title: Is a Prehospital Treat and Release Protocol for Opioid Overdose Safe?
abstract: BACKGROUND
  The current standards for domestic emergency medical services suggest that all patients suspected of opioid overdose be transported to the emergency department for evaluation and treatment. This includes patients who improve after naloxone administration in the field because of concerns for rebound toxicity. However, various emergency medical services systems release such patients at the scene after a 15- to 20-min observation period as long as they return to their baseline.
  
  
  OBJECTIVE
  We sought to determine if a "treat and release" clinical pathway is safe in prehospital patients with suspected opioid overdose.
  
  
  RESULTS
  Five studies were identified and critically appraised. From a pooled total of 3875 patients who refused transport to the emergency department after an opioid overdose, three patient deaths were attributed to rebound toxicity. These results imply that a "treat and release" policy might be safe with rare complications. A close review of these studies reveals several confounding factors that make extrapolation to our population limited.
  
  
  CONCLUSIONS
  The existing literature suggests a "treat and release" policy for suspected prehospital opioid overdose might be safe, but additional research should be conducted in a prospective design.
authors: Division of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors: Daniel
authors: D
authors: Kolinsky
authors: Department of Emergency Medicine, The University of Arizona College of Medicine, Tucson, Arizona.
authors: Samuel M
authors: SM
authors: Keim
authors: Division of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors: Brian G
authors: BG
authors: Cohn
authors: Division of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors: Evan S
authors: ES
authors: Schwarz
authors: Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
authors: Donald M
authors: DM
authors: Yealy
mesh_terms: D000700:Analgesics / Q000009:adverse effects / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use / Q000633:toxicity; D062787:Drug Overdose / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000458:organization & administration; D017408:Guidelines as Topic / Q000592:standards*; D003932:Heroin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D009270:Naloxone / Q000008:administration & dosage* / Q000627:therapeutic use; D061214:Patient Safety / Q000592:standards*
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid; D009270:Naloxone; D003932:Heroin
keywords: emergency medical services; naloxone; opioid overdose; prehospital