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S A M H S A

Opod OvedoseTOOLKIT:

Facts fo Commnt Membes


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TABLE OF CONTENTS

FACTS FOr COMMuNiTy MEMBErS

SCOPE OF THE PrOBLEM 3

STrATEGiES TO PrEVENT OVErDOSE DEATHS 4

rESOurCES FOr COMMuNiTiES 5

ACKNOWLEDGMENTS, ETC. 7

n Acknowledgments

n Disclaimer

n PublicDomainNotice

n ElectronicAccessandCopiesofPublication

n RecommendedCitation

n OriginatingOfce

Also see the other components of this Toolkit:

.FiveEssentialStepsforFirstResponders

.InformationforPrescribers

.SafetyAdviceforPatients&FamilyMembers

.RecoveringfromOpioidOverdose:

ResourcesforOverdoseSurvivors&FamilyMembers


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Tolerancedevelopswhensomeoneuses

anopioiddrugregularly,sothattheir

bodybecomesaccustomedtothedrug

andneedsalargerormorefrequentdose

tocontinuetoexperiencethesameeffect.

Loss of toleranceoccurswhensomeonestopstakinganopioidafterlong-termuse.

Whensomeonelosestolerance

andthentakestheopioiddrugagain,

theycanexperienceseriousadverse

effects,includingoverdose,evenif

theytakeanamountthatcaused

themnoprobleminthepast.

SCOPE OF THE PrOBLEM

Opiateoverdosecontinuestobeamajorpublichealthprob-lemintheUnitedStates.Ithascontributedsignicantlyto

accidentaldeathsamongthosewhouse,misuseorabuseillic-itandprescriptionopioidanalgesics.Infact,overdosedeathsinvolv-

ingprescriptionopioidanalgesicshaveincreasedtoalmost17,000deathsayear[1,2].Asaresult,drugpoisoningdeathsintheU.S.

almostdoubledbetween2001and2010[1].Thisincreasecoincidedwithanearlyfourfoldincreaseintheuseofprescribedopioidsforthe

treatmentofpain[3].

WHAT ArE OPiOiDS?Opioidsincludeillegaldrugssuchasheroinandprescriptionmedicationsusedtotreatpainsuchasmorphine,codeine,methadone,oxycodone(Oxycontin,Percodan,Percocet),

hydrocodone(Vicodin,Lortab,Norco),fentanyl(Duragesic,Fentora),hydromorphone(Dilaudid,Exalgo),andbuprenorphine(Subutex,

Suboxone).Opioidsworkbybindingtospecicreceptorsinthebrain,spinal

cordandgastrointestinaltract.Indoingso,theyminimizethebodysperceptionofpain.Stimulatingtheopioidreceptorsorreward

centersinthebrainalsocantriggerothersystemsofthebody,suchasthoseresponsibleforregulatingmood,breathingand

bloodpressure.

HOW DOES OVErDOSE OCCur?Avarietyofeffectscanoccurafterapersontakesopioids,rangingfrompleasuretonausea,vomiting,

severeallergicreactions(anaphylaxis)andoverdose,inwhichbreath-ingandheartbeatsloworevenstop.

Opioidoverdosecanoccurwhenapatientdeliberatelymisuses

aprescriptionopioidoranillicitdrugsuchasheroin.Italsocan

occurwhenapatienttakesanopioidasdirected,buttheprescriber

miscalculatedtheopioiddoseoranerrorwasmadebythe

dispensingpharmacistorthepatientmisunderstoodthedirections

foruse.

Alsoatriskisthepersonwhotakesopioidmedications

prescribedforsomeoneelse,asistheindividualwhocombines

opioidsprescribedorillicitwithalcohol,certainother

medications,andevensomeover-the-counterproductsthat

depressbreathing,heartrate,andotherfunctionsofthecentral

nervoussystem[4].

