Opioids are valuable tools for addressing pain; however, overdose is always a concern.
The Opioid Overdose Prevention Toolkit equips communities and local governments with material to develop policies and practices to help prevent opioid-related overdoses and deaths. The Opioid Overdose Prevention Toolkit Addresses issues for first responders, treatment providers, and those recovering from opioid overdose.
Scope of Opioid Overdose
Opioid overdose continues to be a major public health probem in the United States. It has contributed significantly to accidental deaths among those who use, misuse or abuse illicit and prescription opioids. In fact, U.S. overdose deaths involving prescription opioid analgesics increased to about 17,000 deaths a year in 2010 [1, 2], almost double the number in 2001 . This increase coincided with a nearly fourfold increase in the use of prescribed opioids for the treatment of pain .
What are Opioids?
Opioids include illegal drugs such as heroin, as well as prescription medications used to treat pain such as morphine, codeine, methadone, oxycodone (OxyContin®, Percodan®, Percocet®), hydrocodone (Vicodin®, Lortab®, Norco®), fentanyl (Duragesic®, Fentora®), hydromorphone (Dilaudid®, Exalgo®), and buprenorphine (Subutex®, Suboxone®). Opioids work by binding to specific receptors in the brain, spinal cord and gastrointestinal tract. In doing so, they minimize the body’s perception of pain. However, stimulating the opioid receptors or “reward centers” in the brain also can trigger other systems of the body, such as those responsible for regulating mood, breathing and blood pressure.
How does overdose occur?
A variety of effects can occur after a person takes opioids, ranging from pleasure to nausea, vomiting, severe allergic reactions (anaphylaxis) and overdose, in which breathing and heartbeat slow or even stop. Opioid overdose can occur when a patient deliberately misuses a prescription opioid or an illicit drug such as heroin. It also can occur when a patient takes an opioid as directed, but the prescriber miscalculated the opioid dose or an error was made by the dispensing pharmacist or the patient misunderstood the directions for use. Also at risk is the person who takes opioid medications prescribed for someone else, as is the individual who combines opioids — prescribed or illicit — with alcohol, certain other medications, and even some over-the-counter products that depress breathing, heart rate, and other functions of the central nervous system .
Who is at risk?
Anyone who uses opioids for long-term management of chronic cancer or non-cancer pain is at risk for opioid overdose, as are persons who use heroin . Others at risk include persons who are:
- Receiving rotating opioid medicationregimens (and thus are at risk forincomplete cross-tolerance)
- Discharged from emergency medicalcare following opioid intoxication orpoisoning.
- At high risk for overdose because of alegitimate medical need for analgesia,coupled with a suspected or confirmedhistory of substance abuse, dependence, or non-medical use of prescription orillicit opioids.
- Completing mandatory opioid detoxifi- cation or abstinent for a period of time(and presumably with reduced opioidtolerance and high risk of relapse toopioid use).
- Recently released from incarcerationand a past user or abuser of opioids(and presumably with reduced opioidtolerance and high risk of relapse toopioid use).
A Word about Words
Tolerance develops when someone uses an opioid drug regularly, so that their body becomes accustomed to the drug and needs a larger or more frequent dose to continue to experience the same effect.
Loss of tolerance occurs when someone stops taking an opioid after long-term use. When someone loses tolerance and then takes the opioid drug again, they can experience serious adverse effects, including overdose, even if they take an amount that caused them no problem in the past.
For much more information about these and other issues, including key strategies to prevent opioid overdose, check out the full SAMHSA Opioid Overdose Prevention Toolkit Updated, released in August of 2014.
The toolkit includes a full digital version, Facts for Community Members, Essentials for First Responders, Safety Advice for Patients, and Information for Prescribers. The toolkit also includes resources for Overdose Survivors and Family Members.
Pub id: SMA14-4742
Publication Date: 8/2014
Audience: People in Recovery as Audience, Prevention Professionals, Community Coalitions, Law Enforcement, Professional Care Providers, Family & Advocates
The toolkit was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA) by the Association of State and Territorial Health Officials, in cooperation with Public Health Research Solutions, under contract number 10-233-00100 with SAMHSA, U.S. Department of Health and Human Services (HHS). LCDR Brandon Johnson, M.B.A., served as the Government Project Officer.