Category Archives: Opioid Toxicity

Question: My question relates to narcan. Do you feel it is necessary in all cases to check BGL prior to administering narcan? The Medical Directive reads uncorrected hypoglycemia as contraindication but in the presence of no diabetic history and an incident history which is clearly indicating opioid overdose combined with critically low oxygen saturation and no ability to ventilate are we to invariably to take a BGL prior to treating obvious signs and symptoms of opioid overdose or can we use clinical judgement based on findings? It goes without saying that a BGL should eventually be taken on such a patient at some point but my question is with a critical patient, no history or finding consistent with low BGL and multiple indicators for OD are we not safe to presume OD, treat accordingly and follow up with BGL afterwards to rule out hypoglycemia?

Question: I have a question regarding the administration of narcan. Narcan seems to be given more often now that there is no patch point. The wording of the medical directive hasn't changed though so just to confirm, are we still just to be giving it when we cannot adequately ventilate the patient? Example, if they are GCS of 3 and breathing inadequately but we are getting good compliance on the BVM and the patient’s vitals are otherwise stable, are we ok to not give it? If we do go ahead and give narcan to a patient who is NOT breathing and they start breathing on their own but are still GCS of 3 are we to stop there since we can now manage their airway or do we continue up to our maximum of 3 doses or until they become GCS of 15?

Question: What is the rationale for the 18 years old and greater age for naloxone administration? (i.e. legal, risk factors?)

Question: We have been trained on the Opioid Toxicity Medical Directive and the educators reiterated to use it as a last resort because of the potential for violence. I understand their concerns. I also appreciate these kits are out in the public for use and our skill set should continue to exceed that of the layperson(s). However, I wonder why not consider expanding the king LT insertion medical directive to include GCS = 3 for PCPs? This would allow safe and effective airway management of suspected overdose patients (or other GCS = 3 patients), even in situations of long transport times. We already preform this task in situations where a ROSC is obtained. We are familiar and proficient with the equipment and there is no additional cost to the services.

Question: On February 21, of this year the London Free Press had an article stating that the Middlesex London Health Unit plans to roll out naloxone kits to the public in hopes of preventing deaths from unintentional overdoses. Toronto Health Unit has already been distributing these kits. Why are Primary Care Paramedics still without this drug when Naloxone now in the hand of the public?

Question: With the Middlesex-London Health Unit distributing Narcan to the public for high risk users, I can't help but picture getting sent code 4 for an overdose and on arrival a bystander hands us this kit because they didn't want to be the Good Samaritan drug user. Will there be any changes to the Narcan Medical Directives to somehow include PCP's in the near future?

Thanks in advance.

Question: If you have a VSA patient with a previous history of methadone use, is it beneficial to patch for Narcan while the patient is VSA or until you get a ROSC?

Question: This question is regarding not giving Narcan to a DNR patient. Obviously, if there is not an underlining medical issue (e.g. terminal CA) and a patient ODs, even with a DNR, we attempt to reverse any issues. However, if the patient does have a medical issue with a DNR, has decided to OD to commit suicide and is in a pre-arrest / arrested state, is it reasonable to assume that since they are breaking the law, that the DNR can no longer be valid?

Question: Can there be some consideration to an inclusion of a (1mg-2mg) Naloxone standing order for VSA patients from a suspected opioid overdose as per current literature and practice?

Question: Dr. Bradford still ok with us not having to patch for naloxone?