Opioid Overdose and Naloxone: A Prehospital Guide
How to recognize opioid overdose, dosing routes for naloxone, what to do when the patient wakes up angry, and the transport decision every EMT faces.
July 8, 2026 · 7 min read
Opioid overdose is one of the most common EMS calls in the U.S. and one of the most frequent NREMT scenarios. The pattern is consistent: pinpoint pupils, respiratory depression, decreased LOC. The intervention that saves the patient is oxygen and ventilation — naloxone is a support, not the primary treatment.
Naloxone dosing
- IN: 2 mg per nostril (4 mg total), can repeat
- IM: 0.4–2 mg, can repeat every 2–3 min
- IV: 0.4–2 mg titrated to respiratory effort — go slow to avoid precipitated withdrawal
The goal is respirations, not consciousness
Titrate to a respiratory rate of about 12 per minute. A fully awake, agitated patient is more dangerous to you and less useful to your assessment. If you must give a full dose (unwitnessed arrest, apneic patient), be ready for vomiting and aggression.
Transport every time
Naloxone's half-life is often shorter than the opioid on board — especially with long-acting opioids like methadone or fentanyl analogs. Re-narcotization is a real risk. Document refusals carefully and involve medical direction when needed.
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