Running head: PREVENTING OPIOID OVERDOSE DEATHS 1

Preventing Opioid Overdose Deaths

Christina M. Collins

Delaware Technical Community College

NUR 340
PREVENTING OPIOID OVERDOSE DEATHS 2

Preventing Opioid Overdose Deaths

Introduction

In the United States the Opioid epidemic is a threat to public health, which affects almost

every community in some way. Many people who have an opioid addiction or dependence

unintentionally die due to opioid overdose. Drug overdose is the number one cause of death in

the United States, with 6 out of 10 deaths related to opioid misuse (CDC: Understanding the

epidemic, 2016). Death by overdose can be prevented. The Department of Health and Human

Services has made addressing opioid abuse a high priority. Important goals to achieve are

reducing the amount of overdose deaths and reducing the amount of people with an opioid abuse

disorder. Lives can be saved. Evidence-based research has shown that increased access to

naloxone reduces overdose deaths, use of medication-assisted treatment (MAT) programs can

reduce opioid uses disorders and overdose, and regulating opioid prescribing practices can

reduce opioid use disorders and overdose.

Overview of Opioid Overdose

How did our communities become plagued by an opioid epidemic? Early on doctors

would have many patients who suffered from chronic pain and they were at their wits-end on

what was the best way to manage the patients pain. According to the National Institute of Drug

Abuse (NIDA) in the late 1990s pharmaceutical companies marketed their opioid pain relievers,

convincing the medical community that not only would their patients pain be relieved, they

would not become addicted. Healthcare providers began to prescribe opioids at an alarming

increased rate and before they realized the addictive properties, misuse and abuse of opioids was
PREVENTING OPIOID OVERDOSE DEATHS 3

in full-effect. Prescription opioid misuse leads to illegal opioid drug use. Due to the increased

abuse of opioids, overdose rates have increased. Since 1999, opioid overdose deaths have

quadrupled. Ninety-one Americans die daily from an opioid overdose (CDC, 2017). In 2015,

33,000 people died from opioid overdose, with more than half related to prescription opioids

(CDC, 2017).

Background Information (Literature Review)

Opioid Prescribing Practices.

In 2016, the CDC published guidelines for opioid prescribing for chronic pain, outside of

the end-of-life setting. Recommendations were geared to the primary care setting for individuals

18 or older. The intent of the guidelines is to improve inappropriate prescribing of opioids. The

guidelines lead to safer practices and less opioids prescribed. It is also important that prescribers

use state prescription drug monitoring programs (PDMP) to ensure safe patient care and to

prevent abuse (CDC, 2017). The PDMP allows prescribers to view other prescription drugs

patients have been prescribed and allows the prescriber to make an informed decision when

adding additional medications. The PDMP can also be informative to the potential risks of

misuse and abuse by patients. Reviewing one study showed that emergency medicine providers

underestimated their opioid prescribing practices. This is significant in that medical

professionals are not aware of the amount of opioids they are prescribing. They presume they

are prescribing less, when in actuality their practices need to be revamped. Education regarding

opioid prescribing is paramount in reducing opioid misused and abuse. An article titled,

Strategies to prevent fatal opioid overdose explored an example of prescriber education in an

overdose prevention program called Project Lazarus in Wilkes County, North Carolina. From
PREVENTING OPIOID OVERDOSE DEATHS 4

2008-2010, providers were educated one-on-one on evidenced-based opioid prescribing. Data

from Wilkes County showed a decrease in the overdose rate from 43 per 100,000 in 2008 to 29

per 100,000 in 2010. This data suggest that education can lead to improved opioid prescribing

practices leading to decreased opioid misuse and abuse

Access to Naloxone.

Overdose occurs when too much of an opiate floods the opioid receptors in the brain, the

natural breathing mechanism is not triggered, leading to respiratory failure (Kim, Irwin, &

