Is extra naloxone needed for overdose reversal in the fentanyl era?

The news that more naloxone than the standard 2‐mg dose is needed in many overdose victims is largely tied to the potent illicit fentanyl. Typically, the first responder waits to make sure the naloxone is working, that the patient starts breathing again, and if not, administers a second dose. But some people now say that it's important to give enough right away, and that those moments without oxygen can be damaging. Naloxone has no effect on someone without opioids in their system; on someone who has overdosed, it pushes the opioids off the receptors and reverses the overdose. On someone who is physically dependent on opioids, it will also produce withdrawal symptoms. Either way, the victim recovers, but if the naloxone is given in a high enough dose to someone who is dependent, that recovery will come with unpleasant withdrawal symptoms. [ABSTRACT FROM AUTHOR]