overdose awareness

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The opioid crisis is widely considered to have its roots in the mid-to late-1990s, when a confluence of factors—including the beginning of the “Pain as the 5th Vital Sign” campaign and the U.S. Food and Drug Administration’s approval of Purdue Pharma’s blockbuster OxyContin—led the U.S. health care system to greatly increase prescribing of opioid painkillers. 

For more than a decade, the steadily increasing rate of overdose deaths involving prescription opioids continued with little notice. But that changed around 2011 when the CDC declared deaths from prescription painkillers an “epidemic.” In the years that followed, the U.S. health care and public health systems took steps to rein in prescribing of opioid painkillers. The CDC developed guidelines aimed at reducing risky prescribing patterns, and many states implemented legal restrictions in addition to the voluntary, well-meaning attempts made by many health care providers to be more cautious in prescribing opioid painkillers. The leveling-off of prescription opioid overdose deaths after 2011 suggest some degree of success, though it was limited, and rates never declined in any large or durable way.

Around the same time that prescription opioid deaths peaked, data on drug overdose deaths show that the opioid crisis made a distinct shift. Deaths began to climb first from heroin, an illegal opioid that has been trafficked for decades by criminal enterprises, then from fentanyl and similar synthetic opioids that criminal enterprises also began to traffic. 

Heroin rose in popularity as individuals who were addicted to prescription opioids suddenly found themselves cut off from a substance on which they had become chemically dependent and sought out a substitute. Seeking to exploit a growing market for illicitly trafficked opioids, drug traffickers eventually turned instead to fentanyl as it is easier to produce in large quantities than heroin, has a higher potency, and is easier and cheaper to smuggle than its counterpart. Resultantly, death rates from heroin began to recede, while those from fentanyl have only continued to surge.

At the national level, data on opioid overdose deaths show multiple, evolving phases of the overdose epidemic. Pre 2011, the growth in opioid overdose deaths was driven primarily by natural and semi-synthetic opioids (i.e., prescription opioid painkillers); but that death rate has since largely plateaued.

Deaths from drug overdose have risen steadily over the past two decades and have become the leading cause of injury death in the United States. Prescription drugs, especially opioid analgesics — a class of prescription drugs such as hydrocodone, oxycodone, morphine, and methadone used to treat both acute and chronic pain — have been increasingly implicated in drug overdose deaths over the last decade. From 1999 to 2013, the rate for drug poisoning deaths involving opioid analgesics nearly quadrupled, and deaths related to heroin have also increased sharply since 2010, with a 39 percent increase between 2012 and 2013.

In response to these recent increases in opioid-related morbidity and mortality, the U.S. Department of Health and Human Services (HHS) has made addressing the opioid abuse problem a high priority and is focused on implementing evidence-based approaches to reduce: 1) opioid overdoses and overdose-related mortality and 2) the prevalence of opioid use disorder.

 Symptoms and Indications of an Overdose:

• Respiratory depression: slow and shallow breathing or cessation of breathing
• Making snoring or gurgling sounds
• Blue or gray skin color
• Dark lips and fingernails
• Unable to talk
• Disorientation
• Pinpoint pupils
• Decreased level of consciousness, can’t be woken up
• No response to stimuli
• Drug paraphernalia in the vicinity
• Note: If you can’t get them to respond, don’t assume they are asleep. Not all overdoses happen quickly and sometimes it can take hours for someone to die. Taking action in those hours means you could save a life.

 What to Do:

• This is a medical emergency: Call 911 for a first responder immediately.
• Try to get the person to respond.
• Administer CPR if you are qualified.
• Rub knuckles on the breast bone.
• If they respond, keep them awake and breathing.
• If their skin is blue, perform mouth to mouth rescue breathing.
• Stay with the person. If you must leave, place the person in a recovery position (on their left side).
• Look around the victim to see if they are carrying NARCAN® (Naloxone), or have it in the vicinity, or if anyone in the area has it… and administer it! Keep in mind, it can take more than one dose of naloxone to revive a person who has overdosed. There is no harm in giving multiple doses to a person in an attempt to revive them.

 What Not to Do:

• Do not put the person in a cold bath.
• Do not inject them with saltwater or stimulant drugs (methamphetamine).
• Do not try to have them walk it off or sleep it off.
• Do not induce vomiting.

Naloxone is a non-scheduled (non-addictive), prescription medication used in opioid overdoses to counteract life-threatening depression of the central nervous system and respiratory system, allowing an individual experiencing an overdose to breathe normally. Naloxone can be administered by non-medical personnel, which makes it ideal for individuals to treat overdose in people who have been prescribed opioid pain medication and in people who use heroin and other opioids. Naloxone only works if a person has opioids in their system and the medication has no effect if opioids are absent (National Harm Reduction Coalition). It may take multiple doses of naloxone to take effect. There is no harm in giving a person who is experiencing an overdose multiple doses of naloxone. 

In the event of an overdose, complete the following steps: 

STEP 1: Stimulate them awake by yelling their name and administering a hard sternum rub to the chest plate.

STEP 2: If you have naloxone/Narcan, use it. Administer one dose every two minutes.

• Injectable: Draw up the entire vial and inject it into the thigh muscle.
• Nasal: Stick the device all the way up one nostril and click the plunger, making sure the device is inserted fully (the medication will absorb through the sinuses).

STEP 3: Call 911; explain someone is not responsive and not breathing.

STEP 4: Provide rescue breathing. Get the person on their back, tip their head back to straighten the airway, pinch their nose, put your mouth over theirs and form a seal, one breath every five seconds.

STEP 5: When the person starts to breathe regularly on their own, roll them into a recovery position on their side.

STEP 6: Be gentle with them and yourself afterward!