In heroin users specifically, 5% needed either repeat naloxone or oxygen > 2 hours after initial naloxone reversal. Observation for 3 hours may be safer, especially for those with polysubstance abuse.
Individual risk factors associated with the development of severe alcohol withdrawal syndrome (SAWS) included a history of delirium tremens and baseline BP ≥ 140mmHg but no individual symptoms or signs associated with exclusion of SAWS. Composite measures fared better, such as the Prediction of Alcohol Withdrawal Severity Scale; a score ≥ 4 had a LR of 174 (95% CI 43-696).
Although opioids are not first-line treatment for ankle sprains, an opioid was prescribed for 25% of emergency department patients diagnosed with an isolated ankle sprain. Prescribing varied widely among states. Additionally, patients prescribe greater quantities of opioids were more likely to transition to continued use.