WHO iS AT riSK?Anyonewhousesopioidsforlong-termmanagementofchroniccancerornon-cancerpainisatriskforopioid

overdose,asarepersonswhouseheroin[5].Othersatriskincludepersonswhoare:

n Receivingrotatingopioidmedicationregimens(thusatriskforincomplete

cross-tolerance).

n Dischargedfromemergencymedicalcarefollowingopioidintoxicationorpoisoning.

n Athighriskforoverdosebecauseofa

legitimatemedicalneedforanalgesia,coupledwithasuspectedorconrmed

historyofsubstanceabuse,dependence,ornon-medicaluseofprescriptionor

illicitopioids.

n Completingmandatoryopioiddetoxica-tionorabstinentforaperiodoftime(and

presumablywithreducedopioidtoleranceandhighriskofrelapsetoopioiduse).

n Recentlyreleasedfromincarcerationandapastuserorabuserofopioids(andpresumablywithreducedopioidtolerance

andhighriskofrelapsetoopioiduse).


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STrATEGiES TO PrEVENT OVErDOSE DEATHSSTrATEGy 1: Encoage povdes, pesons at hgh sk, aml membes and othes to

lean how to pevent and manage opod ovedose. Providersshouldbeencouragedtokeep

theirknowledgecurrentaboutevidence-basedpracticesfortheuseofopioidanalgesicsto

managepain,aswellasspecicstepstopreventandmanageopioidoverdose.

FederallyfundedContinuingMedicalEducationcoursesareavailabletoprovidersat

nochargeatwww.OpioidPrescribing.com(vecoursesfundedbytheSubstanceAbuse

andMentalHealthServicesAdministration)andonMedScape(twocoursesfundedbythe

NationalInstituteonDrugAbuse).

Helpfulinformationforlaypersonsonhowtopreventandmanageoverdoseisavailable

fromProjectLazarusathttp://projectlazarus.org/orfromtheMassachusettsHealth

PromotionClearinghouseatwww.maclearinghouse.org.

STrATEGy 2: Ense access to teatment o ndvdals who ae mssng o addcted to

opods o who have othe sbstance se dsodes.Effectivetreatmentofsubstanceusedisorderscanreducetheriskofoverdoseandhelpoverdosesurvivorsattainahealthierlife.

Medication-assistedtreatment,aswellascounselingandothersupportiveservices,can

beobtainedatSAMHSA-certiedandDEA-registeredopioidtreatmentprograms(OTPs),

aswellasfromphysicianswhoaretrainedtoprovidecareinofce-basedsettingswith

medicationssuchasbuprenorphineandnaltrexone.

Informationontreatmentservicesavailableinornearyourcommunitycanbeobtained

fromstatehealthdepartments,statealcoholanddrugagencies,orfromthefederal

SubstanceAbuseandMentalHealthServicesAdministration(seepage6).

STrATEGy 3: Ense ead access to naloxone. Opioidoverdose-relateddeathscanbe

preventedwhennaloxoneisadministeredinatimelymanner.Asanarcoticantagonist,

naloxonedisplacesopiatesfromreceptorsitesinthebrainandreversesrespiratory

depressionthatusuallyisthecauseofoverdosedeaths[5]. During the period of time

when an overdose can become fatal, respiratory depression can be reversed by giving the

individual naloxone[4].

Ontheotherhand,naloxoneis not effectiveintreatingoverdosesofbenzodiazepines

(suchasValium,Xanax,orKlonopin),barbiturates(SeconalorFiorinal),clonidine,Elavil,

GHB,orketamine.Italsoisnoteffectiveinoverdoseswithstimulants,suchascocaine

andamphetamines(includingmethamphetamineandEcstasy).Howeverifopioidsare

takenincombinationwithothersedativesorstimulants,naloxonemaybehelpful.NaloxoneinjectionhasbeenapprovedbyFDAandusedformorethan40yearsby

emergencymedicalservices(EMS)personneltoreverseopioidoverdoseandresuscitate

personswhootherwisemighthavediedintheabsenceoftreatment[6].


