For the first time on record, the chance of dying of an accidental opioid overdose (1 in 96) is greater than dying in a car accident (1 in 103) or from a fall (1 in 114). According to the National Center for Health Statistics (NCHS), in 2017 the age-adjusted rate of drug overdose deaths in the United States was almost 10 percent higher (9.6 percent) than the rate in 2016.
Prescription opioids are used to manage pain, especially chronic pain resulting from injury, surgery, a disease or condition, inflammation, or other pain outside of cancer care or palliative end-of-life management. Chronic pain is defined as pain that lasts longer than three months or past the time of normal healing.
Prevention
In order to curb addiction to opioids and prevent overdose, the CDC has released a Guideline for Prescribing Opioids for Chronic Pain. Healthcare educators should review it and integrate the guidelines into their curriculum. Among the clinical reminders for caregivers are the following:
- Opioids are not a first-line treatment for chronic pain.
- Acute pain, if treated with opioids, should be treated with immediate release opioids, not extended release or long acting (ER/LA) opioids.
- The lowest effective dosage should be prescribed.
- Caregivers should discuss benefits and risks of opioid use for pain management and discuss the availability of nonopioid therapies with the patient.
In addition to educating caregivers about opioids, caregivers can educate patients about their treatment and how to prevent opioid misuse.
Patients can be taught to work with their doctors to create a plan for pain management, including knowing their options, being able to talk openly with their healthcare provider about side effects and concerns, and having access to follow-up care and consultation.
Patients should also be instructed to take and store opioids properly. They should learn:
- Take the exact amount prescribed when it is prescribed. Do not exceed dosage amounts.
- Never share prescription opioids.
- How to appropriately and securely store prescription opioids.
- The location of a drug take-back program to dispose of unused opioids. They shouldn’t be thrown out, flushed down a toilet, or sold.
- Contraindications of opioids with other prescription medications, illegal drugs, and alcohol.
Teaching Narcan Administration
In an effort to fight the opioid epidemic, some states are making Narcan® Nasal Spray (generic name: naxolone) available for free without a prescription. In Pennsylvania, in 2018, more than 4,500 kits of naloxone were distributed in an effort to expand efforts to fight overdose deaths.
While naxolone can be administered by paramedics, emergency room doctors, and other specially-trained first responders, Narcan nasal spray is simple enough for most bystanders to administer in an emergency. It is a prefilled, needle-free device that requires no assembly. Naxolone can be administered via an injection or with an atomizer that can be used intranasally. Autoinjectable naxolone (EVZIO®) and Narcan are appropriate for non-emergency personnel to use.
For EMS education, Pocket Nurse provides a simulated response kit to teach the administration of naloxone for the complete or partial reversal of opioid overdose. This kit contains a bristoject syringe with a mucosal atomization device. Talk to a pharmacist or other healthcare professional about learning to use the Narcan nasal spray.
