Admittedly, it has been a few minutes since I worked an opioid OD in the field. But I did a a bit of them back in the day and more importantly, given what I do for a living now I am still very aware of the pertinent presentation and related interventions and pharmacology.
That said, I can think of almost no reason to ever intubate a patient for the purposes of opioid OD, no matter how low their Sp02 is.
In many if not most cases you probably don't even need positive pressure ventilation; a jaw thrust and high flow oxygen and an OPA or NPA should improve the Sp02 of anything other than an apneic (or very near-apneic) patient. If you DO need to ventilate, then of course do it. This buys you time to draw up drugs and start an IV or administer IM naloxone. This is worth considering since adequate BVM ventilations are not always easy and are never without risk.
Obviously there are times that the etiology isn't clear, or other factors muddy the waters and in those cases I think it's hard to place any blame on a clinician for for using a BVM or even an ETT on a patient who is in respiratory failure.
But any time the etiology of opioid OD seems apparent, just remember that it takes the same amount of time to give naloxone as it does sux, and the former probably presents fewer risks to the patient and requires less work on your part.
