Most fentanyl overdose survivors need little hospital care: UBC study

People who receive an antidote promptly after a fentanyl overdose and show no complications require little hospital care, according to a study by physicians at the University of British Columbia.

The finding could drive policy change at emergency rooms across B.C., where low-risk overdose might see survivors kept for six to 12 hours and sometimes admitted overnight for observation.

Fentanyl overdoses kill an average of four British Columbians each day and the volume of cases takes a heavy toll on emergency services.

“If you don’t regularly see fentanyl overdoses, you might admit a patient thinking they are at risk of becoming critically ill,” said lead author Frank Scheuermeyer, a clinical associate professor at UBC and an emergency department physician at St. Paul’s Hospital. “But the risk of deterioration or dangerous complications is probably overstated.”

Lengthy observation appears to be unnecessary for people who show no complications, according to the study published in the Annals of Emergency Medicine.

“If you are going to admit people, you want to admit the right people and send the others home,” Scheuermeyer said.

A protocol developed at St. Paul’s Hospital discharges patients considered low-risk after a brief assessment of blood-oxygen levels, respiration and alertness and just two hours of observation — which is usually about 75 per cent of all cases.

“St. Paul’s established a protocol for heroin overdoses about 15 years ago and we tweaked that and kept them a bit longer because fentanyl is a stronger drug,” Scheuermeyer said. “We keep them for two hours and that seems to be adequate.”

During the observation period, doctors and social workers have an opportunity to discuss detoxication options with the patient and ensure they are adequately housed and fed.

Data for the study were collected over four months of overdose treatment involving 1,009 patients at St. Paul’s.

One patient died after being discharged and refusing a take-home naloxone kit. Naloxone is a fast-acting antidote to opioid intoxication, used by paramedics and distributed free to the public in B.C. by pharmacies.

Part of St. Paul’s success is likely because overdose patients are usually resuscitated quickly in the field and transport times are very short, which might not be the case in smaller communities.

“However, when a new batch of drugs hits the street and emergency rooms face a large number of overdoses at once of the type we see in downtown Vancouver, our protocol could help take the guesswork out,” Scheuermeyer said.

Across the province in 2017, 1,156 people died of overdose by illicit drugs, and fentanyl was detected in about 80 per cent of those cases, according to the B.C. Coroners Service.