Treatment for opioid abuse generally starts with treatment of withdrawal in the acute phase. Managing symptoms of overdose and preventing death are the first objective. Securing an airway and supporting the patient during the tremors, seizures, hypertension, nausea, vomiting, and pain are often handled in an ED or medical/surgical setting.
Naloxone (Narcan) can be used for reversal of opioid overdose and is available in IV, SQ, IM, and nasal routes. If a patient is unconscious, follow the ABC’s of emergency response such as calling 9-1-1, checking for a pulse, securing an open airway, and providing rescue breaths. Give the first full dose of naloxone and continue rescue breaths. If the patient doesn’t respond give the second full dose of naloxone. Patients will often respond quickly and be confused and possibly combative. Monitor the patient after recovery with naloxone to prevent another dose of an opioid and follow up with further medical attention.
Using pharmacologic blocking agents is helpful in stopping the opioid overdose. Antagonist medications block opioid receptors so that the desired effect is no longer active. Two opiate substitution medications are currently available in the United States—methadone and levomethadyl acetate—but are only available in strictly regulated environments where medication is received under clinical observation and limited outpatient use (Dowell et al., 2016). Methadone and buprenorphine are synthetic opioid agonists and act on the same mu receptors that opioids activate; therefore, they have been a popular treatment for addiction that is known as opioid substitution therapy (OST). Methadone has a slow onset of action and long elimination half-life of about 24 hours. A longer-acting opioid receptor agonist is buprenorphine, a partial opioid agonist that can reduce cravings and symptoms of withdrawals.
These drugs can be taken less frequently and can help wean a patient from the more fatal opioids. Control trials show that they are more effective than a placebo and can help decrease fatalities from opioids. Access to these drugs is still dependent upon physician-controlled prescribing or treatment programs (but see below for states allowing further access) (Schuckit, 2016).
Getting into approved treatment programs, where these drugs can be given and monitored closely, in combination with behavioral therapy, is often difficult, expensive, and not approved by insurance companies. The strict control of these opiate-substitution drugs is necessary because they do produce a euphoric sensation like the opiates and there is a concern for creating a new market of illicit use. These medications can be given in sublingual, oral, and even intranasal forms. These opioid antagonist drugs act as competition for the mu receptors and, ideally, block the effectiveness of other opiates.
Ten states do allow family members and friends to be trained in giving naloxone for a suspected drug overdose. The following states offer training for naloxone use:
Test Your Knowledge
What is the antidote for an opioid overdose?
Apply Your Knowledge
What is your facility’s process for treatment of an opioid overdose? Do you know how to use Narcan?
YouTube: Using Nasal Naloxone to Reverse Opiate Overdose
YouTube: Coming back from the dead with Naloxone