Harm reduction opportunities following ICU admission for prescription opioid overdose: An 8-year comparative audit at the Royal Melbourne Hospital

Intensive care unit (ICU) admission following prescription opioid overdose represents an important opportunity for multidisciplinary intervention and harm reduction, yet Australian data describing inpatient management are limited. A retrospective audit was conducted of 70 adults admitted to the ICU at the Royal Melbourne Hospital with prescription opioid overdose between 2021 and 2024. The primary outcome was provision of take-home naloxone (THN) before discharge among patients meeting institutional eligibility criteria. Secondary outcomes included opioid education, multidisciplinary involvement and discharge opioid management, with comparison with the previous institutional audit where comparable data were available. Only five patients (7.5%, 95% confidence interval 3.2–16.3) were supplied with THN despite all meeting institutional eligibility criteria. Polypharmacy overdose was common (77%). Most patients received at least one specialist referral (83%), although 15% received no inpatient specialist referral. Opioid education was documented in 58 patients (87%) compared with 17% previously ( P <0.001), although content and documentation were inconsistent. These findings demonstrate persistent gaps in THN provision, structured opioid education and coordinated discharge planning, highlighting ICU admission as an important opportunity for prescription opioid harm reduction. Strengthening guideline-based multidisciplinary interventions during admission may improve patient outcomes and inform harm reduction strategies nationally.