The rationale behind the use of NIV for the management of drug overdose-associated respiratory failure stems from the encouraging experience obtained from patients with hypercapnic COPD exacerbation and cardiogenic pulmonary edema. In these instances, NIV has been shown to reduce mortality and length of hospital stay and avert endotracheal intubation, along with its associated complications (e.g., infections) [2]. Additionally, when NIV was directly compared with invasive mechanical ventilation in patients with COPD exacerbation, it was associated with a lower frequency of complications, although the rate of NIV failure was high, and eventually 60 % of the NIV-treated patients required intubation [17]. Nevertheless, controlled clinical studies are needed to explore whether the benefits from NIV application in these categories of patients might also apply to patients with respiratory failure related to drug overdose.