Management of substance misuse problems in the general hospital.

Opiate overdose produces pinpoint pupils and varying degrees of respiratory depression and impairment of consciousness. If there is coma or bradypnoea, the opiate antagonist naloxone should be given intravenously. If the patient has taken a long-acting opioid such as methadone, a naloxone infusion should be considered1. After the administration of naloxone, opiate-dependent patients will experience acute withdrawal symptoms. This can be a difficult period as the patient may need further doses of naloxone, but is driven to leave the clinic to seek more drugs. An additional dose of naloxone given intramuscularly may offer some protection for patients who insist on leaving.