Ensure access

to treatment

for individuals

who are misusing

or addicted to

opioids or who

have other

substance

use disorders.

Encourage

providers

and others

to learn about

preventing and

managingopioid overdose.
http://www.opioidprescribing.com/http://projectlazarus.org/http://www.maclearinghouse.org/http://www.maclearinghouse.org/http://projectlazarus.org/http://www.opioidprescribing.com/


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Naloxonehasnopsychoactiveeffectsanddoesnotpresentanypotentialforabuse

[1,4].Injectablenaloxoneisrelativelyinexpensive.Ittypicallyissuppliedasakitwithtwo

syringes,atacostofabout$6perdoseand$15perkit[7].

Forthesereasons,itisimportanttodeterminewhetherlocalEMSpersonnelorother

rstrespondershavebeentrainedtocareforoverdose,andwhethertheyareallowedto

stocknaloxoneintheirdrugkits.Insomejurisdictions,thelawprotectsrespondersfrom

civilliabilityandcriminalprosecutionforadministeringnaloxone.So-calledGoodSamaritan

lawsareineffectin10statesandtheDistrictofColumbia,andarebeingconsidered

bylegislaturesinatleastahalf-dozenotherstates[8].Suchlawsprovideprotection

againstprosecutionforboththeoverdosevictimandthosewhorespondtooverdose.To

ndstatesthathaveadoptedrelevantlaws,visittheCDCswebsiteat: www.cdc.gov/

HomeandRecreationalSafety/Poisoning/laws/immunity.html.

STrATEGy 4: Encoage the pblc to call 911. Anindividualwhoisexperiencingopioidoverdoseneedsimmediatemedicalattention.Anessentialrststepistogethelpfrom

someonewithmedicalexpertiseasquicklyaspossible[9,10].Therefore,membersofthe

publicshouldbeencouragedtocall911.Alltheyhavetosayis,Someoneisnotbreathing

andgiveaclearaddressandlocation.

STrATEGy 5: Encoage pescbes to se state Pescpton Dg Montong Pogams

(PDMPs). StatePrescriptionDrugMonitoringPrograms(PDMPs)haveemergedasakey

strategyforaddressingthemisuseandabuseofprescriptionopioidsandthuspreventing

opioidoverdosesanddeaths.Specically,prescriberscanchecktheirstatesPDMP

databasetodeterminewhetherapatientisllingtheprescriptionsprovidedand/or

obtainingprescriptionsforthesameorsimilardrugfrommultiplephysicians.WhileamajorityofstatesnowhaveoperationalPDMPs,theprogramsdifferfromstate

tostateintermsoftheexactinformationcollected,howsoonthatinformationisavailable

tophysicians,andwhomayaccessthedata.Therefore,informationabouttheprogramin

aparticularstateisbestobtaineddirectlyfromthestatePDMPorfromtheboardof

medicineorpharmacy.

Encourage

the public to

call 911.

Encourage

prescribers to

use state

Prescription

Drug Monitoring

Programs.
http://www.cdc.gov/HomeandRecreationalSafety/Poisoning/laws/immunity.htmlhttp://www.cdc.gov/HomeandRecreationalSafety/Poisoning/laws/immunity.htmlhttp://www.cdc.gov/HomeandRecreationalSafety/Poisoning/laws/immunity.htmlhttp://www.cdc.gov/HomeandRecreationalSafety/Poisoning/laws/immunity.html


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rESOurCES FOr COMMuNiTiES

Resourcesthatmaybeusefultolocalcommunitiesandorganizationsarefoundatthefollowingwebsites:

