Concealed rectal opiates presenting as respiratory arrest: the importance of rectal examination in i.v. drug abusers

A case of recurrent respiratory depression due to rectal absorption of concealed opiate drugs in an intravenous drug abuser held in police custody is described. The importance of rectal examination in intravenous drug abusers in police custody is stressed and it is emphasised that drugs may have been concealed in a body cavity at the time of arrest. The use of both the intramuscular and intravenous route for the administration of naloxone in treatment of unconscious intravenous drug abusers suspected of having overdosed on opiates is advocated as these patients frequently discharge themselves from hospital on regaining consciousness and may later present with recurrent respiratory depression.