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SAMHSA Opioid Overdose Prevention TOOLKIT

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SAMHSA Opioid Overdose Prevention TOOLKIT SAMHSA Opioid Overdose Prevention TOOLKIT Opioid Use Disorder Facts Five Essential Steps for First Responders Information for Prescribers Safety Advice for Patients & Family Members Recovering From Opioid Overdose TABLE OF CONTENTS SAMHSA Opioid Overdose Prevention Toolkit Opioid Use Disorder Facts.................................................................................................................. 1 Scope of the Problem....................................................................................................................... 1 Strategies to Prevent Overdose Deaths.......................................................................................... 2 Resources for Communities............................................................................................................. 4 Five Essential Steps for First Responders ........................................................................................ 5 Step 1: Evaluate for Signs of Opioid Overdose ................................................................................ 5 Step 2: Call 911 for Help .................................................................................................................. 5 Step 3: Administer Naloxone ............................................................................................................ 6 Step 4: Support the Person’s Breathing ........................................................................................... 7 Step 5: Monitor the Person’s Response ........................................................................................... 7 Do’s And Don’ts When Responding to Opioid Overdose................................................................. 8 Information for Prescribers................................................................................................................. 9 Opioid Stewardship.......................................................................................................................... 9 Treating Opioid Overdose .............................................................................................................. 12 Legal and Liability Considerations.................................................................................................. 13 Claims Coding and Billing .............................................................................................................. 14 Resources for Prescribers.............................................................................................................. 15 Safety Advice for Patients & Family Members................................................................................. 16 What Are Opioids? ......................................................................................................................... 16 Preventing Overdose ..................................................................................................................... 16 If You Suspect an Overdose.......................................................................................................... 16 What Is Naloxone? ........................................................................................................................ 17 Naloxone Storage .......................................................................................................................... 17 Summary: How to Avoid Opioid Overdose ..................................................................................... 17 Recovering From Opioid Overdose.................................................................................................. 18 Resources for Overdose Survivors and Family Members............................................................... 18 Finding a Network of Support ......................................................................................................... 18 Resources...................................................................................................................................... 19 References ......................................................................................................................................... 20 Acknowledgments ............................................................................................................................. 21 ii OPIOID USE DISORDER FACTS individuals who use opioids and combine SCOPE OF THE PROBLEM them with benzodiazepines, other pioid overdose continues to be a major public health sedative hypnotic agents, or alcohol, all of 2 problem in the United States. It has contributed which cause respiratory depression. significantly to overdose deaths among those who WHO IS AT RISK? Anyone who uses Ouse or misuse illicit and prescription opioids. In fact, all U.S. opioids for long-term management of overdose deaths involving opioids (i.e., unintentional, chronic pain is at risk for opioid overdose, intentional, homicide, and undetermined) increased to more as are individuals who use heroin or 1 than 42,000 deaths in 2016. misuse prescription pain relievers.3 Others WHAT ARE OPIOIDS? Opioids include prescription at risk include those who: medications used to treat pain such as morphine, codeine, . Are receiving rotating opioid medication methadone, oxycodone, hydrocodone, fentanyl, regimens (and thus are at risk for incomplete hydromorphone, and buprenorphine, as well as illegal drugs cross-tolerance). such as heroin and illicit potent opioids such as fentanyl . Have been discharged from emergency analogs (e.g., carfentanil). medical care following opioid overdose. Opioids work by binding to specific receptors in the brain, . Need opioid pain relievers, coupled with a spinal cord, and gastrointestinal tract. In doing so, they suspected or confirmed substance use diminish the body’s perception of pain. However, opioids can disorder or history of non-medical use of also have an impact on other systems of the body, such as prescription opioids or use of illicit opioids. altering mood, slowing breathing, and causing constipation. Have completed opioid detoxification or are Opioid receptor binding causes the signs and symptoms of abstinent for a period of time (and overdose as well as the euphoric effects or “high” with opioid presumably have reduced opioid tolerance use. and high risk of return to opioid use). HOW DOES OVERDOSE OCCUR? A variety of effects can . Have been recently released from occur after a person takes opioids, ranging from pleasure to incarceration and have a history of opioid nausea and vomiting, severe allergic reactions use disorder or opioid misuse (and (anaphylaxis), and overdose, in which breathing and presumably have reduced opioid tolerance heartbeat slow or even stop. and high risk of return to opioid use). Opioid overdose can be due to many factors. For example, overdose can occur when a patient deliberately Tolerance develops when someone misuses a prescription, uses an illicit opioid (such as heroin), uses an opioid drug regularly so that or uses an opioid contaminated with other even more potent his or her body becomes accustomed opioids (such as fentanyl). Overdose can also occur when a to the drug and needs a larger or more patient takes an opioid as directed but the prescriber frequent dose to continue to experience the same effect. miscalculated the opioid dose, when an error was made by the dispensing pharmacist, or when the patient Loss of tolerance occurs when misunderstood the directions for use. It can also occur when someone stops taking an opioid after long -term use. When someone loses opioids are taken with other medications—for example, tolerance and then takes the opioid prescribed medications such as benzodiazepines or other drug again, he or she can experience psychotropic medications that are used in the treatment of serious adverse effects, including mental disorders—or with illicit drugs or alcohol that may overdose, even if the amount taken have adverse interactions with opioids. At particular risk are had not caused problems in the past. 1 OPIOID USE DISORDER FACTS STRATEGIES TO PREVENT OVERDOSE DEATHS STRATEGY 1: Encourage providers, persons at high risk, family members, and others to learn how to prevent and manage opioid overdose. Providers should be encouraged to keep their knowledge current about evidence-based Encourage practices for the use of opioid analgesics to manage pain, as well as specific steps to prevent and manage opioid overdose. The Substance Abuse and Mental Health Services Administration (SAMHSA) to learn funds continuing medical education courses that are available to providers at no about charge from the Providers Clinical Support System (PCSS) at https://pcssnow.org/. Helpful information for laypersons on how to prevent and manage overdose is available from Prevent & Protect at http://prevent-protect.org/. managing opioid STRATEGY 2: Ensure access to treatment for individuals who are misusing overdose. opioids or who have a substance use disorder. Effective treatment of substance use disorders can reduce the risk of overdose and help overdose survivors attain a healthier life. Medications for opioid use disorder, as well as counseling and other supportive services, can be obtained at SAMHSA-certified and Drug Enforcement Administration-registered opioid treatment programs and in specialty substance use disorder treatment programs, as well as from physicians and other Ensure practitioners including nurse practitioners and physician assistants who are trained to
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