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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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FACTS FOr COMMuNiTy MEMBErS
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].
FACTS FOr COMMuNiTy MEMBErS
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/7/29/2019 Toolkit Community
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FACTS FOr COMMuNiTy MEMBErS
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.html7/29/2019 Toolkit Community
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FACTS FOr COMMuNiTy MEMBErS
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_locator7/29/2019 Toolkit Community
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FACTS FOr COMMuNiTy MEMBErS
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-state7/29/2019 Toolkit Community
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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/7/29/2019 Toolkit Community
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HHSPublicationNo.(SMA)13-4742Printed2013
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