Thanks for sharing this on the forum Kirsten. This definitely is an atypical OD presentation which can be related to opioid or a combination with other substances. When fentanyl is present, it can cause complex OD symptoms and can present without other typical opioid OD characteristics. What you've described are symptoms of both muscle rigidity and dyskinesia, which can occur when fentanyl is present in their drugs. If you are suspecting an OD, even if the usual symptoms are not present, it is safe to administer naloxone.