Khoshnood, 2009). Naloxone is a safe and effective opiate antagonist that can reverse the effects

of opiate overdose. Naloxone displaces the opiate from the receptors, which prevents additional

opioids to bind to the receptors. Naloxone rapidly reverses the effect of analgesia and respiratory

depression, preventing death (Hawk, Vaca, & DOnofrio, 2015). Naloxone is a first line defense

in preventing overdose. It is time sensitive, which is why it is important to increase access to as

many people as possible. Opioid overdose is a result of misuse and abuse of opioids, but every

life matters. Naloxone gives an individual another chance at life, the ability to seek treatment

for their addiction, and the ability to one day live a sober life. Naloxone is extremely significant

in the fight against overdose. In 2015, the FDA approved an intranasal administration of

naloxone. Until than naloxone was only available by intramuscular injection. The introduction

of intranasal naloxone is important because it allows more people the ability to administer, it

does not require a skill set to administer, and it is safer because it eliminates needle stick injuries

(Kerr, Kelly, Dietze, Jolley, & Barger, 2009). A review of a study comparing intranasal and

intramuscular administration of naloxone demonstrated that intranasal naloxone is just as

effective and safe as the intramuscular naloxone for first-line treatment in suspected heroin

overdose in the pre-hospital setting (Kerr et al.,2009). Increasing access to naloxone has made
PREVENTING OPIOID OVERDOSE DEATHS 5

significant strides over the years. Naloxone at one time could only be found in a hospital setting.

With harm reduction initiatives, naloxone can be found in hospitals, as well as access has

reached to first responders, police, friends, family, and in as many as 46 states can be found over-

the-counter at pharmacies. Given the ongoing increase of opioid overdose, access to naloxone

will save lives.

Medication-Assisted Treatment (MAT).

Medication-assisted treatment (MAT) is used for the treatment of patients with opioid

addictions. MAT uses the medication methadone or buprenorphine, as well as counseling and

behavioral therapies together to treat opioid addiction. MAT has been shown to increase

treatment retention, decrease opioid use, decrease mortality, and decrease the risky behaviors that

lead to HIV and Hepatitis C (Department of Health and Human Services, 2016). The presidents

budget for 2017 includes expanding access to MAT, support services for pregnant and post-

partum women, evaluating the effectiveness of MAT programs, and expanding access to

buprenorphine to nurse practitioners and physician assistants to write prescriptions if allowed by

state law (HHS, 2016). Widespread access to MAT is important in reducing overdose, as well

as abuse of opioids.

Although there are many initiatives in place to combat opioid abuse or overdose there are

many gaps identified. With medication-assisted treatment there is still a stigma associated with

using medication to prevent addiction. With respect to naloxone many doctors are not educated

thoroughly and often times do not understand their significance in prescribing naloxone to those

in the community. The medical community needs constant education regarding addiction and

overdose in order to continue to make a difference in the opioid epidemic.

The most important recommendation to further decrease opioid overdose is the

availability to educate the world. With knowledge comes improved decision-making. It is also

recommended that physicians are encouraged to prescribe naloxone in proactive ways to the

appropriate at-risk patients, including encouraging the involvement of pharmacists as well as

policy makers. The opioid epidemic is on the fast track to increase unintentional overdoses, but

with continued harm reduction initiatives and the presidents nationwide public health

emergency, there is hope to stopping this epidemic.

References

CDC: Understanding the epidemic. (2017, August 30). Retrieved from

http://www.cdc.gov/drugoverdose/epidemic

Department of Health and Human Services (HHS). (2016). The opioid epidemic: By the

numbers. Retrieved from http://www.hhs.gov/opioids

Hawk, K. F., Vaca, F. E., DOnofrio, G. (2015). Reducing fatal opiod overdose: prevention,

treatment, and harm reduction strategies. Yale Journal of Biology and Medicine, 88, 235-

245.

Kerr, D., Kelly, A., Dietze, P., Jolley, D., & Barger, B. (2009). Randomized controlled

trial comparing the effectiveness and safety of intranasal and intramuscular

naloxone for the treatment of suspected heroin overdose. Addiction, 104(12),

2067-2074. doi:10.1111/j.1360-0443.2009.02724.x

Kim, D., Irwin, K., & Khoshnood, K. (2009, March) Expanded access to naloxone: Options for

critical response to the epidemic of opioid overdose mortality. Health Policy and Ethics.

99(3), 402-407.

National Institute of Drug Abuse. (2017). Opioids. Retrieved from

https://www.drugabuse.gov/drug-abuse/opioids

Michael, S., Babu, K., Androski Jr., C., Rezneck, M. (2016). Emergency medicine providers

systematically underestimate their opioid prescribing practices. Retrieved from

http://escholarship.umassmed.edu/cts_retreat/2016/posters/55/