In a recent issue of Academic Emergency Medicine, we read with interest the article titled: Hospital Observation Upon Reversal (HOUR) with Naloxone: A Prospective Clinical Prediction Rule Validation Study by Clemency et al. In order to avoid over-reliance on this decision rule and possible untoward effects of early discharge, we feel that there are some key points worth considering in this regard. It is important to note that the average dose of prehospital naloxone was 3.1mg, which was administered intranasally (IN) in 85% of the patients. This fact was briefly discussed in the paper in terms of area under the curve (AUC). However, since AUC terminology may not readily translate to clinical meaning for many readers, we feel expanded discussion on this potential confounder is necessary. This article is protected by copyright. All rights reserved.