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The Opioid Crisis: Preventing Overdose

Executive Summary

The increase in opioid-related mortalities calls for focus on all dimensions of the care continuum. Some say prevention is the best medicine and in the case of the opioid crisis, preventing overdose is important to combat an increase in opioid-related mortalities and health dangers. Preventing opioid overdose is a multi-faceted approach that continues to advance and begins with examining overdose risk factors. 

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Addressing Opioid Overdose Risk Factors

Effective prevention of opioid-related overdoses requires addressing and supporting overdose risk factors. General risk factors include:

  • Opioid Availability
  • Combination of Opioids and other psychoactive substances
  • A lack of appropriate treatment
  • Reduced tolerance due to a recent period of abstinence[3]

 

However, gender-informed, culturally responsive, and ethically appropriate health care and treatment programs improve both short-and long-term outcomes for individuals with substance use disorders. For example, Substance use disorders in older women often go undetected by primary care professionals because of a lack of appropriate diagnostic criteria and because many signs of abuse can be mistaken for other conditions more prevalent in later life (e.g., cognitive impairment, anemia, physiological consequences from falls).[2]


Fentanyl

Fentanyl, a newer synthetic opioid painkiller, has a role in the increasing rates of opioid overdose. It is 50 to 100 times more potent than morphine and 30 to 50 times more potent than heroin, a potency strong enough that police and first responders helping overdose victims have themselves overdosed by simply touching or inhaling a small amount. Its use has caused a spike in deaths among users of heroin and prescription painkillers, while becoming easier to obtain and conceal. Some arrested or hospitalized users are surprised to find that what they thought was heroin was actually fentanyl.[1]


General Prevention Strategies

We need to improve prescribing of opioids, expand treatment of addiction, and reduce access to illegal opioids:

  • Improve opioid prescribing to reduce exposure to opioids, prevent abuse, and stop addiction
  • Expand access to evidence-based substance abuse treatment, such as Medication-Assisted Treatment, for people already struggling with opioid addiction.
  • Expand access and use of naloxone - a safe antidote to reverse opioid overdose
  • Promote the use of prescription drug monitoring programs, which give health care providers information to improve patient safety and prevent abuse. 
  • Implement and strengthen strategies that help prevent high-risk prescribing and prevent opioid overdose
  • Improve detection of the trends of illegal opioid use by working with national and local public health agencies, medical examiners, and coroners, and law enforcement [7]

Naloxone and Overdose Prevention

The drug naloxone can be used as an antidote for opioid overdoses if given properly and in time. To prevent death from overdose, people who are at risk for heroin or other forms of opioid overdose should have access to naloxone and a syringe so that it can be injected into a muscle in the case of overdose. Their family members and significant others should also be trained to know the warning signs of overdose and how to administer the naloxone in an emergency.[6]


Prescribing Guidelines and Drug Monitoring Programs

In 2016, the CDC published its "Guideline for Prescribing Opioids for Chronic Pain", recommending opioids only be used when benefits for pain and function are expected to outweigh risks, and then used at the lowest effective dosage, with avoidance of concurrent opioid and benzodiazepine use when possible. Silvia Martins, an epidemiologist at Columbia University, has suggested getting out more information about the risks:

  • Greater “social acceptance” for using these medications (versus illegal substances) and the misconception that they are “safe” may be contributing factors to their misuse.
  • Hence, a major target for intervention is the general public, including parents and youth, who must be better informed about the negative consequences of sharing other’s medications prescribed for their own ailments.
  • Improved training of medical practitioners and their staff is important to better recognize patients at potential risk of developing nonmedical use, and to consider potential alternative treatments as well as closely monitor the medications they dispense to these patients.[1]

 

A prescription drug monitoring program (PDMP) is an electronic database that tracks controlled substance prescriptions. PDMPs can help identify patients who may be misusing prescription opioids or other prescription drugs and who may be at risk for overdose.[5]

Clinical practice guidelines encourage use of the PDMP prior to prescribing to assess a patient’s history of controlled substance use. It is possible to improve the way opioids are prescribed, reducing the number of people who misuse, abuse, or overdose from them, while making sure patients have access to safe, effective pain management.[5]


Prevention through Treatment

In the case of the opioid crisis, treatment of opioid addiction or opioid use disorder is a way to avert opioid overdose and overdose-related harms before a problem occurs. There are several approaches that can be used to treat opioid addiction. Existing strategies include Medication-Assisted Treatment, counselling, behavioural therapy, psychosocial interventions, and holistic therapies. As the opioid crisis strengthens, more and more treatments for addiction are being developed. 


How healthcare organizations and community members can help:

  • Learn more about opioids so you can help people who are most at risk for opioid use disorder and overdose in your community.
  • Provide tools and information for healthcare professionals working on overdose prevention and treatment.
  • Help those struggling with opioid use disorder find the right care and treatment.
  • Increase awareness and share best practices with providers and patients in your community.[8]

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