Pupillary constriction (or pupillary dilation due to anoxia from severe overdose) and at least 1 of the following signs or symptoms developing during, or shortly after, opioid use:

1. Drowsiness or coma
2. Slurred speech
3. Impairment in attention or memory

Severe: Hypotension ↓(<90/60) (*TACHY instead of BRADY due to reflex)

Management

• Attending to vital life signs, airway, breathing, and circulation is the most important first step.
  • In severe respiratory depression, the individual may require intubation.
• Naloxone is the emergency treatment of choice and should be administered as soon as possible if there is high clinical suspicion for an opioid overdose.
  • Naloxone can be administered via intravenous, intramuscular, subcutaneous, or intranasal routes.
• Post-naloxone administration, the individual can become combative or violent, and use of restraints may be required.