Introduction: Patients who present to the Emergency Department (ED) with a drug overdose often require long periods of monitoring. After their initial assessment and stabilization, they spend a significant amount of time in a high cost acute care bed in the ED for monitoring until they are medically cleared for psychiatric care or to be discharged. The shift length at this ED is a maximum of 8 hours; meaning any patients staying over 8 hours must be handed over between physicians, increasing the chance of medical errors. The objective of this study is to examine the total ED length of stay (LOS) of this patient group after physician initial assessment (PIA) to determine if there is there justification for the creation of a toxicology observation or short-stay unit for these patients. Methods: A single-centre, blinded retrospective chart review was conducted examining all adult patients presenting to the ED at an urban academic tertiary care centre with a drug overdose in 2018. Variables examined include: Disposition (home, admitted to acute care setting, admitted to non-acute care setting), time from PIA to disposition and total length of stay from PIA to discharge home or admission to hospital. The primary outcome is total length of stay in the ED after PIA.M Results: A total of 1006 patients presenting with an overdose were included. A total of 388 patients were admitted with 44% (172) having an ED LOS greater than 8 hours and 36% (138) staying 8 hours after PIA. The median [IQR] LOS in the ED for all patients was 343 minutes [191-565] while the median [IQR] time to PIA was 37 minutes [15-97]. The majority of these patients (54%) were discharged with no consulting services involved, 23% received a consult to psychiatry, 22% were consulted to internal medicine and 5% of patients were consulted to Critical Care Medicine. Conclusion: This demonstrates patients presenting to the ED with an overdose are seen in the ED by a physician quickly, however many stay in the department over 5 hours from their initial assessment in a monitored setting. While a majority of these patients are able to go home, 44% of admitted patients wait greater than 8 hours in the ED on monitors. The creation of a toxicology observation unit would be helpful for this population to increase patient safety and ease ED bed congestion.