Naloxone is a potent opioid receptor antagonist that reliably reverses life-threatening respiratory depression in opioid overdose but can precipitate severe withdrawal in opioid-dependent individuals.1 Guidelines recommend naloxone specifically for respiratory depression and not for reduced level of consciousness alone, with lower doses recommended in patients who may be opioid-dependent.2 3 The extent to which such guidelines are applied in practice has received little attention.

In Scotland, concurrent use of opioids and other central nervous system (CNS) depressants is frequent,4 and many patients are also prescribed opioid substitution therapy (OST).5 Both may affect the response to naloxone and consequent risk to patients and providers.6

We undertook a service evaluation aiming to:

(1) Describe the characteristics of patients being treated with naloxone in the pre-hospital and emergency department (ED) setting in one region of Southeast Scotland.

(2) Describe the current practice of naloxone administration and associated adverse events.

The charts of all ED patients who received naloxone from a healthcare professional in the pre-hospital or ED setting between December 2021 and November 2022 at one District General …