Most fentanyl overdoses don’t require long ER stays
Antidote and two hours’ observation adequate for many patients: 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 survivors may be kept for six to 12 hours and sometimes even 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.
Vancouver Fire and Rescue Services logged 486 overdose calls in March, the highest since July of last year.
“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,” he 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 — 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 was collected over four months of overdose treatment involving 1,009 patients at St. Paul’s.
One patient died after being discharged and refusing a takehome 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 short, which may 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,” said Scheuermeyer.
Police estimate 32 people died of overdose in Vancouver in March, up from 18 in February.
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. The Fraser Valley health region recorded the most fentanylrelated overdoses, with 377.
More than 2,100 British Columbians have died using fentanyltainted drugs since 2012.