Unpopular Opinion: Naloxone in breathing patients.
Ok, here's my unpopular take: Naloxone has a place in patients who are profoundly unconscious from a suspected opiate overdose even if they are breathing adequately and are not suffering from respiratory depression. I'm not talking about people who are a little "on the nod," I'm talking about GCS3, not protecting their airway type patients.
Given a choice between three alternatives:
Naloxone (dosed in the lowest appropriate dose you can) to the point they can protect their own airway, and likely wake up enough to have a conversation about their wishes. My personal dosing strategy is 0.4mg IM repeated every 5 minutes or so, usually 1 or two doses is effective. I would do less if I had IV access, but has most of my patients choose to AMA after waking up, I prefer to be as non-invasive as possible.
Essentially do nothing to protect their airway, beside maybe basic airway adjuncts, transport them, and then either have the hospital intubate them or wake them up with naloxone anyway.
Intubate them (inappropriately in my view), transport them to hospital and have them admitted to the ICU for a day or two.
I feel like option 1 is the least invasive, most ethical and the best use of healthcare resources. I think it's also what most patients would prefer. The downside is obviously precipitated withdrawal, but by choosing the lowest possible dose to achieve your desired goal, this can be minimized (but not wholly avoided).
While I think that option 1 is the best outcome for the patient, it is also the best option for the healthcare system. I'm based on the west coast of Canada, and quite frankly, if we brought every patient who had overdosed to hospital, the system would immediately collapse.
Anyway - I expect spirited disagreement, but that's what reddit is for. Discuss!
Edit: Oh well, glad to see it's not actually an unpopular take