A 54-year-old male is brought to an emergency room via ambulance. He is obtunded and is breathing shallowly. He responds minimally to stimulation. His wife states that “he was sleepy today but had more pain than usual.” She calls for the ambulance when he stopped breathing. His past medical history is signifcant for multiple back surgeries, which have left him with chronic pain. His wife says his pain has gotten worse over the past few months. She also reports that he takes multiple medications for his pain, including opioids, but she does not know which specifc names or doses. He has a longstanding relationship with his current pain physician, and his wife believes that he may have recently had his opioid medication increased, although she is not certain. His blood pressure is 90/72, heart rate is 105, and respiratory rate is 6. Oxygen saturation is 92%, and oral temperature is 38 °C. The patient is not able to answer questions or follow commands, although he is arousable with sternal stimulation. Physical exam shows normal pupils that are round, equal in size, and reactive to light. A full body exam shows no signs of trauma or needle marks. No topical patches are found on his body. Breath sounds are shallow but clear. The abdomen is soft, and bowel sounds are absent.