Objective: Analysis of a large consecutive case series of cases brought to an Emergency Department (ED).Design: Retrospective chart review.Setting: Emergency Department in Broward County, Florida.Patients: Medical records of patients with registered diagnoses of opioid overdose in 2016 and 2017.Outcomes: Demographics, toxicology results, mental-health comorbidities, use/response to naloxone, and hospital disposition.Results: Seven hundred and seventy nine opioid-overdose cases were identified (35 percent female, 65 percent male; age 36.2). Heroin intoxication was registered in 77 percent of discharge diagnoses, and 17.7 percent were prescription pain medications. Urine samples were collected in 39 percent and 81.5 percent of patients received naloxone (mean dose 4.0 mg ± 2.2). Sixty-five percent of cases were discharged home, 17.5 percent left the ED against medical advice, and 17.5 percent were admitted to the hospital/intensive care unit/behavioral unit.Conclusion: There is an alarming number of visits to the ED due to opioid overdoses with differences in age and gender. Clinicians are facing diagnostic, treatment and follow-up challenges for the management of these cases.