The assessment of a suspected opiate toxicity begins with managing any immediate threats to airway, breathing and circulation. In the case of an opiate overdose, respiratory depression will be present and will require immediate intervention.
The normal pupil size for an adult is 2-5mm in bright light or 4-8mm in darkness. For the suspected opiate overdose the pupillary size is less than 2mm. When assessing pupillary response with a light, the EMS provider should note the starting size of the pupil and the size once the light has moved over the eye. Both pupils should move simultaneously. It is important to note the pupil shape, size and reactivity however not all opiates produce pinpoint pupils. Demerol for example does not. EMS providers must use all senses in determining a differential diagnosis or searching for clues around the patient.
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