Management considerations following overdosesof modified-release morphine preparations

[1] Often current practice dictates that patients with presumed opioid overdose can be safely discharged one hour after naloxone administration if they meet certain criteria: 1) ambulate as usual; 2) have oxygen saturation on room air of > 92%; 3) have a respiratory rate>10 breaths/min and < 20 breaths/min; 4) have a temperature of > 35.0 °C and < 37.5 °C; 5) have a heart rate>50 beats/min and < 100 beats/min; and 6) have a Glasgow Coma Scale score of 15. Vital signs: blood pressure 123/78 mmHg, heart rate 60 beats per minute, temperature 36.7 °C, and respiratory rate 15 breaths per minute. The most common preparations with an immediate release component include Avinza and Oxycontin, and the early resolution of initial symptoms with those formulations may be misleading. Because delayed toxicity is a reality, the decision making process regarding a patient care plan where MR opioid preparations are involved should include a prolonged observation period in a monitored unit even if there is apparent lack of symptoms of early clinical toxicity.