A 60-year-old man with a 15-year history of oxycodone dependence presented to a substance abuse detoxification program with acute withdrawal symptoms, including dilated pupils, nausea, vomiting, diarrhea, and hot and cold flashes. He reported his last opiate intake was 2 days earlier. He felt his addiction was out of control and he wanted treatment. Per the treatment program's protocol, the patient received buprenorphine/naloxone (4.0 mg/1.0 mg) for opiate detoxification, first at 2:00 PM and then again at 4:00 PM.
When the nurse checked on the patient at 7:00 PM, he was difficult to arouse and cyanotic with notable respiratory muscle retractions, a respiratory rate of 8 breaths per minute, and oxygen saturation of 67%. History: His medical history was notable for hypertension and a 30-year history of tobacco use (2 packs per day). He went to a local emergency department (ED) a month…
