Opioid Addiction Prevention
According to The New York Times “It’s the deadliest drug crisis in American history.”
Recommended steps of Prevention
STRATEGIES TO PREVENT OVERDOSE DEATHS
STRATEGY 1: Encourage providers, persons at high risk, family members, and others to learn how to prevent and manage opioid overdose. Providers should be encouraged to keep their knowledge current about evidence-based practices for the use of opioid analgesics to manage pain, as well as specific steps to prevent and manage opioid overdose.
The Substance Abuse and Mental Health Services Administration (SAMHSA) funds continuing medical education courses that are available to providers at no charge from the Providers Clinical Support System (PCSS) at https://pcssnow.org/.
Helpful information for laypersons on how to prevent and manage overdose is available from Prevent & Protect at http://prevent-protect.org/.
STRATEGY 2: Ensure access to treatment for individuals who are misusing opioids or who have a substance use disorder. Effective treatment of substance use disorders can reduce the risk of overdose and help overdose survivors attain a healthier life. Medications for opioid use disorder, as well as counseling and other supportive services, can be obtained at SAMHSA-certified and Drug Enforcement Administration-registered opioid treatment programs and in specialty substance use disorder treatment programs, as well as from physicians and other practitioners including nurse practitioners and physician assistants who are trained to provide care in office-based settings with buprenorphine and naltrexone.
Information on treatment services available in or near your community can be obtained from your state health department, your state alcohol and drug agency, or the SAMHSA Behavioral Health Treatment Services Locator at https://www.findtreatment.samhsa.gov.
STRATEGY 3: Ensure ready access to naloxone. Opioid overdose-related deaths can be prevented when naloxone is administered in a timely manner. (For instructions on how to use naloxone, go to http://prescribetoprevent.org). Naloxone displaces opioids from receptor sites in the brain and reverses respiratory depression that usually is the cause of overdose deaths.2 Naloxone is an appropriate response for all opioid overdose events, including fentanyl-involved overdoses. Multiple doses of naloxone may be required when the overdose results from ingestion of large amounts of opioids or potent opioids such as fentanyl, carfentanil, or other opioid analogs.4 (For more information regarding the various formulations of naloxone, see https://www.drugabuse.gov/publications/naloxone-opioid-overdose-life-saving- science/naloxone-opioid-overdose-life-saving-science.)
On the other hand, naloxone is not effective in treating overdoses of benzodiazepines, barbiturates, clonidine, GHB, or ketamine. It is also not effective against overdoses of stimulants, such as cocaine and amphetamines (including methamphetamine and MDMA). However, if opioids are taken in combination with other sedatives or stimulants, naloxone may be helpful.
Naloxone injection has been approved by the Food and Drug Administration (FDA) and used for more than 40 years by emergency medical services personnel to reverse opioid overdose and resuscitate individuals who otherwise might have died in the absence of treatment.5 Naloxone comes in several forms, including injectable, intranasal, and auto-injector. Injectable naloxone is typically supplied as a kit with a minimum of two doses and two syringes.6 Brief education on how to administer naloxone using a syringe can be obtained from the provider of the naloxone kit or from http://prescribetoprevent.org/. The FDA has also approved an intranasal naloxone product (a nasal spray) and a naloxone auto-injector that delivers a therapeutic dose of naloxone in an overdose situation. The intranasal spray is a prefilled, needle-free device that requires no assembly. The auto-injector can deliver a dose of naloxone through clothing, if necessary, when placed on the outer thigh.
Prior to 2012, just six states had laws that expanded access to naloxone or limited criminal liability.7 By mid-2017, every state and the District of Columbia had enacted statutes that provide criminal liability protections to laypersons or first responders who administer naloxone. Forty-six states and the District of Columbia have statutes that provide civil liability protections to laypersons or first responders who administer naloxone. Thirty-seven states have statutes that offer criminal liability protections for prescribing or distributing naloxone. Forty-one states have statutes that offer civil liability protections for prescribing or distributing naloxone, and 46 states have statutes that allow naloxone distribution to third parties or first responders via direct prescription or standing order. To find relevant laws for each state, visit the Prescription Drug Abuse Policy System at http://www.pdaps.org/
STRATEGY 4: Encourage the public to call 911. An individual who is experiencing an opioid overdose needs immediate medical attention. An essential first step is to get help from someone with medical expertise as quickly as possible.8 Therefore, members of the public should be encouraged to call 911. All they have to say is “Someone is unresponsive and not breathing” and give a specific address and/or description of the location. Thirty-seven states and the District of Columbia have “Good Samaritan” statutes that prevent prosecution for possession of a controlled substance or paraphernalia if emergency assistance is sought for someone who is experiencing an overdose, including an opioid-induced overdose.9
STRATEGY 5: Encourage prescribers to use state prescription drug monitoring programs (PDMPs). State PDMPs have emerged as a key strategy for addressing the misuse of prescription opioids and thus preventing opioid overdoses and deaths. Specifically, prescribers can check their state’s PDMP database to determine whether a patient is filling the prescriptions provided and/or obtaining prescriptions for the same or a similar drug from multiple prescribers.
While nearly all states now have operational PDMPs, the programs differ from state to state in terms of the exact information collected, how soon that information is available to prescribers, and who may access the data. Therefore, information about the program in a particular state is best obtained directly from the Prescription Drug Abuse Policy System at http://www.pdaps.org/, the specific state PDMP, or the state’s board of medicine or pharmacy.