Celebrity overdose from drugs raises public awareness of opioid overdose; for example, the celebrity Prince died of a self-administered opioid overdose, which later was identified by autopsy as fentanyl. He had allegedly been using fentanyl for chronic back pain and had also earlier reversed an overdose by the use of Narcan. Investigators revealed that Prince did not have a valid prescription for opioid medications.
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 medical/surgical setting.
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 911, 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 requiring followup medical attention.
Pharmacologic blocking agents are 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 Antagonist medications block opioid receptors so that the desired effect is no longer active.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. They are only available in strictly regulated environments under clinical observation and for limited out-patient use (Dowell, 2016). Patients who are abusing opioids must be sober for at least 5 days before they can begin a naloxone treatment plan.
Did You Know . . .
Methadone and buprenorphine are synthetic opioid agonists and act on the same mu receptors as opioids. Therefore they have been a popular treatment for addiction, 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, which is a partial opioid agonist and 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 methadone is more effective than a placebo and can help decrease fatalities from opioids. Access to these drugs is still dependent upon physician-controlled programs (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; the tight regulation is due to the fear of creating a 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.
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What is your facility’s process for treatment of an opioid overdose? Do you know how to use Narcan? Do you know how to teach its administration?