While walking into the emergency department (ED) for a Friday night shift, I heard the patch on the EMS radio reporting a patient found down, unresponsive, not breathing and cyanotic on the sidewalk. An initial dose of naloxone had restored the patient’s respiratory drive, but ongoing resuscitation was in progress, with a five minute ETA. For me, the prehospital EMS providers and my department colleagues, it was yet another shift treating a patient with an acute life threatening opioid overdose. Over the next five hours of the same shift, there were three more opioid overdoses, each as severe as the first. All required supportive care and were eventually discharged from the ED. Fortunately, none died, unlike others in the days and weeks before. Three of the four patients had a history of being prescribed, or using illicitly, methadone and/or buprenorphine, with no recent or related history of abusing prescription narcotics.