Use naloxone response and the opioid toxidrome as the immediate safety checkpoint before assuming a simple intoxication. Keep synthetic opioid exposure in mind when routine screening is negative or the clinical picture is severe.

Respiratory rate should guide naloxone dosing; Hypoventilation warrants 2 milligrams of naloxone; Normal respirations justify a lower titrated dose; Synthetic opioids are chemically manufactured and can be far more potent than natural opiates; The opioid toxidrome classically combines depressed consciousness, pinpoint pupils, and hypoventilation