Sbstance Abse and Mental Health Sevces Admnstaton (SAMHSA)

n NationalTreatmentReferralHelpline1-800-662-HELP(4357)or1-800-487-4889(TDDforhearingimpaired)

n NationalSubstanceAbuseTreatmentFacilityLocator:www.ndtreatment.samhsa.gov/TreatmentLocatortosearchbystate,city,county,andzipcode

n BuprenorphinePhysician&TreatmentProgramLocator:www.buprenorphine.samhsa.gov/bwns_locator

n StateSubstanceAbuseAgencies:www.ndtreatment.samhsa.gov/ufds/abusedirectors

n CenterforBehavioralHealthStatisticsandQuality(CBHSQ):www.samhsa.gov/data/

n SAMHSAPublications:www.store.samhsa.gov1-877-SAMHSA(1-877-726-4727)

Centes o Dsease Contol and Peventon (CDC)

www.cdc.gov/Features/VitalSigns/PainkillerOverdoseswww.cdc.gov/HomeandRecreationSafety/Poisoning

Whte Hose Ofce o Natonal Dg Contol Polc (ONDCP)

StateandLocalInformation:www.whitehouse.gov/ondcp/state-map

Assocaton o State and Tetoal Health Ofcals (ASTHO)

PrescriptionDrugOverdose:StateHealthAgenciesRespond(2008):

www.astho.org

Natonal Assocaton o State Alcohol and Dg Abse Dectos (NASADAD)

StateIssueBriefonMethadoneOverdoseDeaths:www.nasadad.org/nasadad-reports

Natonal Assocaton o State EMS Ofcals (NASEMSO)

NationalEmergencyMedicalServicesEducationStandards:

www.nasemso.org

Amecan Assocaton o the Teatment o Opod Dependence (AATOD)

PrevalenceofPrescriptionOpioidAbuse: www.aatod.org/prevalence.html

Resources that

may be useful

to local communities

and organizations
http://www.buprenorphine.samhsa.gov/bwns_locatorhttp://www.findtreatment.samhsa.gov/ufds/abusedirectorshttp://www.samhsa.gov/data/http://www.store.samhsa.gov/http://www.cdc.gov/Features/VitalSigns/PainkillerOverdoseshttp://www.cdc.gov/Homeand%20RecreationSafety/Poisoninghttp://www.whitehouse.gov/ondcp/state-maphttp://www.astho.org/http://www.nasadad.org/nasadad-reportshttp://www.nasemso.org/http://www.aatod.org/prevalence.htmlhttp://www.aatod.org/prevalence.htmlhttp://www.nasemso.org/http://www.nasadad.org/nasadad-reportshttp://www.astho.org/http://www.whitehouse.gov/ondcp/state-maphttp://www.cdc.gov/Homeand%20RecreationSafety/Poisoninghttp://www.cdc.gov/Features/VitalSigns/PainkillerOverdoseshttp://www.store.samhsa.gov/http://www.samhsa.gov/data/http://www.findtreatment.samhsa.gov/ufds/abusedirectorshttp://www.buprenorphine.samhsa.gov/bwns_locator


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rEFErENCES 1.CentersforDiseaseControlandPrevention(CDC),NationalCenterfor

HealthStatistics.CDCWONDEROnlineDatabase,2012.

2.BeletskyLB,RichJD,WalleyAY.Preventionoffatalopioidoverdose.JAMA. 2013;308(180):18631864.

3.HarvardMedicalSchool.Painkillersfuelgrowthindrugaddiction:Opioidoverdosesnowkillmorepeoplethancocaineorheroin.Harvard MentHlth Let.2011;27(7):45.

4.BMJEvidenceCentre.Treatmentofopioidoverdosewithnaloxone.British Medical Journal.UpdatedOctober23,2012.[AccessedMarch24,2013,atwww.bmj.com]

5.EnteenL,BauerJ,McLeanR,WheelerE,HuriauxE,KralAH,BambergerJD.OverdosepreventionandnaloxoneprescriptionforopioidusersinSanFrancisco.J Urban Health.2010Dec;87(6):931941.

6.SealKH,ThawleyR,GeeLetal.Naloxonedistributionandcardiopulmonaryresuscitationtrainingforinjectiondruguserstopreventheroinoverdosedeath:Apilotinterventionstudy.J UrbanHealth. 2005;82(2):303311.

