Who Is Safe for Early Discharge After Naloxone Administration?

Because of naloxone's short half-life, it is unclear how long patients should be observed after receiving naloxone to reverse opioid overdose. The increased availability of synthetic opioids with variable durations of action makes predicting subsequent deterioration even more problematic. The St. Paul's Early Discharge Rule (Acad Emerg Med 2000; 7:1110) was derived to identify patients safe for discharge at 1 hour but has not been externally validated.

Researchers prospectively enrolled 538 adult patients transported to an urban emergency department after receiving naloxone in the field. After 1 hour, treating clinicians recorded the elements of the Discharge Rule as well as their own judgment about whether the patient was safe for discharge…