When should I consider referring a patient with opioid overdose to secondary care for further management?

Consider referring a patient with opioid overdose to secondary care for further management if:

• There is a need to address the primary emergency problem in an acute or emergency setting, as opioid withdrawal symptoms should be treated alongside this, with referral to further drug services as appropriate.
• The patient has medical conditions requiring urgent treatment that cannot be managed in primary care.
• The patient is in police custody, serving a short prison sentence, or a short period of remand, where opioid withdrawal symptoms may require specialist opioid agonist medication.
• There is uncertainty about opioid dependence or tolerance, especially in complex cases or young people, where confirmatory laboratory tests and specialist assessment may be needed.
• The patient has comorbid physical or mental health problems that require integrated treatment alongside opioid overdose management.
• There is a risk of severe withdrawal symptoms or complications that cannot be safely managed in the community or primary care setting.

Referral to secondary care ensures appropriate emergency treatment, specialist detoxification, and management of complications related to opioid overdose and dependence.

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