Overdose Prevention

Opioid Epidemic Statistics

  • The majority of drug overdose deaths involve opioids today, and numbered 66% in 2016
  • From 2000 to 2015 more than half a million people died from drug overdoses
  • Since 1999, the amount of prescription opioids sold in the U.S. nearly quadrupled, yet overall, no change has been reported in the amount of pain Americans experience
  • Among new heroin users, approximately 75% report abusing prescription opioids prior to using heroin
  • Heroin-related deaths more than tripled between 2010 and 2015, with 12,989 heroin deaths in 2015
  • Opioids killed 42,249 U.S. citizens in 2016; about 12,000 more than the year prior and more than any year on record. Nearly half of all opioid overdose deaths involve a prescription opioid. 

Ways to combat the opioid crisis

  • Prescription drug monitoring programs
  • State prescription drug laws
  • Insurance strategies such as prior authorization, quantity limits, and drug utilization review
  • Quality improvement programs in health care systems to increase implementation of recommended prescribing practices
  • Youth substance abuse prevention, such as intensive family or school-based programs
  • Patient education on the safe storage and disposal of prescription opioids
  • Patient discussions with providers regarding the risks and treatment options before taking opioid medication   

Overdose Prevention

Opioid overdose continues to be a major public health problem in the United States. It has contributed significantly to accidental deaths among those who use or misuse illicit and prescription opioids. 


According to Centers for Disease Control and Prevention, health care providers wrote 259 million prescriptions for painkillers in 2012, enough for every American adult to have a bottle of pills. 


How does overdose occur?

A variety of effects can occur after a person takes opioids, ranging from pleasure to nausea, vomiting, severe allergic reactions  including 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 can also 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 simply misunderstood directions for use.  Also at risk, are individuals who misuse opioids and combine them with sedative hypnotic agents resulting in sedation and respiratory depression. 


Signs of OVERDOSE, which often results in death if not treated, include:  

  • Extreme sleepiness, inability to awaken verbally or upon sternal rub    
  • Breathing problems that can range from slow to shallow breathing in a patient that cannot be awakened  
  • Fingernails or lips turning blue/purple  
  • Extremely small “pinpoint” pupils  
  • Slow heartbeat and/or low blood pressure    


Signs of OVERMEDICATION, which may progress to overdose, include: 

  • Unusual sleepiness, drowsiness, or difficulty staying awake despite  loud verbal stimulus or vigorous sternal rub  
  • Mental confusion, slurred speech, intoxicated behavior  
  • Slow or shallow breathing  
  • Extremely small “pinpoint” pupils, although normal size pupils do not  exclude opioid overdose  
  • Slow heartbeat, low blood pressure  
  • Difficulty waking the person from sleep    

Who is at risk of overdose?

  • Anyone who uses opioids for long-term management of chronic cancer or non-cancer pain is at risk for opioid overdose
  • Individuals who use heroin  
  • Receiving rotating opioid medication regimens (and thus are at risk for incomplete cross-tolerance) 
  • Discharged from emergency medical care following opioid intoxication or poisoning 
  • At high risk for overdose because of a legitimate medical need for analgesia, coupled with a suspected or confirmed substance use disorder, or non-medical use of prescription or illicit opioids 
  • Completing mandatory opioid detoxification or abstinent for a period of time (and presumably with reduced opioid tolerance and high risk of relapse to opioid use) 
  • Recently released from incarceration and who have a history of opioid use disorder (and presumably have reduced opioid tolerance and high risk of relapse to opioid use) 
  • Certain medical conditions including liver and kidney dysfunction 
  • Unsecured opioid medications in the household   

References

Ali, M., Dowd, W., Classen, T., Mutter, R. and Novak, S. (2016, June). Prescription drug monitoring programs, nonmedical use of prescription drugs, and heroin use: Evidence from the National Survey of Drug Use and Health. Addictive Behaviors, 69, 65-77. doi: org/10.1016/j.addbeh.2017.01.011

  

Centers for Disease Control and Prevention (CDC). (2016). Understanding the Epidemic. Retrieved from https://www.cdc.gov/drugoverdose/epidemic/index.html 


Centers for Disease Control and Prevention (CDC). (2016). Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics. Retrieved from http://wonder.cdc.gov  


Rudd, R.A., Seth, P., David, F. and Scholl, L.  (2016, December). Increases in Drug and Opioid-Involved Overdose Deaths — United States, 2010–2015. MMWR Morb Mortal Wkly. DOI: 10.15585/mmwr.mm6550e1.