title: Recurrent opioid toxicity after pre-hospital care of presumed heroin overdose patients.
abstract: BACKGROUND
  In patients with presumed heroin overdose, the recommended time of observation after reversing heroin toxicity with naloxone varies widely. The aims of this study were to examine the incidence of recurrent opioid toxicity and the time interval in which it occurs after pre-hospital treatment in presumed heroin overdose patients.
  
  
  METHODS
  We undertook a retrospective study in Helsinki (population, 560,000). Records were reviewed from 1 January 1995 to 31 December 2000. Patients included were treated by the emergency medical service (EMS) for a presumed heroin overdose. Patients with known polydrug/alcohol use or the use of opioids other than heroin were excluded. The EMS records were compared with the cardiac arrest database and the medical examiners' records.
  
  
  RESULTS
  One hundred and forty-five patients were included. The median dose of pre-hospital administered naloxone was 0.4 mg. After pre-hospital care, 84 patients refused further care and were not transported to an emergency department (ED). Seventy-one received pre-hospital naloxone, and no life-threatening events were recorded during a 12-h follow-up period in these patients. After pre-hospital care, 61 patients were transported to an ED. Twelve patients received naloxone in the ED for respiratory depression. All had signs of heroin use-related adverse events within 1 h after receiving pre-hospital naloxone.
  
  
  CONCLUSIONS
  Allowing presumed heroin overdose patients to sign out after pre-hospital care with naloxone is safe. If transported to an ED, a 1-h observation period after naloxone administration seems to be adequate for recurrent heroin toxicity.
authors.affiliation: Helsinki Emergency Medical Service, Helsinki University Central Hospital, Helsinki, Finland. james.boyd@hus.fi
authors.forename: J J
authors.initials: JJ
authors.lastname: Boyd
authors.forename: M J
authors.initials: MJ
authors.lastname: Kuisma
authors.forename: A O
authors.initials: AO
authors.lastname: Alaspää
authors.forename: E
authors.initials: E
authors.lastname: Vuori
authors.forename: J V
authors.initials: JV
authors.lastname: Repo
authors.forename: T T
authors.initials: TT
authors.lastname: Randell
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D000701:Analgesics, Opioid / Q000506:poisoning*; D062787:Drug Overdose; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D005387:Finland; D003932:Heroin / Q000008:administration & dosage / Q000506:poisoning*; D006801:Humans; D007267:Injections; D008297:Male; D008499:Medical Records; D012008:Recurrence; D015203:Reproducibility of Results; D012120:Respiration Disorders / Q000139:chemically induced; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D003932:Heroin