7.CofnPO,SullivanSD.Costeffectivenessofdistributingnaloxonetoheroinusersforlayoverdosereversal.Ann Intl Med. 2013;158:19.

8.Banta-GreenC.GoodSamaritanoverdoseresponselaws:LessonslearnedfromWashingtonState.Washington,DC:OfceofNationalDrugControlPolicy,ExecutiveOfceofthePresident,TheWhiteHouse,March29,2013.[Accessedathttp://www.whitehouse.gov/blog/2013/03/29/good-samaritan-overdose-response-laws-lessons-learned-washington-state]

9.StrangJ,ManningV,MayetSetal.Overdosetrainingandtake-homenaloxoneforopiateusers:Prospectivecohortstudyofimpactonknowledgeandattitudesandsubsequentmanagementofoverdoses.

Addiction. 2008;103(10):16481657.

10.GreenTC,HeimerR,GrauLE.Distinguishingsignsofopioidoverdoseandindicationfornaloxone:AnevaluationofsixoverdosetrainingandnaloxonedistributionprogramsintheUnitedStates.Addiction.2008;103(6):97998.
http://www.whitehouse.gov/blog/2013/03/29/good-samaritan-overdose-response-laws-lessons-learned-washington-statehttp://www.whitehouse.gov/blog/2013/03/29/good-samaritan-overdose-response-laws-lessons-learned-washington-statehttp://www.whitehouse.gov/blog/2013/03/29/good-samaritan-overdose-response-laws-lessons-learned-washington-statehttp://www.whitehouse.gov/blog/2013/03/29/good-samaritan-overdose-response-laws-lessons-learned-washington-statehttp://www.whitehouse.gov/blog/2013/03/29/good-samaritan-overdose-response-laws-lessons-learned-washington-statehttp://www.whitehouse.gov/blog/2013/03/29/good-samaritan-overdose-response-laws-lessons-learned-washington-state


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Acknowledgments

ThispublicationwaspreparedfortheSubstanceAbuseandMentalHealthServicesAdministration(SAMHSA)bytheAssociationofStateandTerritorialHealthOfcials,incooperationwithPublicHealthResearchSolutions,undercontractnumber10-233-00100withSAMHSA,U.S.DepartmentofHealthandHumanServices(HHS).LCDRBrandonJohnson,M.B.A.,servedastheGovernmentProjectOfcer.

DsclameTheviews,opinions,andcontentofthispublicationarethoseoftheauthorsanddo

notnecessarilyreecttheviews,opinions,orpoliciesofSAMHSAorHHS.

Pblc Doman NotceAllmaterialsappearinginthisvolumeexceptthosetakendirectlyfromcopyrightedsourcesareinthepublicdomainandmaybereproducedorcopiedwithoutpermissionfromSAMHSAortheauthors.Citationofthesourceisappreciated.However,thispublicationmaynotbereproducedordistributedforafeewithout

thespecic,writtenauthorizationoftheOfceofCommunications,SAMHSA,HHS.

Electonc Access and Copes o PblcatonThispublicationmaybeorderedfromSAMHSAsPublicationsOrderingWebpageatwww.store.samhsa.gov.Or,pleasecallSAMHSAat1-877-SAMHSA-7(1-877-726-4727)

(EnglishandEspaol).

recommended CtatonSubstanceAbuseandMentalHealthServicesAdministration.SAMHSAOpioidOverdosePreventionToolkit:FactsforCommunityMembers.HHSPublicationNo.(SMA)13-4742.Rockville,MD:SubstanceAbuseandMentalHealthServices

Administration,2013.

Ognatng OfceDivisionofPharmacologicTherapies,CenterforSubstanceAbuseTreatment,SubstanceAbuseandMentalHealthServicesAdministration,1ChokeCherryRoad,Rockville,MD20857.
http://www.store.samhsa.gov/http://www.store.samhsa.gov/


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HHSPublicationNo.(SMA)13-4742Printed2013

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