Rescue Breathing in Response to Overdose

"Rescue breathing for persons suspected of having an opioid overdose has considerable support among harm reduction programs and in the medical literature.¹⁸ This preference is based on the physiology of an opioid overdose. Opioids suppress the autonomic respiratory response to declining oxygen saturation and rising carbon dioxide levels. If this response remains suppressed, the consequences are hypoxia, acidosis, organ failure and death. The majority, if not all, of the community-based naloxone programs in the United States train responders in a rescue breathing technique. In this technique, the nostrils of the unconscious individual are pinched closed, a seal is formed between the mouths of the victim and the responder, and breaths are introduced every five seconds by the responder. Further support for rescue breathing comes from the Substance Abuse and Mental Health Services Administration (SAMHSA) in its Opioid Overdose Toolkit.¹⁹ In late 2014, WHO issued guidelines on community management of opioid overdose recommending, 'In suspected opioid overdose, first responders should focus on airway management, assisting ventilation and administering naloxone.'²⁰ This was rated as a strong recommendation based on a weak quality of evidence."