  “safe” observation time for fentanyl is unknown.

Recently, a retrospective study evaluating the safe observation period in 1009 suspected (uncomplicated) fentanyl overdose ED visits (827 unique patients).

Results:

 In the field:

• 476 (47.1%) received bystander naloxone
  • 422 (44.1%) had field GCS of 15
  • 547 (57.2%) had pulse oximetry of >= 95%.
•  EMS administered naloxone to 546 (57.1%) patients (mean dose 0.4 mg IV)

In the ED:

• 16 patients received additional naloxone in the ED
• Mean length of stay: 173 minutes (IQR: 101 to 267 minutes)
• 90% of the patients were discharged within 380 minute.
• One patient was admitted and one patient died after discharge within 24 hours.

Conclusion:

• Majority of the patients were safely discharged after 3 - 4 hours after receiving naloxone and if able to maintain GCS 15 with oxygen level 95% while able to ambulate normally.
• However, some patient may require up to 6 hours of observation.  

References

Scheuermeyer FX et al. Safety of a brief emergency department observation protocol for patients with presumed fentanyl overdose. Ann Emerg Med 2018 (PMID: 29530654)